Objective: N/A

Background: Painless/painful limb and moving fingers (PLMF) is a variant of painful limbs and moving extremities, a rare movement disorder. Underlying pathophysiology can be cryptogenic or from abnormalities in central or peripheral nervous systems. We present a case with multiple central and peripheral etiologies contributing to this even rarer variant.

Method: N/A

Results: A 74-year-old right-handed female with a history of occupational hand overuse presented with two years of involuntary right finger movements. Movements occurred exclusively at rest and resolved with voluntary movement without significant progression. Concurrently, she experienced difficulties with fine motor tasks and pain with finger flexion in the right hand. She was diagnosed with trigger finger in digits 2-5; release surgery of 3^rd and 4^th digits did not alleviate the movements. She also had significant pain in ulnar and median distributions of the right palm and wore a wrist splint, which was also ineffective for the movements. MRI cervical spine revealed moderate cervical canal narrowing with advanced right neural foraminal narrowing. Nerve conduction studies and electromyography showed severe carpal tunnel syndrome, C7 radiculopathy, and axonal sensorimotor polyneuropathy in the right extremity. Huntington’s disease gene, Wilson’s disease work-up and autoimmune panel were negative.

Evaluation revealed non-stereotyped, semi-rhythmic, flexion/extension movements of various digits individually or in synchrony at different joints (metacarpal, proximal interphalangeal and distal interphalangeal) along with thenar atrophy and reduced grip strength in the right hand. There was no dystonic posturing, choreiform movements, or motor impersistence. No other limb or craniocervical movements were noted. She was diagnosed with PLMF superimposed on diagnoses of trigger fingers, carpal tunnel syndrome, and cervical radiculopathy.

Conclusion: We report the 10^th case of PLMF variant in literature, which can be precipitated by multiple neurological pathologies and coexist with musculoskeletal abnormalities. Comprehensive evaluation and increased recognition of this rare variant are important to differentiate it from other movement disorders.

References: 1. Spillane JD, Nathan PW, Kelly RE, Marsden CD. Painful legs and moving toes. Brain. 1971;94(3):541–56. doi: 10.1093/brain/94.3.541.

2. Walters AS, Hening WA, Shah SK, Chokroverty S. Painless legs and moving toes: a syndrome related to painful legs and moving toes? Mov Disord. 1993;8(3):377–9. doi: 10.1002/mds.870080325.
3. Hassan A, Mateen FJ, Coon EA, Ahlskog JE. Painful legs and moving toes syndrome: a 76-patient case series. Arch Neurol. 2012;69(8):1032–8. doi: 10.1001/archneurol.2012.161.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/case-report-painful-limb-and-moving-fingers-syndrome/