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Image challenge
Acutely shaky hand
  1. You-Jiang Tan1,
  2. Chee Hao Teo2,
  3. Cassandra Chan2
  1. 1 National Neuroscience Institute, Singapore
  2. 2 Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
  1. Correspondence to Dr You-Jiang Tan, National Neuroscience Institute, Singapore, 169608, Singapore; whyjae{at}gmail.com

https://doi.org/10.1136/emermed-2023-213733

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    Clinical introduction

    A 57-year-old man presented acutely with involuntary movements of his left hand. He had hypertension, chronic kidney disease and chronic obstructive pulmonary disease. These movements were best described as sudden, recurrent and arrhythmic loss of tone and power of the left wrist and fingers (video 1). They were most prominent when extending the left wrist, but were absent when the arms were at rest and were not elsewhere. There were no additional neurological deficits. Serum urea, ammonia, sodium, potassium, calcium, magnesium, phosphate …

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    Footnotes

    • Contributors Y-JT was involved in the conceptualisation, crafting of the draft manuscript and review of the final manuscript. CHT and CC were involved in obtaining and editing the video and figure used in this study, and the review of the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.