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Distal upper limb amyotrophy

MedGen UID:
Concept ID:
Disease or Syndrome
Synonym: Distal muscle atrophy of the upper limbs
HPO: HP:0007149


Muscular atrophy of distal arm muscles. [from HPO]

Conditions with this feature

Charcot-Marie-Tooth disease X-linked dominant 1
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Disease or Syndrome
GJB1 disorders are typically characterized by peripheral motor and sensory neuropathy with or without fixed CNS abnormalities and/or acute, self-limited episodes of transient neurologic dysfunction (especially weakness and dysarthria). Peripheral neuropathy typically manifests in affected males between ages five and 25 years. Although both men and women are affected, manifestations tend to be less severe in women, some of whom may remain asymptomatic. Less commonly, initial manifestations in some affected individuals are stroke-like episodes (acute fulminant episodes of reversible CNS dysfunction).
Charcot-Marie-Tooth disease X-linked recessive 5
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Concept ID:
Disease or Syndrome
X-linked Charcot-Marie-Tooth neuropathy type 5 (CMTX5), part of the spectrum of PRPS1-related disorders, is characterized by peripheral neuropathy, early-onset (prelingual) bilateral profound sensorineural hearing loss, and optic neuropathy. The onset of peripheral neuropathy is between ages five and 12 years. The lower extremities are affected earlier and more severely than upper extremities. Initial manifestations often include foot drop or gait disturbance. Onset of visual impairment is between ages seven and 20 years. Intellect and life span are normal. Carrier females do not have findings of CMTX5.
Charcot-Marie-Tooth disease axonal type 2C
MedGen UID:
Concept ID:
Disease or Syndrome
The autosomal dominant TRPV4 disorders (previously considered to be clinically distinct phenotypes before their molecular basis was discovered) are now grouped into neuromuscular disorders and skeletal dysplasias; however, the overlap within each group is considerable. Affected individuals typically have either neuromuscular or skeletal manifestations alone, and in only rare instances an overlap syndrome has been reported. The three autosomal dominant neuromuscular disorders (mildest to most severe) are: Charcot-Marie-Tooth disease type 2C. Scapuloperoneal spinal muscular atrophy. Congenital distal spinal muscular atrophy. The autosomal dominant neuromuscular disorders are characterized by a congenital-onset, static, or later-onset progressive peripheral neuropathy with variable combinations of laryngeal dysfunction (i.e., vocal fold paresis), respiratory dysfunction, and joint contractures. The six autosomal dominant skeletal dysplasias (mildest to most severe) are: Familial digital arthropathy-brachydactyly. Autosomal dominant brachyolmia. Spondylometaphyseal dysplasia, Kozlowski type. Spondyloepiphyseal dysplasia, Maroteaux type. Parastremmatic dysplasia. Metatropic dysplasia. The skeletal dysplasia is characterized by brachydactyly (in all 6); the five that are more severe have short stature that varies from mild to severe with progressive spinal deformity and involvement of the long bones and pelvis. In the mildest of the autosomal dominant TRPV4 disorders life span is normal; in the most severe it is shortened. Bilateral progressive sensorineural hearing loss (SNHL) can occur with both autosomal dominant neuromuscular disorders and skeletal dysplasias.
Neuronopathy, distal hereditary motor, type 2C
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Concept ID:
Disease or Syndrome
Any neuronopathy, distal hereditary motor in which the cause of the disease is a mutation in the HSPB3 gene.
Distal myopathy with posterior leg and anterior hand involvement
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Concept ID:
Disease or Syndrome
Williams distal myopathy is an autosomal dominant slowly progressive muscular disorder characterized by distal muscle weakness and atrophy affecting the upper and lower limbs. Onset occurs around the third to fourth decades of life, and patients remain ambulatory even after long disease duration. Muscle biopsy shows nonspecific changes with no evidence of rods, necrosis, or inflammation (summary by Duff et al., 2011). Mutation in the FLNC gene can also cause myofibrillar myopathy-5 (MFM5; 609524), which shows a different pattern of muscle involvement and different histologic changes.
Charcot-Marie-Tooth disease dominant intermediate E
MedGen UID:
Concept ID:
Disease or Syndrome
Autosomal dominant intermediate Charcot-Marie-Tooth disease E with focal segmental glomerulonephritis is characterized by the neurologic features of CMT, including distal muscle weakness and atrophy and distal sensory loss, and the features of FSGS, including proteinuria, progression to end-stage renal disease, and a characteristic histologic pattern on renal biopsy (summary by Boyer et al., 2011). Isolated focal segmental glomerulosclerosis-5 (FSGS5; 613237) is also caused by heterozygous mutation in the INF2 gene. For a discussion of genetic heterogeneity of CMTDI, see 606482.
Charcot-Marie-Tooth disease, axonal, type 2FF
MedGen UID:
Concept ID:
Disease or Syndrome
Charcot-Marie-Tooth disease type 2FF (CMT2FF) is an autosomal dominant progressive axonal sensorimotor peripheral neuropathy characterized by early-childhood onset of difficulties walking or running due to atrophy and weakness of the lower limbs. Most patients have foot and ankle deformities, requiring surgery or walking aids. Some patients lose independent ambulation. There is also prominent involvement of the upper limbs, with weakness and atrophy of the forearm, wrist, and intrinsic hand muscles. Proximal muscle function is preserved. Affected individuals have variable distal sensory impairment. Most patients have hyporeflexia, although brisk reflexes, suggesting upper motor involvement, have been described in 1 family. Sural nerve biopsy showed abnormal myelination (Rebelo et al., 2021). For a phenotypic description and a discussion of genetic heterogeneity of axonal CMT type 2, see CMT2A (118210).
Neurodevelopmental disorder, nonprogressive, with spasticity and transient opisthotonus
MedGen UID:
Concept ID:
Disease or Syndrome
Nonprogressive neurodevelopmental disorder with spasticity and transient opisthotonus (NEDSTO) is an autosomal recessive complex neurologic disorder characterized by delay of gross motor milestones, particularly walking, associated with axial hypotonia and peripheral spasticity apparent from infancy or early childhood. Affected individuals often show transient opisthotonic posturing in infancy, and later show abnormal involuntary movements, including chorea, dystonia, and dyspraxia. Some patients have impaired intellectual development, although the severity is highly variable; most have speech delay and articulation difficulties and a happy overall demeanor. Brain imaging shows myelination defects in some patients. The disorder is nonprogressive, and many patients may catch up developmentally in the second or third decades (summary by Wagner et al., 2020).
Charcot-Marie-Tooth disease, demyelinating, IIA 1H
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Concept ID:
Disease or Syndrome
Demyelinating Charcot-Marie-Tooth disease-1H (CMT1H) is an autosomal dominant peripheral sensorimotor neuropathy with onset usually in adulthood (third to fifth decades). Affected individuals present with foot deformities, upper or lower limb sensory disturbances, and motor deficits, mainly impaired gait. Of note, many patients complain of unpleasant sensory sensations in the upper extremities and hands. The disorder is slowly progressive and becomes more apparent with age, although patients usually remain ambulatory. Other features include hypo- or areflexia, limb muscle weakness, and impaired gait. Electrophysiologic studies are consistent with a demyelinating polyneuropathy. Rare patients may have hyperelastic skin or develop age-related macular degeneration (summary by Auer-Grumbach et al., 2011 and Safka Brozkova et al., 2020) For a discussion of genetic heterogeneity of autosomal dominant Charcot-Marie-Tooth disease type 1, see CMT1B (118200).

Professional guidelines


Yeo CJJ, Simeone SD, Townsend EL, Zhang RZ, Swoboda KJ
J Neuromuscul Dis 2020;7(3):257-268. doi: 10.3233/JND-190453. PMID: 32333595
Viala K, Renié L, Maisonobe T, Béhin A, Neil J, Léger JM, Bouche P
Brain 2004 Sep;127(Pt 9):2010-7. Epub 2004 Aug 2 doi: 10.1093/brain/awh222. PMID: 15289267

Recent clinical studies


Kaji S, Kawarai T, Miyamoto R, Nodera H, Pedace L, Orlacchio A, Izumi Y, Takahashi R, Kaji R
J Neurol Sci 2016 May 15;364:45-9. Epub 2016 Mar 2 doi: 10.1016/j.jns.2016.03.001. PMID: 27084214
Thakar S, Ks A, Hegde AS
Spine J 2016 Feb;16(2):e57-8. Epub 2015 Oct 1 doi: 10.1016/j.spinee.2015.09.055. PMID: 26433034
Rigamonti A, Usai S, Curone M, D'Amico D, Bussone G
Neurol Sci 2004 Jun;25(2):102-3. doi: 10.1007/s10072-004-0239-y. PMID: 15221630
Pullicino P
Stroke 1994 Sep;25(9):1870-2. doi: 10.1161/01.str.25.9.1870. PMID: 8073471

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