Overview of Hand Weakness

If you have hand weakness or have been experiencing "heaviness" in one or both of your hands, there could be a number of different reasons for this. Sudden hand weakness is concerning as it may be a sign of a stroke—a serious medical emergency.

However, if you have had a nagging hand weakness, it's usually not related to a serious medical problem and is rarely life-threatening. Hand weakness lasting for weeks or months is typically caused by a treatable medical condtion. If left untreated, the weakness can worsen along with the underlying cause.

This article looks at eight possible causes of sudden or persistent hand weakness, including how each is diagnosed and treated.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is one of the most common causes of hand weakness and pain. Carpal tunnel syndrome is caused by overuse of the hand, arm, or wrist, often due to repetitive movements such as operating machinery or typing.

Carpal tunnel syndrome is caused by swelling on the inside of the wrist. The swelling compresses a nerve, called the median nerve, that travels through a "tunnel" of bones and ligaments inside the wrist. This causes pain, tingling, numbness, and weakness as well as the loss of coordination of the hand. The pain and weakness can travel up the arm if the pressure on the nerve persists.

Diagnosis and Treatment

A healthcare provider or physical therapist can usually diagnose carpal tunnel syndrome by reviewing your symptoms and examining your hand and arm. Sometimes a nerve conduction study (which tracks electrical activity through nerves) may be needed to confirm the diagnosis.

Carpal tunnel syndrome is a treatable problem. Rest, ice, and over-the-counter anti-inflammatory medications usually help. A wrist brace and adjustment of the wrist motion during work can prevent carpal tunnel syndrome from getting worse.

For the most severe cases, a simple surgical procedure called a carpal tunnel release severs a ligament in the wrist to relieve pressure permanently.

Diabetic Neuropathy

Diabetes is a chronic medical condition in which the body is unable to properly regulate blood sugar. One of the complications of diabetes is nerve damage, referred to as diabetic neuropathy. Diabetic neuropathy most often affects the hands and feet.

When it affects the hands, diabetic neuropathy can cause weakness, pain, tingling, and trouble coordinating hand movements,

Diagnosis and Treatment

Most people with diabetic neuropathy are aware they have diabetes. But, in some instances, diabetic neuropathy may be the first sign of diabetes.

Your healthcare provider can often diagnose diabetic neuropathy based on your symptoms, medical history, and a physical exam. Blood tests can identify whether you have diabetes.

The next step involves diabetes management which can help improve symptoms, especially if they have not been occurring for too long.

Peripheral Neuropathy

While diabetes is the most common cause of neuropathy, there are a number of causes that can also cause hand weakness. Neuropathy that occurs in nerves outside the brain and spinal cord is referred to as peripheral neuropathy. The hands and feet are most commonly affected.

Peripheral neuropathy can be caused by many things, including:

• Alcoholism
• Chemotherapy
• Chronic kidney disease
• Chronic liver disease
• HIV
• Hypothyroidism
• Lead poisoning
• Lupus
• Lymphoma
• Phenytoin (used to treat epilepsy)
• Rheumatoid arthritis
• Sjogren syndrome
• Traumatic nerve injury
• Vitamin B12 deficiency

Diagnosis and Treatment

Your healthcare provider may need to take blood tests to determine if the cause of neuropathy is related to an infection, autoimmune disease, metabolic disorder, nutritional deficiency, or a drug side effect.

Irrespective of the cause, peripheral neuropathy causes the same symptoms (pain, numbness, tingling, burning, or weakness). Most neuropathies will improve once the underlying cause is treated.

Osteoarthritis

Osteoarthritis, also referred to as "wear-and-tear arthritis," is a condition that causes progressive deterioration of joints. When it affects the hands, osteoarthritis can cause pain, weakness, stiffness, difficulty gripping, and deformity of the finger joints.

If you have arthritis, you may be able to ignore the milder, early symptoms. But over time, as the breakdown of joint cartilage continues, the pain and weakness can worsen and become debilitating.

Diagnosis and Treatment

Your healthcare provider can diagnose arthritis based on your symptoms, a physical exam, X-rays, and possibly blood tests. Arthritis is a painful condition that is treatable with anti-inflammatory drugs, ice/cold application, and physical therapy. It can be debilitating but is rarely life-threatening.

Cervical Radiculopathy

Many people experience radiculopathy (the pinching of a spinal nerve root) at some point in their life. This can occur when spinal bones degenerate and collapse, when there is a traumatic spinal injury, or when there is the displacement of tissues between the spinal bones.

A pinched nerve in the cervical spine of the neck (called cervical radiculopathy) can cause hand weakness because this is the part of the spinal cord that controls hand movements.

Sometimes, a pinched nerve in the neck can cause pins-and-needles sensations (paresthesia), back or shoulder pain, and shooting pains in distant parts of the body such as the leg.

Diagnosis and Treatment

Your healthcare provider can often tell if you have a pinched nerve based on your symptoms and a physical exam. A nerve conduction study and/or imaging tests like a computed tomography (CT) scan may be needed to confirm the diagnosis.

The treatment varies by the cause but may include anti-inflammatory drugs, steroid injections, or different types of surgery. Physical therapy can also help. Some people with a pinched nerve improve without any treatment (such as a pinched nerve that develops during pregnancy).

Herniated Disc

A herniated disc is a displacement of the cartilage that supports and anchors the spine. A herniated disc can press on the spinal nerves and affect how they work.

Because the spinal nerve roots control many different sensations and movements of the body, the building of a disc can trigger different symptoms based on where it occurs. Herniated discs in the cervical spine can cause nagging pain and weakness in the hand or arm.

Diagnosis and Treatment

Your healthcare provider can diagnose a herniated disc based on your symptoms, a physical exam, and an imaging test such as a spinal X-ray, spinal CT scan, or spinal magnetic resonance imaging (MRI) scan.

A herniated disc can be treated with physical therapy, anti-inflammatory drugs, or opioid medication.s

Surgery may be used in certain situations. Even so, the pain and weakness may not always be resolved with surgery, so careful consideration is needed to weigh the possible benefits and risks.

If you have a herniated disc, it is usually recommended to take extra care when doing physical activities, especially when lifting heavy objects.

Saturday Night Palsy

Saturday night palsy (also known as compressive neuropathy) is a specific kind of nerve injury that occurs when the radial nerve of the upper arm is compressed for a long time. This is often caused by sleeping in a position that presses on the radial nerve for hours.

Symptoms include hand weakness, numbness, and prickly sensations similar to when a limb has fallen asleep.

The term is slightly tongue-in-cheek and refers to motor weakness caused by drinking too much and falling asleep in a slumped position. However, any sleeping position that places too much pressure on the radial nerve can cause the same type of hand weakness.

Diagnosis and Treatment

Saturday night palsy can be diagnosed by symptoms alone and often does not require treatment once the pressure is removed. With that said, there are cases when prolonged compression causes severe nerve damage and the loss of hand function and/or sensation.

Nonsteroidal anti-inflammatory drugs (NSAIDs), oral corticosteroids, and steroid injections may be used to reduce inflammation and improve symptoms. In rare instances, surgical nerve repair may be needed.

Ulnar Neuropathy

Ulnar neuropathy is caused by the injury of a nerve called the ulnar nerve. This nerve, which controls arm and hand movement, is most often compressed at the elbow. Mild compression of the ulnar nerve is caused by leaning on the arm, which produces a tingling sensation often referred to as "bumping the funny bone."

Damage to the ulnar nerve from traumatic injury, arthritis, compression, or infection can cause pain, tingling, hand or arm weakness, and a loss of sensation (particularly with the ring finger).

Diagnosis and Treatment

The diagnosis and treatment of ulnar neuropathy are similar to other forms of neuropathy. If an infection is involved (typically bacterial), antibiotics may be prescribed. Traumatic injuries may require an elbow brace until the symptoms improve. Some cases require no treatment.

Summary

There are many possible causes of sudden or persistent hand weakness. Most are treatable and rarely serious, although they can cause significant discomfort and disability if left untreated.

Some of the more common causes include carpal tunnel syndrome, diabetic neuropathy, peripheral neuropathy, hand osteoarthritis, cervical radiculopathy, herniated discs, Saturday night palsy, and ulnar neuropathy.

Some of these can be treated with steroids or other anti-inflammatory drugs (particularly those associated with nerve inflammation or injury). Others may require physical therapy or surgery. It may also be necessary to treat the underlying cause, such as diabetes or an infection, before the hand weakness and pain fully resolve.

A Word From Verywell

If you experience sudden weakness or paralysis of a limb, particularly on one side of the body, you need to call 911 as this may be a sign of a stroke.

If you have gradually worsening hand weakness or pain for weeks or months, you are not having a stroke. Nevertheless, it is important to see a healthcare provider because most of the common causes of hand weakness can be effectively treated if diagnosed early.