What Is Quadriparesis?

Table of Contents
View All
Table of Contents

Quadriparesis occurs when there is weakness in all four of your limbs—both arms and both legs. Also referred to as tetraparesis, this condition differs from quadriplegia, which causes paralysis (the loss of ability to move) in each of the body’s limbs.

Depending on the cause, quadriparesis can affect both sides of the body equally or can be more impactful on one side than the other. Most often diagnosed by a neurologist, the treatments available and overall prognosis for quadriparesis can vary widely depending on the underlying cause of the condition. 

Here is an overview of the types, symptoms, causes, diagnosis, and treatment of quadriparesis.

Candid Portrait of Businessman in Wheelchair on the Move

Xavierarnau / Getty Images

Types of Quadriparesis

There are two types of quadriparesis, each with its own unique presentation. They are:

  • Spastic quadriparesis: This causes an increase in muscle tension, which leads to the arm and leg muscles reflexively contracting when they are stretched or moved. As a result, movement of the extremities becomes jerky and difficult, and many of your daily tasks are impacted. Generally, spastic quadriparesis is caused by problems originating in the brain itself.
  • Flaccid quadriparesis: This type occurs when muscles in both the arms and legs are afflicted by weakness, which may either be stable or worsen over time. Individuals with flaccid quadriparesis have lower overall muscle tone and generally experience significant fatigue with normal activities. Usually, flaccid quadriparesis originates in the spinal cord.

Quadriparesis Symptoms

There are several unique symptoms that may be present with quadriparesis, depending on which version of the condition you have, including:

  • Spastic quadriparesis causes significantly increased muscle tightening and hardness in your arms and legs. The muscles in these areas reflexively contract in response to being stretched or moved, particularly when moved quickly. This can ultimately lead to joint contractures, in which your arms or legs become “stuck” in a particular position due to abnormal muscle activation.
  • Flaccid quadriparesis causes somewhat opposite symptoms. Individuals with this condition will experience significant muscle weakness in their arms and legs along with weak or absent reflexes. Limbs may seem “floppy,” and normal movements can become labored and extremely tiring. Depending on the original cause of the quadriparesis, other muscle groups, including those involved in breathing or vision, may also be affected.


There is a wide variety of underlying conditions that can cause an individual to develop quadriparesis, such as the following:

  • Congenital versions of the disorder, which are those present at birth, are most frequently caused by cerebral palsy. This condition occurs when damage or trauma affects a baby’s brain either during development in the womb or while the child is being born.
  • Acquired versions, which arise after birth, have many different causes. Among the more common reasons for arm and leg weakness are lesions or tumors in the spinal cord; spinal cord injuries caused by falls, car accidents, or ruptured intravertebral disks; or neurologic disorders, such as amyotrophic lateral sclerosis (ALS) or conversion disorders. In addition, more uncommon issues like metabolic disorders, including Guillain-Barre syndrome or diabetic ketoacidosis, and even being bitten by a snake with neuroparalytic venom may be to blame.


Diagnosing the underlying cause of your quadriparesis is essential in discovering the treatment options that are available to you. Unfortunately, at times this can be a challenging process. A thorough evaluation by a neurologist is often the first step in your journey.

During this visit, your physician will typically assess your reflexes, check your muscle tone, and examine your ability to perform simple arm and leg movements.

Imaging is also commonly utilized to visualize any abnormalities in the body. This can include an X-ray, MRI (magnetic resonance imaging), CT (computed tomography) scan, or bone scan.

In addition, blood draws or genetic testing may be ordered. In some cases, nerve conduction tests are also needed for assessment.


Just as the causes of quadriparesis can vary widely, treatments for the condition can also differ based on the cause. Some treatment options include:

  • Chemotherapy and radiation: These may be part of the course of treatment for spinal lesions, but—depending on their location and whether or not they are cancerous—they may need to be surgically removed.
  • Surgical procedures: Surgery is commonly used to remove a bulging vertebral disk in the cervical (neck) region or to decompress the spinal cord if this is the cause of your extremity weakness.
  • Dietary substitutions or supplementation: Dietary changes may be helpful in certain metabolic disorders. Additionally, enzyme or chemical replacements are also sometimes ordered to help restore normal function.
  • Assistive devices: For individuals with chronic weakness or spasticity, a wheelchair or walker may help make mobility easier. Other tools designed to improve independence with bathing, dressing, and feeding may also be appropriate.
  • Physical therapy: Some individuals with joint contractures undergo physical therapy, injections, or even surgical release procedures designed to reduce tension or improve mobility in an affected joint.


Several causes of quadriparesis are treatable, and people affected by them can return to a relatively normal and active life. These include the following causes:

  • Several of the various metabolic disorders
  • Some spinal tumors or lesions
  • Certain types of cervical disk problems

Additionally, many people with cerebral palsy or spinal cord injuries are able to live long and active lives with the help of assistive devices.

Not all types of quadriparesis are as effectively treated, however. Unfortunately, some conditions are progressive in nature and currently lack effective treatments. Regrettably, several of the diagnoses are even deadly in the long run. Among the more serious diagnoses are ALS and certain types of metabolic disorders.

A Word From Verywell

Losing the strength in your arms and legs can be extremely scary, and it can significantly impact your ability to perform daily tasks. Because of this, it is crucial to find a doctor who is skilled in evaluating your individual condition. Once a diagnosis has been made, your treatment options will be outlined and a plan can be formulated. Working hand in hand with your neurologist is the key to managing your symptoms and maintaining your independence.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Galli J, Gavazzi F, De Simone M, Giliani S, Garau J, Valente M, Vairo D, Cattalini M, Mortilla M, Andreoli, Rice G, Fazzi E. Sine causa tetraparesis. Medicine. 97(52). doi: 0.1097/MD.0000000000013893

  2. Kaushik R, Kharbanda PS, Bhalla A, Rajan R, Prabhakar S. Acute flaccid paralysis in adults: our experience. J Emerg Trauma Shock. 2014;7(3):149-154. doi:10.4103/0974-2700.136847

  3. Cleveland Clinic. Cerebral palsy.

  4. American Association of Neurological Surgeons. Spinal tumors.

  5. Cleveland Clinic. Inherited metabolic disorders.

By Tim Petrie, DPT, OCS
Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade.