Wrist Weakness and Wrist Drop

What wrist weakness feels like

People describe a weak wrist in different ways:

• dropping cups or struggling to pour from a kettle
• difficulty turning keys, door handles or jar lids
• the wrist "giving way" when you push up from a chair
• the hand hanging down and not lifting (wrist drop)
• weakness only when it hurts, with normal strength once the pain settles

It helps to work out whether the wrist is weak because it hurts or weak even without pain. Painful weakness points to the joint, tendons or bone. Painless weakness, especially with numbness, points to a nerve, the spinal cord or the brain.

Wrist drop

In wrist drop, you cannot extend (cock back) the wrist and fingers. The muscles that lift the wrist are all supplied by the radial nerve, which winds around the upper arm bone. Common causes of radial nerve injury:

• "Saturday night palsy": sleeping deeply with the arm draped over a chair back, often after alcohol
• Fracture of the upper arm bone (humerus), which can stretch or trap the nerve
• Crutches pressing into the armpit
• tight tourniquets, handcuffs or a long period of pressure during surgery
• rarely, lead poisoning, diabetes or vasculitis affecting the nerve

Most compression-related wrist drop recovers over weeks to a few months once the pressure is removed.

A pinched C7 nerve root in the neck and some strokes can also cause wrist drop, so a doctor checks neck movement and the rest of the nervous system.

Causes of wrist weakness

Injury

• Sprains and fractures: a fall on an outstretched hand can sprain ligaments or break the scaphoid or wrist bones. A scaphoid fracture can look like a sprain on day one. Pain at the base of the thumb after a fall needs an X-ray.
• Tendon injuries: a cut or rupture of the tendons that bend or straighten the wrist causes loss of a specific movement.
• Ligament tears: such as a scapholunate tear, cause clicking, pain and weak grip.

Tendon and joint problems

• De Quervain's tenosynovitis: pain on the thumb side of the wrist with gripping and lifting a baby. Common in new parents.
• Tendinitis from overuse: repetitive typing, racquet sports and manual work.
• Arthritis: osteoarthritis causes stiffness and aching. Rheumatoid arthritis often starts in the wrists and knuckles with morning stiffness lasting over 30 minutes and swelling of both sides.
• Ganglion cysts: a lump on the back of the wrist that can press on structures and weaken grip.

Nerve problems

• Carpal tunnel syndrome: compression of the median nerve at the wrist. It causes tingling of the thumb and first fingers and weakness of grip and thumb movements rather than true wrist weakness.
• Ulnar nerve compression: at the elbow (cubital tunnel), causing numbness of the ring and little fingers and weak grip.
• Cervical radiculopathy: a pinched nerve root in the neck from a disc or arthritis. Neck pain spreads down the arm, with numbness and weakness in a particular pattern. C6 and C7 roots supply the wrist muscles.
• Peripheral neuropathy: from diabetes, alcohol or vitamin B12 deficiency, typically starting in the feet before the hands.

Brain, spinal cord and muscle disease

• Stroke: sudden weakness of one side of the body, sometimes most obvious in the hand and wrist.
• Multiple sclerosis: episodes of weakness or numbness lasting days.
• ALS (motor neuron disease): painless, progressive weakness with muscle wasting and twitching, often starting in one hand.
• Myositis and myopathy: usually affect shoulders and hips before the wrists, but inclusion body myositis characteristically weakens finger and wrist flexors.
• Amyloidosis: protein deposits can cause carpal tunnel syndrome in both wrists and neuropathy.

Weak wrist causes compared

How doctors diagnose wrist weakness

A doctor will ask how and when the weakness started, what movements are affected, whether there is pain or numbness, and about injuries, sleeping position, neck problems, diabetes and alcohol use. The examination tests the strength of each wrist and finger movement, sensation, reflexes and neck movement.

Tests may include:

• X-ray after injury, and sometimes a CT or MRI for scaphoid fractures and ligament tears
• Nerve conduction studies and electromyography (EMG): show which nerve is affected and how badly
• MRI of the neck for suspected nerve root compression
• Blood tests: blood sugar, vitamin B12, thyroid function, inflammatory markers and rheumatoid factor
• Brain scan urgently if stroke is suspected

Treatment

• Injuries: a splint or cast, then strengthening exercises. Some fractures and tendon ruptures need surgery.
• Radial nerve palsy from pressure: a wrist-extension (cock-up) splint keeps the hand in a useful position while the nerve recovers. Physical therapy maintains movement. Recovery typically takes weeks to a few months. If there is no recovery after 3 to 6 months, nerve studies and sometimes surgery are considered.
• Tendon problems: rest, a splint, ice, over-the-counter pain relievers (follow the label dose), and a steroid injection for de Quervain's if needed.
• Carpal tunnel syndrome: a night splint, steroid injection or carpal tunnel release surgery.
• Arthritis: exercise, splints and, for rheumatoid arthritis, disease-modifying medicines started early to prevent joint damage.
• Cervical radiculopathy: most improve with time, physical therapy and pain relief over 6 to 12 weeks.

Exercises for a weak wrist

Once pain and serious causes are excluded, simple strengthening helps: squeezing a soft ball, wrist curls with a light weight or water bottle, and resistance-band wrist extensions. Start light, and stop if pain increases.

Frequently asked questions

What causes sudden wrist weakness?

Sudden weakness with no injury can come from compression of the radial nerve (for example after sleeping on the arm), a pinched nerve in the neck, or a stroke. If weakness comes with face drooping, slurred speech or leg weakness, call 911 immediately.

What are the symptoms of weak wrists?

Weak wrists cause difficulty gripping, lifting or pouring, dropping objects, the wrist giving way when pushing, and in wrist drop, an inability to lift the hand backward. Depending on the cause there may also be pain, swelling, stiffness, numbness or tingling.

Is wrist drop permanent?

Usually not. Wrist drop from pressure on the radial nerve often recovers within weeks to a few months with a splint and therapy. Recovery is slower or incomplete if the nerve is cut or badly stretched, as can happen with some arm fractures, which may need surgery.

Can carpal tunnel cause wrist weakness?

Carpal tunnel syndrome weakens grip and thumb movements, which can feel like a weak wrist. It also causes numbness or tingling in the thumb, index and middle fingers that is often worse at night. It does not cause wrist drop.

How can I strengthen a weak wrist?

After a doctor rules out fractures and nerve problems, use gentle exercises: grip squeezes with a soft ball, wrist curls and reverse curls with a light weight, and resistance-band exercises, 10 to 15 repetitions daily. A physical or hand therapist can tailor a program.