Wrist and Finger Drop in Myasthenia Gravis

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Several years after the diagnosis of myasthenia gravis, a 40-year-old man developed weakness of the right hand grip and as a result lost his job. After obtaining a second job, he developed weakness of his left hand, losing this job as well. He consulted a series of physicians, including neurologists, and a variety of diagnoses for his hand weakness was considered. The neurologic examination showed distal weakness of the left hand, especially involving wrist and finger extension. Electrophysiologic studies showed significant decrement after repetitive nerve stimulation of the left, but not right, radial nerve. Although uncommon, distal and strikingly asymmetric weakness can be a manifestation of myasthenia gravis.

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