When a conscious person is unable to voluntarily move, one or more, otherwise normal joints of the body, it is considered to be paralyzed.
When a conscious person is unable to voluntarily move, one or more, otherwise normal joints of the body, it is considered to be paralyzed. The inability to move may be limited to just one small joint of the hand or the whole hand or the elbow or the shoulder or one side of the body or the half of the lower body or the whole body. Thus, there can be a large spectrum of inability to move a body part. These are all considered to be paralyzed.
There can be many reasons for the paralysis.
In the normal person, the brain initiates a signal for a conscious person to move a part of the body. This signal propagates through the spinal cord to a specific nerve followed by to a muscle and which in turn actuate a joint to move.
The paralysis can be because of an injury to any part of the Brain- Nerve- Muscle-Tendon axis. For example, a sharp injury like a stab in the neck, can damage a set of nerves passing to the hand, resulting in paralysis of one or more muscles of the shoulder, or elbow or the hand.
A person may get head injury, injuring the part of the brain which controls the hand resulting in a paralysis of one side of the body.
A person may have a paralytic stroke, because of deranged blood supply to a very tiny but a very specific part of the brain leading to paralysis of one side of the body.
Paralysis can follow injury to the spinal cord.
Paralysis can occur if a motor cyclist falls off the motor bike and lands on the side of his head resulting in BRACHIAL PLEXUS injury. Only the shoulder and the elbow or the whole upper extremity may get paralyzed in the ensuing brachial plexus injury.
Following an injury to the radial nerve, one may get wrist drop. The person may not be able to extend the wrist, the fingers and the thumb This can also follow fracture of the humerus bone and injury to the radial nerve in the close vicinity.
One may present with a situation where only the terminal joint of the thumb cannot bend or straighten. This may not necessarily be because of any nerve injury but following tendon rupture.
The paralysis can follow, when the nerve is diseased, like a viral infection of a nerve. One of these conditions is Guillen Barre Syndrome. Infection like Poliomyelitis or Polio can also lead to a paralytic condition.
Motor neuron disease, Hirayama disease, Multiple sclerosis are some of the other conditions which present as some form of paralysis.
An abnormal lump or tumour can press a particular nerve and present as a paralytic condition affecting only the part where the nerve is affected.
At time a normal structure can press a nerve, leading to paralysis of a muscle. For example, in a condition called carpal tunnel syndrome, the thickened flexor retinaculum may press on the median nerve. Synovitis of the flexor tendons may compromise the dimensions of the carpal tunnel, causing median nerve dysfunction. This manifests as tingling and numbness in the hand. There may be a lump in the carpal tunnel leading to carpal tunnel syndrome.
Surgery can help alleviate numerus paralytic conditions and improve the quality of life. The surgery may involve nerve repair, nerve grafting, nerve transfer or tendon transfer, removal of the offending space occupying structure or some type of joint surgery like arthrodesis.
Nerve Repair: If the nerve is damaged, it is repaired under microscope. An appropriately repaired nerve regrows over a period of time under suitable conditions in young patients.
Nerve Grafting: If there is large gap between the two ends of the nerve to be reconnected, the gap is bridged using a nerve graft. The nerve graft is usually obtained from the leg. The most common source of nerve graft is sural nerve.
Nerve transfer: A nerve gives out multiple branches, exactly like a tree trunk gives out multiple branches. One of these branches is rerouted in such a way that it connects the recipient nerve through the transferred nerve to the headquarters, that is the brain. This rerouting of the nerve will restore the function of the targeted muscle.
Tendon transfer: The other method to restore function of a paralyzed joint is called tendon transfer. Almost 80 percent of the liver is spare. One can live normal life with a single kidney. This kind of spare capacity exists in many parts of the body including the heart, brain and muscles. The spare muscle is relocated to function in place of one which is more important but is paralyzed.
Arthrodesis or joint fusion: Multiple joints work in unison. Function of one joint affects the function of other joints. If one joint is adversely positioned, the other joints also get adversely positioned. Hence at times, one of the joints is immobilized in such a way, that the function of other joints is enhanced significantly.
On other occasions, fusing the joint can spare a few muscles for transferring to other joints for augmentation of overall hand function.
The patient with a paralytic condition may seek treatment after a significant delay. The nerve surgery may not be feasible after a significant delay. With a delay, the treatment option may get limited and directed at the tendons and the muscle. For tendon surgery, the target joints should be soft, supple and passively mobile. The patient may need a prolonged period of dynamic splinting to mobilize the joints or may need surgery to make the joints passively mobile and prepare for tendon transfer surgery.
When managing paralysis caused by certain neurological disorders, reconstructive surgery offers a powerful pathway to restore active movement, grip strength, and independent mobility. However, not all nerve diseases are eligible for surgical intervention. Selecting the right candidate requires a deep understanding of how the underlying condition behaves over time. The primary surgical tool used to restore lost limb function is tendon transfer surgery. This procedure works by taking a healthy, functioning but spareable muscle-tendon unit and rerouting it to replace a paralyzed muscle. For this surgery to be successful, the patient's neurological deficits must be completely stable. Does Progression Matters in Surgical Selection? The single most critical factor when considering a patient for surgical reconstruction is whether their nerve condition is progressive or static. If a disease is actively destroying nerve cells, any muscle chosen as a "donor" will eventually lose its nerve supply too, causing the surgical reconstruction to fail.This creates an important clinical distinction. While certain conditions are pathologically classified as motor neuron disorders or nerve roots pathologies, they are highly amenable to surgery because their destructive phase comes to a complete halt. Conversely, classic neurodegenerative Motor Neuron Diseases (MND), such as ALS, are strictly contraindicated.Targeted Nerve Diseases Amenable to ReconstructionTo build an effective treatment plan, we categorize surgically amenable nerve diseases into distinct clinical entities: Post-Polio Residual Paralysis (PPRP) : Although polio is an infectious motor neuron disease, the destruction halts entirely once the acute viral phase resolves. This leaves behind a completely static pattern of flaccid paralysis. Because it spares sensory nerves and leaves highly functional "donor" muscle options, PPRP remains a classic, gold-standard indication for lower limb and foot drop reconstruction. Guillain-Barré Syndrome (GBS): GBS is an acute, monophasic autoimmune attack on the peripheral nerves. While the vast majority of patients achieve near-complete neurological recovery over months, a small percentage of severe axonal variants are left with permanent, unchanging residual paralysis. Once these deficits have completely plateaued (typically evaluated years post-onset), tendon transfers can safely restore isolated functional losses like a dropped foot. Leprosy (Hansen's Disease) : A bacterial peripheral neuropathy that targets specific nerves in highly predictable patterns. Once a patient has completed a full course of multi-drug antibiotic therapy (MDT) and the infection is entirely arrested, stable deformities like claw hand or foot drop can be permanently corrected using robust, unaffected donor muscles Hirayama Disease: This unique, mechanical motor neuron disorder progresses during adolescence but completely self-limits and stabilizes after 3 to 5 years. Because it classically spares specific forearm muscles (like the brachioradialis), it leaves behind ideal donor targets to reconstruct thumb opposition and finger extension once the disease halts
Spastic condition may follow some kind of damage to the brain. It may be immediately after birth, or later in the life after head injury, or an episode of stroke. The patient typically presents with a tightness of a specific group of muscles.
In a very typical scenario, the posture of the affected upper extremity is:
Tingling, numbness, or the sensation of the hand “falling asleep” is a common complaint. This can affect part of the hand, the whole hand, or even just a single finger.
Traumatically-amputated fingers and hands are replanted (reattached) by us routinely and successfully since 1991.
Of innumerable causes of pain in the hand, a few are presented here.
Medically reviewed by Dr. Pankaj Jindal (MS Orthopaedics & Reconstructive Microsurgeon), Specialist Hand Surgeon, Jindal Hand Surgery, Pune, Maharashtra, India.Maharashtra Medical Council Reg. No. 66746Last reviewed: 2026-10-03
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Hand, wrist and nerve surgery is all Dr. Jindal does, since 1991.
