Bilateral distal weakness in the arms suggests which condition?

• A. Polyneuropathy
• B. Myositis
• C. Neuromuscular junction disorders
• D. Alcohol myopathy

Answer: (A)

Bilateral distal weakness in the arms points to a problem affecting peripheral nerves in a length-dependent pattern. In polyneuropathy, multiple nerves are involved, and because longer nerves are affected first, symptoms appear in the distal parts of the limbs. This often means symmetric weakness in the hands and feet, with possible sensory changes and reduced reflexes.

In contrast, inflammatory myopathies like myositis typically cause weakness that is proximal—around the shoulders and hips—rather than at the distal hands. Neuromuscular junction disorders such as myasthenia gravis usually produce fatigable weakness that is also often proximal and may involve ocular or bulbar muscles, with variability tied to use. Alcoholic myopathy is primarily a proximal myopathy from chronic alcohol exposure, not a pattern of distal arm weakness.

So the described pattern most closely matches a length-dependent polyneuropathy.