Lingering Peripheral Neuropathy

[FishDiver]

I did five dives over the last four days in water from 46-48 degrees F. Dive time was from 50-65 minutes. During the first dive I lost most of the sensation and stength in my hands during the last 15 minutes of the dive. I never lost complete sensation during the next four dives.

Due to the loss of strength and dexterity I switched from wet 5ml gloves to 7ml three-fingered mitts after the first dive and wore them for the remaining four dives.

It has now been 24 hours since the last dive and I still have a numb, tingling feeling in my finger tips. I wore gloves to bed last night to try and improve the circulation. Should I be concerned that repeated diving in cold water will make this condition more severe and permanent or is this a common condition?

 

[Bubbletrubble]

What you're experiencing doesn't sound normal at all. A health professional would describe the numb, tingling sensation as a paresthesia.

Does it occur in all of your fingertips? Or is there a particular distribution (4th/5th fingers vs. index/middle fingers vs. thumb)?
Do you notice an accompanying color change (bluish tinge, whiteness, or redness) to the affected areas?
Have you ever experienced this sensation in your hands before (outside of diving)?
Have you ever had frostbite of the affected fingers?
Have you ever been diagnosed with any circulatory problems?
Have you ever been diagnosed with any nervous system issues?
Do you have diabetes?
Are you a smoker?
Are you currently taking any medications (prescription or other)?
Have you ever been diagnosed with Raynaud's phenomenon?
Any recent injuries to your elbow? Fractures/dislocations of the humerus? Recent history of lacerations to the affected extremity?

Without knowing anything more, I would say that Raynaud's should be high on the differential. It would be helpful to see a doctor about this. Don't be surprised if the doctor asks all/most of the above questions.

If you have Raynaud's, there are specific things that you can do to avoid the paresthesia. At the top of the list would be to avoid the cold trigger(s). Your physician will escalate to more aggressive intervention (meds) if necessary.

Let us know how it goes...

 

[Web Monkey]

I did five dives over the last four days in water from 46-48 degrees F. Dive time was from 50-65 minutes. During the first dive I lost most of the sensation and stength in my hands during the last 15 minutes of the dive. I never lost complete sensation during the next four dives.

Due to the loss of strength and dexterity I switched from wet 5ml gloves to 7ml three-fingered mitts after the first dive and wore them for the remaining four dives.

It has now been 24 hours since the last dive and I still have a numb, tingling feeling in my finger tips. I wore gloves to bed last night to try and improve the circulation. Should I be concerned that repeated diving in cold water will make this condition more severe and permanent or is this a common condition?

Call Diver's Alert Network immediately for a referral to a doc to get checked out.

If you leave this too long, it may be yours forever.

Reach DAN by Phone:

• Diving Emergencies (
  
  Remember: Call local EMS first, then DAN!)
  1-919-684-9111
  International Emergency Hotlines
• Non-Emergency Medical Questions
  1-800-446-2671 or 1-919-684-2948, Mon-Fri, 8:30am-5:00pm (ET)

Terry

 

[FishDiver]

What you're experiencing doesn't sound normal at all. A health professional would describe the numb, tingling sensation as a paresthesia.

Does it occur in all of your fingertips? Or is there a particular distribution (4th/5th fingers vs. index/middle fingers vs. thumb)?
Do you notice an accompanying color change (bluish tinge, whiteness, or redness) to the affected areas?
Have you ever experienced this sensation in your hands before (outside of diving)?
Have you ever had frostbite of the affected fingers?
Have you ever been diagnosed with any circulatory problems?
Have you ever been diagnosed with any nervous system issues?
Do you have diabetes?
Are you a smoker?
Are you currently taking any medications (prescription or other)?
Have you ever been diagnosed with Raynaud's phenomenon?
Any recent injuries to your elbow? Fractures/dislocations of the humerus? Recent history of lacerations to the affected extremity?

Without knowing anything more, I would say that Raynaud's should be high on the differential. It would be helpful to see a doctor about this. Don't be surprised if the doctor asks all/most of the above questions.

If you have Raynaud's, there are specific things that you can do to avoid the paresthesia. At the top of the list would be to avoid the cold trigger(s). Your physician will escalate to more aggressive intervention (meds) if necessary.

Let us know how it goes...

The answers are "NO" to all the above questions. I am an experienced cold water diver in good health with no symptoms prior to the dives noted above.

 

[Bubbletrubble]

The answers are "NO" to all the above questions. I am an experienced cold water diver in good health with no symptoms prior to the dives noted above.

If the paresthesia doesn't occur in all of your fingers, which ones in particular?

 

[FishDiver]

If the paresthesia doesn't occur in all of your fingers, which ones in particular?

Left hand thumb, index and middle fingers.

 

[Bubbletrubble]

Left hand thumb, index and middle fingers.

That's interesting. A paresthesia restricted to that region would be consistent with distribution of a branch of the median nerve.

Did you tweak/strain your left hand/wrist in any way during or prior to the dive?
Do you have a history of repetitive stress injury or carpal tunnel syndrome?

If I had this, I'd do a couple of different physical exam maneuvers to test for median nerve involvement (identical to tests performed for carpal tunnel syndrome - CTS):

• Phalen's test: With both hands facing down, place the backs of your hands together. Hold this position for a minute. If this causes pain, tingling, or numbness in the thumb, index finger, and middle finger, then this would be a positive test.
• Tinel's test: With your right hand, tap on the inside middle part of the left wrist. Does this tapping cause a shooting pain from the wrist to the hand? That would be a positive Tinel's sign.

Here's a video that shows how to do the tests:

Schedule an appoint with your physician. It's unusual that cold exposure would cause CTS-like symptoms. As you probably already know, carpal tunnel syndrome occurs when the median nerve running through the wrist becomes compressed. There are several options for treatment that would help. NSAIDs (e.g., ibuprofen) might help in the short-term.

NINDS has a nice fact sheet on CTS. You might find some of the info interesting.

FWIW, there are several medical conditions that can be associated with CTS-like symptoms (unlikely but possible). It would be prudent to get checked out by a professional.

 

[FishDiver]

That's interesting. A paresthesia restricted to that region would be consistent with distribution of a branch of the median nerve.

Did you tweak/strain your left hand/wrist in any way during or prior to the dive?
Do you have a history of repetitive stress injury or carpal tunnel syndrome?

If I had this, I'd do a couple of different physical exam maneuvers to test for median nerve involvement (identical to tests performed for carpal tunnel syndrome - CTS):

• Phalen's test: With both hands facing down, place the backs of your hands together. Hold this position for a minute. If this causes pain, tingling, or numbness in the thumb, index finger, and middle finger, then this would be a positive test.
• Tinel's test: With your right hand, tap on the inside middle part of the left wrist. Does this tapping cause a shooting pain from the wrist to the hand? That would be a positive Tinel's sign.

Schedule an appoint with your physician. It's unusual that cold exposure would cause CTS-like symptoms. As you probably already know, carpal tunnel syndrome occurs when the median nerve running through the wrist becomes compressed. There are several options for treatment that would help. NSAIDs (e.g., ibuprofen) might help in the short-term.

NINDS has a nice fact sheet on CTS. You might find some of the info interesting.

FWIW, there are several medical conditions that can be associated with CTS-like symptoms (unlikely but possible). It would be prudent to get checked out by a professional.

I got a positive on the Tinel's. If it isn't directly related to diving or cold exposure, I am not worried about it. I truly appreciate all of your insights and information.

 

[Bubbletrubble]

I got a positive on the Tinel's. If it isn't directly related to diving or cold exposure, I am not worried about it. I truly appreciate all of your insights and information.

I'm happy that you found the info helpful.

I would still urge you to schedule an appointment with your primary care physician. There might be some obvious things which would be revealed by a focused physical exam. At the very least, motor function and various modalities of sensation should be localized in the affected limb -- this would be very important in following the progression/improvement of the issue. A referral to a neurologist might also be appropriate. He/she would be able to do a series of tests to confirm the diagnosis and give you techniques of avoiding this problem in the future. Something as simple as certain hand stretches might be helpful. There are also several OTC and prescription-based meds that might help.

Good luck with everything...

 

[FishDiver]

I made a Dr. appointment for this afternoon. I was dragging my feet because my old doctor is out on maternity leave and her replacement is on vacation. So I get to consult with yet another doc that I will never see again. I'll post back with the diagnosis.