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Losing My Grip : Lost My Touch
Carpal Tunnel Syndrome - Hand/Wrist Pain & Numbness
by Dr. Gary Eaton

You are tuning up for the salt having conquered the wind, tamed the line, and hit the targets for a month. The trip is 3 weeks away so you simulate fishing conditions and cast 45 minutes before work every morning and half an hour at lunch. The long summer days allow you another 90 minutes when you get home. None are smaller than a seven weight for this world and more time spent on the nine and twelve. Your hands are a little sore, but you sleep okay.

Cleaning your fly line while watching your DVD of "The Instructor", you notice you can barely feel the line between your thumb and index finger. You remember you had to have your daughter tie a nail knot for you because you seemed too clumsy last night. Your wrists were sore in the morning all this week. Last night, you got up in the middle of the night and had to shake your hands vigorously to reduce the numbness. You dropped a cup of coffee this morning. You had to stop and rest a few times when winding in that 130 foot cast.

Is this serious?
What should you do?
How do you find out more?

Any decrease in sensitivity of the fingers or loss of strength in the hands needs a doctor visit. This arose a few weeks into a stepped-up activity, so stopping the practice while you're getting looked at is appropriate. Your casting instructor is a muscle & nerve doctor so you impose for some advice.

Doctor Caster doesn't like the distribution of numbness to your thumb and index finger, mostly. He tells you that your mid-sleep ritual of shaking is a positive "Flick" test. Easy fatigue when gripping your small reel handle for repetitive motion like reel winding fits the other pieces. He wants you to be tested for Carpal Tunnel Syndrome, medically called "Median Nerve Entrapment Mononeuropathy".

Being a "syndrome", it is a clinical diagnosis, but there is a 'best' test. Electrodiagnostic testing for nerve conduction and a needle electromyogram, EMG, are needed to determine severity and prognosis.

What can be done?
First, cut way back on the casting.
Second, wear neutral wrist splints all-night, every night.
Third, hand therapy daily or every other day, for a couple of weeks or more.
Fourth, you might want to consider a corticosteroid, cortisone, injection into the wrist aimed at the "Carpal Tunnel".

This combination of interventions might salvage your saltwater trip, but when you get back you'll need to aggressively address the conditions that contributed to your nerve compression.

There is some evidence to support the idea of becoming leaner. You might have to rule-out metabolic conditions like diabetes and hypothyroidism. The hand therapist may show you ways to adapt your work to reduce forces at the wrist. Adapting equipment you use often by increasing diameter of grips and handles and cushioning hard objects into your palm might be suggested.

If these maneuvers do not cause improvement in 6 weeks, repeat nerve conduction studies may be in order. Surgical release should be considered early if there is both sensory and motor slowing on the tests. Surgery reduces pressure on the nerve, but it may take months to see full benefits. The night-time wrist splints will be required even with surgery. Surgery also alters the mechanics of your wrist structures and you will be well-advised to demonstrate to the therapist what you do with your fly rod so proper adaptations can be tried.

Gary Eaton D.O. is a board certified physician in the US specializing in Physical Medicine & Rehabilitation (PM&R) and Pain Medicine. He worked for nearly 10 years as a firefighter and paramedic. Beginning to fly fish as a teen in Colorado with a Herter's bamboo 5wt (which he still has), in the last few years he's been instructing formally and earned his CCI certification from the FFF in 2006. "I continue to learn."

The information contained in this writing is general in nature and does not imply a doctor:patient relationship of any sort. All are advised to seek qualified medical help before instituting any treatment measures. Health conditions of a particular individual could make all or part of the information provided inappropriate for a given person. The author,, and affiliates assume no liability nor responsibility regarding this information or it's use.

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