Correspondence

Paddler's Palsy

N Engl J Med 1996; 334:125-126January 11, 1996

Article

To the Editor:

One of us, a 40-year-old physician (C.H.R.), decided to take up white-water kayaking. After he had two hours of instruction on flat water, his thumbs and the first two fingers of both hands became numb. He attributed the symptoms to the cold. After four more hours of instruction, he awoke from sleep the following night with tingling in the thumbs and first two fingers of both hands. In the morning he could not start his car because his right hand lacked strength to turn the ignition key. He moved on to more advanced kayaking, with only mild pain in the right elbow. However, after capsizing in the rapids, he realized that he did not have enough upper-body strength to make a critical maneuver. Driving home, he noticed fasciculations of the first dorsal interosseus muscle of his right hand.

The next day, he still could not start his car with his right hand or turn a doorknob. Examination by the other one of us, who is a neurologist (V.M.T.), revealed bilateral weakness of the intrinsic muscles of both hands, with the right hand much weaker than the left. There was mild weakness of wrist extension and of thumb adduction and abduction. There was some numbness in the median-nerve distribution bilaterally, but no weakness of the muscles of the upper arm or forearm. His reflexes were normal.

With one week's abstinence from kayaking, his motor and sensory function returned to normal. The signs and symptoms in the distributions of the median, ulnar, and radial nerves were most consistent with a bilateral stretch injury to the brachial plexus, presumably from energetic hyperextension of the shoulders while he paddled the kayak.

C. Harker Rhodes, M.D., Ph.D.
Vijay M. Thadani, M.D., Ph.D.
Dartmouth–Hitchcock Medical Center, Lebanon, NH 03755