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Hand(handlebar) & Shoulder Syndromes
There are several hand and upper extremity injury syndromes
associated with cycling.
ULNAR NERVE NEUROPATHY (little finger and ring finger)
Numbness of the small and ring finger is the result of
irritation of the Ulnar nerve. After leaving
the side of the neck, the ulnar nerve then travels through the
arm pit, down the arm to the handand fingers. As it crosses the
wrist, the ulnar nerve and artery run through the tunnel known
asGuyon's canal. The cause of Gunyon's Canal Syndrome includes
trauma to the area, fractures ofthe bones that form the floor of
the tunnel, and small, benign tumors of the nerve or
surroundingtissues of the tunnel. Another common cause of this
syndrome is from pressure of bicyclehandlebars seen with avid
cyclists. In that case it is overuse of the wrist, especially
bending thewrist down (flexing) and out, or putting constant
pressure on the palm. Road vibrationtransmitted through the
handlebars may be the cause in some cases as well.
The symptoms begin with a feeling of pins and needles in the
ring and little finger, starting in theearly morning before waking.
This can progresses to a burning pain of the wrist and
hand,followed by decreased sensation and eventually clumsiness in
the hand as the ulnar nerve also
supplies many of the small muscles of the hand.The diagnosis of
Guyons canal syndrome begins with a careful history and
physicalexamination by your doctor. Compression can occur at
several areas along the ulnar nerve, andyour doctor will want to
find exactly where the nerve is being affected. Electrical studies
such asNerve Conduction (which measures how fast nerve impulses
travel along the nerve) may help topin point your problem.
Treatment involves taking frequent breaks or limiting the amount
of time you are performingtasks that require flexing and turning
out the wrist, or place constant pressure on the palm. Youwill need
to evaluate how you are gripping the handlebars, particularly how
you are holding yourhand in relation to your forearm, and consider
a change in your riding/gripping style on thehandlebars or hoods.
Lowering your seat to take pressure off your palm or wrist may be
of help.
Also consider increasing the padding in your gloves or other
measures to decrease thetransmission of road vibration. A wrist
splint may be worn at night to decrease aggravating thecondition.
Anti-inflammatory medications(such as ibuprofen or aspirin) may be
helpful. And inextreme cases surgery may be necessary to cut the
ligament that forms the roof of Guyons canalto relieve the pressure
on the nerve. The ligament will eventually heal back, but the canal
will belarger than before thus providing more leeway in how you
position your wrist.
MEDIAN NERVE NEUROPATHY (carpal tunnel syndrome; thumb and ring
finger)
The most common surgical neuropathy is the compressive
neuropathy of the Median Nerve as itpasses through the Carpal
Tunnel in the wrist Irritation at this level in the course of the
mediannerve causes numbness of the thumb and index fingers. As with
Ulnar neuropathy, it can beaggravated by wrist position and road
vibration, and the approaches to treatment are similarincluding
changing the aggravating motion/position, anti-inflammatories, and
ultimately surgeryif all else fails.
Common fixes for both
Ice and NSAIDs (motrin, ibuprofen) acutely
Use a firm but relaxed grip on the bar
Change hand positions frequently
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Try padded gloves or cushy handlebar tape
Concentrate on keeping your wrists straight (bar ends on
mountain bikes and aero bars ona road bike keep the wrists in a
more neutral position)
Alter your position on the bike to stay more upright (a higher
stem or more spacers in theheadset)
SHOULDER PAIN
Developing shoulder pain is a common complaint, especially on
long rides. A common questionI receive is similar to the
following:
Q. We take a group of teens on a 400 mile bicycle trip every
summer through our church. One ofthe teens has complained
extensively about shoulder discomfort. What do you advise?
In this situation, shoulder pain on longer (than training)
rides, the problem is generally due toplacing too much weight on
the hands and riding with straight elbows (rather than keeping
themslightly flexed) which transmits more road shock to the arms
and upper body. Solutions include:
a more upright posture on the bike with less weight on
outstretched arms
a higher stem
perhaps tilt the seat back a little (just a single click or it
may put excessive
pressure on the perineum)
concentrating on keeping the elbows bent while riding
longer training rides - closer to the length of your long day on
your next adventure
