TrailTramp

Long time lurker here, first time poster.

I hereby summon the Sages.

I need your advice on a hand injury, maybe you've experienced a similar situation, or know someone/read about it. I'll really appreciate any leads on the diagnose, the right professional to approach, tests, etc.

For the past week I've been suffering from pain in my right hand. It started while cycling up a mountain trail (light gravel), as a shooting pain starting in the bottom of my wrist (center) and going right to my thumb/index/middle fingers (I suspect nerve-related as it shoots up like through a pipeline). It was triggered by weight/pressure/effort on my hand, as soon as I was on the hoods or hit the brakes, it would kick in (9/10 pain). If pain wasn't triggered, there was a constant pain in a specific spot (middle of the union between the wrist and the forearm) but at a lower intensity (3/10). I aborted the ride and at one point on my walk home, all my fingertips went numb (I can't pinpoint what triggered it), it stayed like that for 5-10 min and then it went away (haven't had numbness since). While off the bike, weight, pressure and effort on the right hand triggered the pain. One week after the incident, pain hasn't gone away, though triggering sensitivity has decreased.

I'm 38, 100kg, I've been cycling for 10-15 years now, but long-ish distances (40-70km) for only the past year (I'm planning for long bikepacking trips), and I had wrist pain in the past year on those long rides (numbness), but they went away after a bike fit setup optimization. There was no gradual pain leading to last weak.

Post bike fit, I did mess with the hood position and I'm probably throwing my weight on my hands as I haven't been using my core; both could be our main suspects, I guess

I'd like to get a diagnose to figure out what the damage is and what the recovery options are, and then back to a bike fit (no messin' around this time) and training to have the right position on the bike.

I live in Quebec, Canada, and while (most) health care is public, waiting times are insane and getting referrals from a GP are a pain. Unless I want to spend 3-4 months to get all the correct forms and authorizations, I really need to know the full roadmap to the right test/specialist by the time I meet my GP.

Any leads on what this thing could be?
Focalized tests? (EMG/Ultrasound/MRI?)
Does this sound like I'd need to check the spine? Other areas?
Would diagnose for this be something for a neurologist to assess? Physiatrist? Other?

squirtdad

info on type of bar and setup might be helpful, sounds like dropbar and modern brake/shift levers?

Iride01 

When you hold on to the bars or hoods, are your hands bent back almost 90 degrees to your forearms? Might be carpal tunnel. Or perhaps your bars are too wide and causing some issues similar to shin splints.

instock

Definitely sounds like a nerve pain. Yep. Especially the numbness. You are probably pinching a nerve somewhere. The carpal tunnel gets a lot of attention, but there are other tunnels that those nerves have to go through. You need a neurologist.

Erzulis Boat 

Sitting at a desk, right hand on mouse all day, base of palm on edge of desk. I know someone that had a very similar situation as you, and this is what the culprit was.

A possibility if this applies.

Flip Flop Rider

you came to the right place

Juan Foote

I was also going to say something about carpal tunnel.

You might find playing with stack height or fore/aft positioning of your saddle to help alleviate the weight being put on your wrists.

I personally had the bike shop put some small silicone pad/strips in under the tape, which was also quite cushy. That, alongside changing positioning of my hands overall as well as frequently helped greatly with a situation very similar to your own. Of note, I also had them lower the seat height just a smidge.

VegasTriker

See this article on "Cyclists Palsy" https://www.physio-pedia.com/Cyclist%27s_palsy
The older you are and the more cumulative miles, the more likely you are to suffer the symptoms. It can carry over into normal life in the form of carpal tunnel syndrome and the symptoms can arise even while off the bike.
Mine got so bad that even riding recumbents that put no pressure on the hands left me with tingling and numbness. I underwent carpal tunnel release surgery. That ended the symptoms but I never returned to riding a road bike because it can come back and only one hand was operated on.

coffeesnob

old age creeping in

philbob57

Good info here: Numb Hands.

Carpal tunnel release cured my hand numbness.

soyabean

Agreed.

Internet less and bike more.

Easy fix!

TrailTramp

Thanks to y'all for chipping in, I appreciate it!

Due to Kafkaesque forum policies, my individual replies were embargoed yesterday, so, here goes a blanket one, because it seems I can't post more than once a day... In a forum...

-I ride a gravel bike with modern STI levers (terrible branding, right?). I ride mostly on the hoods, switch to aerobars from time to time (to prevent what just happened, haha) and I'm only on the drops on technical descents.
-Both previous bike fitting sessions addressed weight on hands and saddle pain, and they resulted in these changes: Raised handlebar (Condor, +50mm), shorter stem with a +30 deg angle, saddle change (SQ Lab, no pain), saddle position and seat post optimization (lowered), raised aerobars, brake lever position change.
-Hand position: The only thing I changed from the bike fit was the shifters because it felt too agressive (I felt like I was falling off a cliff), so I rolled them slightly back. When compared to my forearms, my hands bend a bit towards the ground but not on an extreme 90 degree angle. As I mentioned, I haven't experienced any pain since that bike fit (or since my adjustment, a couple of days after that).
-Carpal tunnel: I used to date an industrial designer in college, she got CTS from trackpads and hours at the computer, and ever since, I've used ergonomic mice (vertical ones). I haven't had symptoms so far, but then again, I've used computers daily for the past 20 years, or as a couple Dutch-culture-friendly commenters mentioned, a freshly hatched chick I am no more

Thanks to your very thoughtful tips on nerve damage, I went to a GP today and the doctor found no signs of major damage. The guy did an ultrasound, but since he was not an ultrasound technician, and the clinic had none, he could only rule out large cysts blocking the nerve. He said that nerve damage is only picked up by EMGs around 3 weeks in, so he advised me to wait a month, avoid any activity that could set back the nerve from recovering, and if the pain is not gone, then go for an EMG and a proper ultrasound. Any cycling neurologists/imaging technicians/etc in the house? Does that make sense? Or should I get those referrals and have those tests done?

It seems to me that the pink elephant in yours truly's room is I that need to learn how to cycle properly, without injuries. FFS mates, I had no idea I needed to engage my core to keep the weight off my hands. I mean, we need lessons to run, drive a car and go skydiving, it seems silly to exclude bikes from the list. Any of you know where I could find something like that?

soyabean

Like I said.

Internet less and bike more.

Easy fix!

GhostRider62

I have hand pain from nerve compression thru the carpal tunnel, cubital tunnel, and foraminal cervical compression. The worst part was constantly dropping latte cups at a popular cycling stop. Numbness and weakness generally implies compressed nerves along the chain, in your case most likely at the hand.

Usually a pain of 7 is about where people can no longer work and chronic pain at 8, people kill themselves.

With a 9, you belong in the trauma center. I know first hand all the testing for nerve pain, but you have something really unusual.

1 week? You are contemplating psychiatry? MRI? Neurology?

Nerves injury takes a long, long time to heal compared to broken hips, ribs, clavicles, scapulas, elbows, arms, etc. Make your appointments but don't be surprised if in 4 months, your hand feels better.

Pratt

I get intermittent numbness in my non-dominant hand. A large variety of glove, hand position, body position, hydration strategies have not alleviated it. It seems to stem from cervical/brachial/axial compression of the nerves from that hand.
Just to complicate things.

streetsurfer

I've had great results from using gyro exercise balls and building my wrist strength through the full range of motion, with their use. This provides better tracking and less nerve path and joint irritation from things rubbing that ought not. The joint is better supported and less prone to injury.

most all of the occurrences of it also stopped their regularity whenI had to cease consumption of wheat gluten due to Coeliac Disease. And within a couple weeks, at that. It also faded if I did any extended fasting prior to the discovery of CD.

these are my experiences with carple tunnel, trigger finger, cubital tunnel issues and thoracic outlet impingements. May or may not be related to yours. Stuff to consider, I'd say, at the least

Calsun

Knowing that compression of the ulnar nerve from bicycling was a potential problem I have for the past 50 years taped my own handlebars. I would start by buying the largest handlebars I could find - usually ones from Cinelli. Then I wrap thin foam around the top of the bars to increase the diameter of this section of the handlebar. Last step is to wrap the bar with normal bike tape. There is now special tape made for tennis rackets that would also work well as a first layer for the top flat section of the handlebar.

This provides more contact area for my hands on the top of the handlebar. I also wear bike gloves that have sorbothane padding. The last aspect is to vary ones position on the handlebars as one rides. I will have my hands on the top of the handlebar and then move them to the hoods on the brake levers and also down into the drops. I even sit up in the saddle to take all the weight off of my hands. This minimizes the amount of time that there is pressure on the nerves of my hands.

This combination of bike modification, glove choice, and riding behavior has been 100% effective. And this includes multiple trips where I rode more than 120 miles each day over a 10 day period.

streetsurfer

LimbSavers vibration reducing wrap

KJL

I am currently suffering the same ailment. I have never had this prior on my current bike set-ups (MTB, Gravel Race, Commuter) - It gets so bad that I can barely manage to shift. I ride one handed when possible because no matter where I put my wrist it's unbearable. The only thing that seems to help is rest. Which means no riding unfortunately. I attribute my pain to overuse and bad ergo work desk set up? I do a bit of video gaming too - I bought a wrist wrap and that seems to isolate the wrist so that you limit the motion so maybe try that.

Calsun

I have had employees who developed tunnel carpel problems from spending too much time at keyboards doing data entry. What helps is a brace but also proper keyboard height. Too low a keyboard and the wrist is bent and there is pressure on the tendons in the wrists. Elevating the keyboard helps a good deal. Ice packs also reduce inflammation and promotes healing (15-20 minutes with an ice pack). With a bicycle having a handlebar stem that allows for having the handlebars an inch higher would be worth a try.

I also need to do hand stretching with my fingers pulled back which helps with the muscle and tendon tension from having ones hands and fingers bent into an unnatural position for lengthy periods of time. I also have Dupuytren's so my hands cramp up if I grasp anything for an extended period of time whether it is a paint brush or a camera.

It takes a lot longer than one would hope to recover from the abuse of overuse. The tendency is to ignore the discomfort and power through but this is unwise.

Carbonfiberboy 

I assume you read the Numb Hands link posted above. The problem is usually incorrect hand placement and not changing hand position every 5 minutes (literally). The other part of this problem is too much pressure on the hands. I don't see anything in your bike fit description that would have had a positive effect on that, more likely the opposite. You should check your bike fit outcome against my bike fit primer here: How can I fitting my bike

And change your hand position every 5 minutes.

Maelochs

My takeaway from all this is to do All the hings you see suggest4d here---first and foremost, Stop leaning on the bars. Make absolutely sure you don't have Any unbalanced or odd-angle stress on the wrists, and always lean on the pads of the hands, never between them. Move frequently .... this is the sort of thing which builds over time, and compounds from different activities ... so your online time coupled with the cycling might be accumulating to cause injury.

Once you get some damage, it takes a long time to heal, and you pretty much have to stop everything that irritates the injury .... so it is best not to let it get bad (maybe too late for you.)

Caveat: while I have had hand issues such as many here describe, I am NOT a doctor, nor a nurse, nor did i stay in a Holiday Inn ..... to me it sounds like nerve injury, but I know exactly zero about anything ....

But I have had luck by paying constant attention to had position, riding position, wrapping my bars fat, limiting some non-work computer time at times, and always paying attention to the slightest twinge, because I know I won't feel anything until the damage has started.

The good news is that in my opinion, you can get back to normal even though it might take six months off the bike and in a wrist brace ... the bad news is I am about as ignorant and can be.

I do not recommend amputation, but again, I know nothing .....

wheelreason

Patient: Doctor I went online and asked knowlefgable folks about my condition
Doctor: Mayo Clinic?
Patient: No, cycling forum
Doctor: Get out of my office, oh, and "don't do that"...

Carbonfiberboy 

IME one can't just stop leaning on the bars. One has to change to a position which puts less pressure on the hands. And oddly enough, more reach at the same hip angle usually puts less pressure on the hands. It's also important to have a position which allows the shoulder and arm joints to flex to absorb the shocks and vibration. Moving the OPs hands back does the opposite thing. He might at least look at the photos in the numb hands post and see what a comfortable long distance position looks like.

alcjphil

I have to wonder. You ride a gravel bike yet you feel the need to have aerobars. Why? I know that they have been used for long distance gravel races. Why that someone would set up their bike for short distance local rides is beyond me
Set up your bike for the local rides you do and you will be better off