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Preventing Wrist Pain in Cyclists


Wrist pain is one of the most common complaints among cyclists. Kenneth R. Means Jr., MD, attending hand surgeon at the Curtis National Hand Center at MedStar Union Memorial Hospital in Baltimore, MD, spoke with About.com on why cyclists experience this pain. The attending physician and clinical research director also offers advice on how to prevent pain in the wrist.   

About.com: What are some reasons cyclists may feel wrist/hand/finger pain when riding?
Dr. Means: One of the most common issues cyclists have is what is called "cylcist's palsy." This is when they feel numbness/weakness in their hand/fingers due to prolonged periods of applying pressure to their palms/wrists. Other potential issues would be worsening of wrist/hand/finger arthritis due to prolonged pressure/gripping on handle bars. Similarly, trigger fingers, when the fingers get locked in a bent position, may develop from repetitive gripping. Of course we also see a fair amount of significant injuries from falls while cycling; really any part of the upper extremity can be fractured/injured from a cycling injury but we most commonly see wrist fractures. 

About.com: The two most common wrist overuse injuries in cyclists are carpal tunnel syndrome and handlebar palsy. Can you define each one? 
Dr. Means: Carpal tunnel syndrome is when a nerve in the wrist, the median nerve, has too much pressure on it. When this occurs people start to feel numbness and pain, especially in their thumb, index, middle, and ring fingers. If the pressure is more severe they can start to lose muscle strength in their thumbs as well and the "pad" of the thumb can waste away. When people have carpal tunnel syndrome they also often have pain while sleeping at night, reading, driving, and talking on the phone. 

Handlebar palsy a.k.a. cyclist's palsy as I mentioned above, classically refers to when cyclists apply prolonged pressure to a different nerve in the wrist called the ulnar nerve. This is the "funny bone" nerve that runs from the elbow into the hand. When this nerve has pressure on it at the wrist people can experience numbness in their ring and little fingers. If the pressure is more severe or prolonged people can develop severe weakness of nearly all of their hand muscles, causing weakness in grip and pinch activities. They can even develop a "paralyzed" looking hand in which the ring and small finger start to curve involuntarily and the entire hand appears to be wasting away. 

About.com: If a cyclist experiences wrist pain, what is the first thing he/she should do? 
Dr. Means: Especially if it is associated with numbness or nerve/burning type pain that goes into the digits, they should immediately adjust their position so as to take pressure off of the nerves. 

About.com: How is wrist pain treated? 
Dr. Means: It really depends on what the wrist pain diagnosis is.

About.com: Who should a cyclist see to treat the pain? Why? 
Dr. Means: Typically we would recommend that they see a hand surgeon or a sports medicine physician as those are the types of physicians that are most experienced with the kinds of injuries or other problems that cyclists can have. 

About.com: How can wrist pain be prevented? 
Dr. Means: When it comes to the nerve injuries mentioned, prevention is definitely the best medicine. The best ways to do this are to be aware of the possible symptoms and adjust position/pressure points as needed either by changing the way the hand/wrists rest on the handlebars or by adjusting the handlebars themselves.  If these simple interventions are not successful you can try a brace or pad to protect the wrist nerves. Hand, physical, or occupational therapists are usually able to provide these devices. Often times the bike's seat height requires adjustment so that the rider is not placing excessive pressure on the hands/wrists while riding. 

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