WARNING: A local motorcyclist was killed this weekend when a deer ran into him! In many parts of the country hunting season is open and it may change animal behavior. A few years ago, on a pre-dawn run, one of my children actually ran into a deer. So, please be extra cautions, extra vigilant out there and don’t just go bombing down a hill on your bike without paying great attention.
CARPAL TUNNEL SYNDROME
Many athletes experience significant hand numbness while astride their bike. Often this involves the thumb, index and long fingers and with a change in hand location or position this feeling dissipates. The distribution of this numbness is in the median nerve as can be seen in the accompanying picture (Google images).
This can also be accompanied by a feeling of tingling but when these feelings go away completely off the bike, it’s no real cause for concern. Those who progress to weakness, occasionally dropping items, night time numbness, etc. may benefit from evaluation. The chronic case will often be accompanied by atrophy of the muscles at the base of the thumb. This condition can accompany pregnancy, diabetes, obesity,arthritis and other illnesses.
Evaluation consists of an examination of both upper extremities, neck, pulses and sensory. Although occasionally obtained, usually x-rays are not helpful in making the diagnosis. A neurologist can perform a nerve test known as an EMG to determine if there’s compression of the median nerve by a ligament in the wrist thus slowing nerve function. In some cases, blood work is also helpful.
The treatment options are pretty wide, depending in the diagnosis, and whether or not the CTS is secondary to one of the causes listed above. Many benefit from simple night splints, mattress change, biking hand position change, or other mechanical alteration. But, unfortunately a release of the pressure on the nerve by releasing the ligament is in order for others. When indicated, it’s a highly successful procedure but we try to avoid surgery when there are other alternatives.
John Post, MD