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Guyon tunnel syndrome (medical condition)

This topic contains 14 replies, has 9 voices, and was last updated by  Swalfoort 10 mos, 1 week.

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Swalfoort

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Sep 16 2013 at 12:01pm #

After a weekend of doing stupid things, or at least one stupid thing, I developed pain in the pinkie and ring finger of my left hand. Just a strong ache, and maybe some pins and needles.

I think this is just a short term stress injury, but in researching it, I wonder if my stupid action just hurried along something that I was going to develop anyway.

This is the same injury that is sometimes called cyclists palsy. A nerve becomes trapped while passing through the wrist, or inflamed enough to impede smooth movement due to pressure or misuse. (It is similar to carpal tunnel syndrome, but less common and affects a different nerve.) While I have experienced some hand pain/tingling on some longer rides, this is the first time that the pain and discomfort have occurred while off the bike.

RICE and monitoring seem to be the proper protocol.

But, I think I need to think about handlebar positioning and handgrip/hand placement. Has anyone else experienced this, or have recommendations on “ergonomic grips?” (Note: I have ergonomic grips now, but may need some other design, style or position.) Anything specifically designed to address this question of putting too much pressure on the pad of the hand just below the pinkie knuckle?

I’d love to hear from any others who have “beat” this condition, or learned to manage it. I am still hoping that mine is a temporary injury, and not a true “condition,” of course.

  • This topic was modified 10 mos, 1 week ago by  Swalfoort.

rice rocket

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Sep 16 2013 at 12:57pm #

Does your primary bike have a flat bar or road bar?


Swalfoort

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Sep 16 2013 at 1:09pm #

I went from a road bar, where i rode mostly on the hoods, to a metropolis bar – almost a moustache bar. Ironically, I did so to relieve pressure on the hands.

I actually think that I inflamed something over the weekend doing something unrelated to cycling. But, ulnar nerve entrapment and/or compression is so commonly related to cycling that I figure it COULD be from cycling. Maybe. Or that I should think about the tie in to cycling as I try to remediate the current pain.


Drewbacca

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Sep 16 2013 at 1:16pm #

I had this problem riding on the C&O… the combination of too high tire pressure, long rides, and most importantly, having my saddle too far forward forcing excessive weight on my hands. It took over a month for the numbness to go away.

I would look at saddle position before blaming handlebars. The saddle, by design sits behind the crank. Stand up, bend over to touch your toes and notice that your butt goes back automatically… it has to do with balance. If you don’t put your posterior back far enough to maintain a balance, more body weight ends up on your hands.

Gloves with too much padding have been known to cause this problem as well, by filling the grove where the nerve is exposed and placing additional pressure on it.


rice rocket

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Sep 16 2013 at 1:32pm #

I know nothing about moustache bars, sorry.

I look at wrist angle and placement on road bars as pretty close to mimicking what most ergo products are modeled after nowadays (like ergo keyboard, ergo mice, etc, with focus on keeping wrist rotation near neutral). And I figured pro cyclists all ride road bars for a reason, and do 20x the mileage I ever will within a year.

If you were having issues on road bars, I’d check the fit there before throwing them out completely.


Mikhail

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Sep 16 2013 at 3:30pm #

I had numbness after one of first long trip for two weeks. Switched to road bars, bought padded gloves (not too much) and keep my hands moving on a bar — road bar allows me to have 5 different positions. Saddle position, as Drewbacca says, is very important. One other thing — I never keep my hands straight, I always have them slightly bent in elbows.


Vannevar

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Sep 16 2013 at 6:17pm #

I think that I have had this and with help was fortunate to make it go away. Is it the pinky finger and only one side of the ring finger, the side facing the pinky? In other words, the shaded area in this image?

I came by this image after my first trip to DC and everybody’s hands had the effects you describe for a few weeks. Fortunately it passed after a while. For the next trip, we all used aero bars – not for the aero benefits, but for the alternative hand position. And there are absolutely important factors with aero bars that must be observed.

Sometimes there’s more than only handlebar aspects to this, but there’s also weight distribution issues. Is too much of the upper body weight on your hands, etc? So you end up looking at stem height, seat position, and bike fit.

In my own case, we raised the stem, rotated some weight off the handlebars and onto the seat post, and I got handlebars with lots of alternative hand positions.

Personally, I really have benefited from Matt Tinkey’s advice and bike-fitting. He’s no longer at UPMC southside, I believe he’s now at Top Gear Bike Shop Wexford , (724) 799-8796, http://topgearbicycleshop.com/


Swalfoort

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Sep 16 2013 at 6:37pm #

It seems like I have the symptoms of GTS/ulnar nerve compression, but the more research I do, the less likely it seems that it is bike related. Maybe just a strain/sprain.

It’s my left hand. The fleshy part of the palm (lower right, as I look at it) just started aching during a drive to mid-Ohio last week.. Eventually, the base of the ring finger was also achy. There was never any real “tingling” and there seems to be little forearm involvement. There was no ulnar nerve compression at the elbow at the time (my arm was in mid air, not resting on anything, nor was I squeezing the steering wheel).

But, all the symptoms seem to lead to ulnar nerve involvement. A friend (a massage therapist) did find some knotting of the ulnar nerve “channel” a few inches below the elbow. Massage hurt like hell, but did seem to help.

Here’s the odd stuff: I was driving – a classic trigger for GTS flare up. But, it was on smooth roads, and for no more than an hour or two at the time of first pain. I have a new bike with a new riding position, but I have not been on the bike much in recent weeks – I rode 10 miles this weekend as part of the lock ride, but nothing else for a week or more. And, the new bike (4 months) has a much more upright/wrist friendly position than the last one (6 years with no problem).

Final oddity; over the weekend I came into possession of a new television. It’s fairly large, and relatively heavy, although a flat screen. To move it from the car to the house, I grabbed it along the top edge, and then carried it that way. My hands were in a tight crab position while carrying this tv (and rigid due to my fear of dropping it). I didn’t carry it all that far, but it WAS a weird position. And then, a day or two later, I get these hand pains.

For now I am going to assume that it is a muscle strain or something in the upper hand/lower finger area. But, I will be hyper monitoring for new GTS symptoms for the next few months, I suspect.


Swalfoort

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Sep 16 2013 at 6:39pm #

And Vannevar, yes that is the exact location of the pain (although not much tingling, unless I think about it too hard). That’s what led me to GTS inquiries.


joanne

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Sep 16 2013 at 7:06pm #

I get exactly that after a long bike ride–mostly numbness in my pinky and outer ring finger, rather than pain though. It will persist for a couple of days after a very long ride.

I was talking to a friend about this at Flock–he said he’d had the same problem, and ergonomic grips fixed the issue for him. I haven’t tried it yet myself. In any case, I hope your hands feel better soon!


Drewbacca

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Sep 16 2013 at 7:23pm #

no idea about “tingling” as I’ve only had numbness… but I think the same nerve is the one tied to the “funny bone” so I can see where it could cause tingling.


edmonds59

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Sep 16 2013 at 7:53pm #

I think your long term solution to this is riding a unicycle.
Hope you find out what’s going on!


salty

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Sep 16 2013 at 11:25pm #

The first time I rode the MS150 (1994) my hands and fingers were numb/tingling afterwards. It basically felt like when your leg falls asleep. Fretting a guitar was really painful; I had to take some time off from playing. It was really sucky but luckily after a couple weeks things went back to normal.

I was riding MTB with flat bars and that was by far the longest ride I’d ever done. I put some cheap bar ends on so I could vary my hand position, and paid attention to doing so as well as riding no-hands occasionally, and did not have the same issue the following year. I’ve also never had a problem with drop bars, but I do take care to vary my hand position as much as possible on long rides.


kelw

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Sep 17 2013 at 7:25am #

When diagnosing conditions like this many people neglect the more proximal points of entrapment of a nerve. What becomes the ulnar nerve can be compromised in the C spine, at the roots, thoracic outlet/inlet, underneath the scalenes or other muscles, brachial plexus, cubital tunnel, guyon’s canal, and anywhere in between. Sometimes you may only notice the symptoms in your pinky even if the nerve is compressed in a more proximal location. Posture is often a big contributing factor with these types of symptoms. I would be sure to take that into consideration when trying to identify patterns to your symptoms.


Swalfoort

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Sep 17 2013 at 8:28am #

Thanks, all! I’ll be doing some experimentation.

To Kelw; thank you for the broader perspective. I had considered cubital tunnel syndrome and brachial involvement, but discounted them as I am asymptomatic above the wrist. Other than where a massage therapist gave me a deep tissue massage on the arm, that its! That is still sore, but in a good way.

I am also fairly convinced that it may be even more proximal than what you suggest — a simple injury to the 4th metacarpal.

But, the discussion of cubital tunnel (ulnar nerve entrapment at the elbow), and guyons tunnel syndrome (ulnar nerve entrapment/compression at the wrist), both of which can create tingling/motor loss/pain in the pinkie and ring finger are extremely relevant to cyclists. So, I am glad this thread got as much involvement as it did.

I will keep you all posted.

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