Cyclist Palsy (Lost use of right hand)

ghost15026

Anyone had experience with Cyclist's Palsy? Was out riding today - about 35 miles into a 55 mile ride it seemed like my right SRAM Force brifter was incredibly difficult to shift. Only on the downshift (where it requires strength). I ended up having to reach across with my left hand to shift.

Started to wonder as I finished my ride if I pinched a nerve but I didn't have any numbness or pain. Got to my car and couldn't start it - didn't have the strength. Reached across with my left hand and it started easy and fine. As I"m typing now my right hand can't use the numpad hardly (and I type really fast).

Few other bits. I'm 33, fit. My bike fit is fantastic (road bike). I frequently change hand positions including into a set of aero bars. I use shallow drop Ergosum's. I ride 60-70% of the time in the drops this year. I've also been riding about 50-60 miles at a time at least once a week, on occasion 35 miles plus another 50+ miler.

Anyone out there want to lend some experience? Going to the doc tomorrow.

Heeeelp! I don't want to be a runner!

fleetzz

This does not sound good. Did your strength return? How long has it been? if less than 4 hours would go to the ed now.

ghost15026

Read up on the condition on Google for lack of anything better to do. Pretty sure it is Cyclist's Palsy (never heard of it until I Googled the symptoms). Looks like a temporary thing (2-32 weeks) - just have to stay off my hand. Looks like it's a result of riding in the drops and long distance riding (which I do both).

I got a tiny bit of coordination/strength back this morning. Unfortunately, the doctor's office is closed. Read to take some NSAID's to deal with the nerve inflammation. Just hoping I didn't diagnose myself wrong.

I'll try to get an appointment with my doc sometime this week. Bummer.

sijomial

Carpal tunnel syndrome perhaps?

(Agree about not wanting to be a runner!)

fleetzz

I hope that is all it is but you didn't report any sensory symptoms, only motor. Did you have any numbness/tingling during the ride?

ghost15026

I hope that is all it is but you didn't report any sensory symptoms, only motor. Did you have any numbness/tingling during the ride?

No numbness. Only loss of motor control. So not much of a warning symptom. That's why I thought it was my brifter/derailleur cable. The lack of control/strength didn't really hit home with me until I tried to start my car (and didn't have the strength).

Based on my reading the ulnar is both sensory and motor control. It is possible to affect just sensory (common), motor, or both. Looks like I win with motor control. :-\

Evidently it often gets misdiagnosed by doctors. Usually as carpal tunnel which leads to totally unnecessary surgery and extended time to recover. I'll just have to get a referral to a specialist or sports medicine doctor familiar with the subject I guess.

Probably going to pay the ridiculous $350 to $450 for a BG Fit at the LBS. Obviously, I can't allow this to continue. The sad part is I *feel* incredibly comfortable on my bike.

fleetzz

You should probably look into seeing a hand specialist (typically an orthopedist), or a neurologist who can do nerve conduction studies and who can tell whether it is motor, sensory or both. Either will likely be able to diagnosis this more accurately than a GP. I don't need a referral for specialists but you may need one depending on where you life/your insurance.

fleetzz

carpal tunnel usually affects the thumb and index/ring fingers, and nearly always involves sensation. Not sure how that can be mixed up.

ghost15026

A fellow MFP'r indicated they were following this thread so here's an update. Still experiencing the same issues (weakness in hand/forearm, loss of ringer finger adduction). I no longer have the hand/finger/wrist strength for a brifter suddenly. Hopefully, this is just temporary.

I visited my general practitioner today for a specialist referral. The result of the appointment is that I'm now scheduled to see a hand surgeon (orthopedic surgeon) on Friday. Yay.

I avoided telling my GP what I thought about the issue at first. I gave her the facts+symptoms plus other more mundane info (diet, prior meds, etc.). She was mostly mystified after basic tests (needle pricks, push/pull/grip and other strength tests). She was certain about the symptoms but not the cause. I explained Cyclists' Palsy to her and she looked it up while we discussed the matter further.

Towards the end of the visit she believed Cyclist palsy was probable but other possibilities still exist (nerves at neck). So I'm off to the orthopedic surgeon. I found an excellent article hosted by Angel Sports Injury/Physiotherapy (just Google "Cyclists Palsy Angel") for anyone interested. While there is other info out there the Angel site cites a study on endurance cyclists.

What I've discovered so far about Cyclist Palsy and hand numbness:

1. Hand numbness/pins & needles (sensory) is common and this may or may not affect hand control (motor) - nothing new to us cyclists (like 90% of long-distance cyclists encounter numbness),
2. It is also common to lose some hand control/strength (motor) but get not warning symptoms such as numbness (sensory),
3. The issue is self-limiting. That means your hand will more likely paralyze/parathesis/partially paralyze before you can cause permanent or extensive damage,
4. The ailment often heals on its own by refraining from use for 2-4 weeks,
5. Cyclists Palsy more commonly affects mountain rather than road cyclists,
6. Cyclists Palsy is an overuse injury similar to Carpal Tunnel,
7. The primary contributor is simply weight and vibration on the wrist which is why it tends to affect mountain bikers, endurance/long-range cyclists (touring), and those who spend a lot of time in the drops (TDF?),
8. Too much weight+time on the hoods can lead to Carpal Tunnel. Too much in the drops leads to Cyclists' Palsy. Great!
9. A study on 25 long-distance cyclists (600km/372 mile run) indicated 92% had some sort of issue involving their hands (sensory, motor, or sensory+motor). Yeah, 372 miles. lol.

The solutions are the usual. More glove padding, bar tape padding, new/adjusted handlebars, frequent hand position changes, overall bike fit, etc. While I think my bike fit is great (very little numbness, comfortable), I think the big contributors to my problems were the lack of warning (non-sensory) causing it to sneak up on me, excessive time in the drops, and simply very long runs. Maybe if my hands gave me some type of warning (pain/numbness) I would have switched positions more often but noooo...

fleetzz

Thanks for the update---hope this resolves quickly on its own without any intervention!

ghost15026

Okay, last update. FYI for anyone else who encounters Cyclists Palsy. Had my hand surgeon/orthopedist appointment today. He confirmed it was in fact Cyclists Palsy. In fact, he knew it almost right away which was a start contrast to my general practitioner.

Regained about 50% of my strength back in just the last two days (Started Sunday, got strength back on Thursday and Friday). The surgeon didn't give a firm time-frame on how long to heal but implied it would be less than 6 weeks (a follow-up appointment was scheduled at 6 weeks).

I was told I can start cycling immediately but in shorter distances/durations during each ride. I can still ride the same total time/distance I just have to break it up a bit. Granted, I still don't have all my hand/arm strength back to shift reliably.

I was also told to angle my drops so that my wrist/hand is angled neutral or slightly upward from my arm (rotate my bars forward). Previously my wrist was neutral or slightly downward which was, sadly, a very comfortable position. This was despite the fact that my drops were pointed somewhere below my rear brakes already. Oh well.

Oh, and I got some type of arm support to wear during day/night. My wife asked why it was lime green. I told her it was to shame me. So folks, here it is, the Sock of Shame:

fleetzz

Thanks for the update, hope recovery is quick.