Ulnar Neuropathy

Tools used in Graston® Technique for Ulnar Neuropathy Treatment

If you follow me on Facebook you already know that I lost the use of my ring and pinkie fingers on both hands after the completion of the STP last week. During the last 50 miles of the 200 mile ride, I started having significant problems shifting my front gear, especially into the biggest ring and, in fact, had to reach across with my right hand to shift up much of that time. I had been having problems with my front derailleur prior to the STP, had it repaired, and assumed that my derailleur was once again out of adjustment and therefore difficult to shift. Later in the ride, I also found that I could no longer squeeze my water bottles to drink and had to suck the water from them, and even later, found I could not even grasp the bottles and dropped them at every rest stop when trying to drink. I stopped drinking water while riding due to fear of losing my bottles on the ride. When I got home, my friend who drove me asked if I would play something on the piano and to my shock--I couldn't play, my hands would not work! Shock and dismay! I tried to do an Internet search on the computer to find out what was wrong with my hands but could only type with my thumb and index fingers.

Function was still impaired the next morning and after slowly typing and searching the Internet, I discovered that I had probably developed Ulnar Neuropathy or "Cyclist's Palsy." I contacted Russell Cree of Upper Echelon Fitness who immediately scheduled me to come in the next day for a complete sport's medicine assessment with him and his team to figure out what was going on, wanting to ensure that I did not have a spinal issue as the cause of my neuropathy. He also wanted to do a medical bike fit to see if something had changed from my initial fit he had done in February. I also had a physical exam with my physician who concurred I had a peripheral nerve palsy without any cervical involvement.

Ulnar nerve and its branches, courtesy of http://www.netterimages.com

Russell and his team concurred that I indeed had Ulnar Neuropathy caused by entrapment of the ulnar nerve at Guyon's canal, caused by pressure and vibrations from my grasp and hand position during the STP. Ulnar neuropathy is just like Carpal Tunnel syndrome except that it involves the ulnar nerve on the pinkie side rather than the radial nerve on the thumb side of the hand. The ulnar nerve passes through a tunnel between the pisiform and hamate bones and the pisohamate ligament that join them together. Your hand position on your handlebars can put pressure on the ulnar nerve within Guyon's canal; combined with road vibration, this can cause enough damage to inhibit nerve impulses to travel through this area, thus causing weakness and loss of function to the pinkie and ring fingers.

The good thing about this injury is that it is generally well self-healing with rest. I had chiropractic treatment on my neck, back, shoulders, arms, and hands to eliminate any sources of pressure or entrapment along the entire ulnar nerve, as well as deep tissue sports massage to loosen muscle and other tissue adhesions. The muscles of my forearms were very tight, probably contributing as well to ulnar nerve entrapment. They also suggested ice and stretching. Recovery is expected to be about a couple weeks.

The pad on the pinkie side of my palm (hypothenar eminance) was particularly tender. During my medical bike fit, we determined that during my ride, probably due to fatigue, I had shifted my hands in the hoods of my integrated shift/brake levers so that the hypothenar eminance (shown on the left in red) rested solidly on my handlebars rather than riding in the area between the hypothenar and thenar eminances (should ride in the area delineated in blue). This position most definately contributed to my condition.

To prevent this, I will have to be vigilant about hand position. I also purchased new riding gloves with more padding over Guyon's canal, and will add gel padding under the bar tape on my handlebars to reduce vibration transfer to my hands. It is also important to change hand positions during long rides, taking hands out of the hoods to the top bar during parts of the ride you don't need to be concerned with shifting, braking, or low body position. And furthermore, the dreaded core strengthening....I will need to work on continued core strength so I can hold my torso in the forward riding position without putting so much weight on my hands. Russell raised my handlebars 1cm to relieve hand pressure during my recovery. I will decrease this when fully recovered but remember to raise my handlebar height in the future during long distance rides.

This week I was also seen by an Occupational Therapist who specializes in hands for further assessment and treatment. She went over a whole host of stretches and "nerve glides" to increase my flexibility and free up any catches or constriction on my ulnar nerves. In addition, she referred me for Graston® treatment. Graston® Technique is a procedure used to detect and treat adhesions in muscles and other structures. We all develop adhesions, or scar tissue, as our bodies work to repair themselves. Training causes micro tears in tissue, which leads to more scar tissue. This scar tissue is not flexible nor as strong and actually shrinks and shortens muscle fibers, which can decrease strength and even entrap nerves. Scar tissue also blocks blood flow to tissue, further decreasing strength. During Graston® treatment, the practitioner runs metal instruments along the muscles, tendons, and ligaments and can feel areas of scar tissue, which they can then "break up" with the tools. It is similar to deep tissue massage, but the tools do not yield to scar tissue as a masseuse's hands would, thus Graston® can break up more areas of adhesion. Like deep tissue massage, this procedure can be painful and lead to soreness and even bruising as scar tissue is broken up and blood supply rushes back into the tissues. My session had the same sensation as a deep tissue massage and the skin of my arms got very red and flushed like you'd get from an "Indian rub burn," but when it was done, they felt extremely energized, probably from the increased blood flow. I had some soreness the next couple of days, but no visible bruising. I will have this done once a week for the next few weeks.

Here is a video with more information on Graston® Technique. It shows a treatment for carpal tunnel  syndrome, which, again, is similar to my condition but involves the radial nerve rather than the ulnar nerve.

So my prognosis is great! By Sunday, a week after the condition started, I was significantly improved. I was even able to play the piano, not perfectly, in fact I still had some problem with spatial awareness with my pinkies and decreased stretch, but I did go for a bike ride at the Oregon Coast without any hand issues. I will be continuing weekly deep tissue massage and Graston® treatment, sports chiropractic treatments every other week, stretching, and acupuncture.

Fort Steven's State Park

Due to my hand issues, I opted out of the Girlfriends and Dudes Triathlon so I could rest and and heal before the Midsummer Triathlon July 31st. Girlfriends and Dudes is a charity event, not USAT sanctioned....Midsummer is a USAT event and held at Blue Lake where my last tri with my 2nd place finish time, so I really want to be healed up for it and do well in comparison. So, instead of the tri, I went to the Oregon Coast with my friend Kevin and we rode from Warrenton to Ft. Steven's State Park. 

It was misty and rainy, but a great ride. No hand problems. I did have tire and tube problems, though. During the STP I realized my tires were pretty much shot and prayed and hoped that my tires would hold together for my ride--they did, but that was the end of them. At mile 12.5 of this ride I developed a rear flat (which caused a low-speed crash, but I was fine). I changed the tube, found no sharp objects in my tire, proceeded on and developed another rear flat at mile 12.75. This time I could hear air pouring out of my tire, not just my tube, and found several large holes in the tire. Long story short, we got a ride back to the start by some very nice people and I will be purchasing new tires for OJ this week.

So, I should be back up and training this week. Hope everyone is doing well and talk to you soon!