Member Case Study: Cycling & Shifting Wrist Pain

author : AMSSM

comments : 0

I recently bought a new road bike and have been putting in 3 and 4 hour rides. After long rides (or even short rides which require a lot of shifting) I develop an area of pain in my right wrist.

I recently bought a new road bike and have been putting in 3 and 4 hour rides. After long rides (or even short rides which require a lot of shifting) I develop an area of pain in my right wrist at the base of the 2nd and 3rd metacarpal (where they articulate with the trapezoid and capitate). The pain causes me to unconsciously hold my wrist throughout the day. It is clearly from shifting with my index and middle finger. The LBS made some adjustments to the position of my shifters but there hasn't been much improvement.

Does this sound like something that I should be concerned about over the long-term? Is it something that should improve as I put more mileage on the bike or is it time to consider some major bike modifications?

Answer by Andrew Getzin, MD
Member AMSSM

I am sorry to hear that you been having hand pain.  It must be frustrating to have a new bike and not be able to fully appreciate it.  There are several common problems that affect the hands in cyclist, including cyclist palsy (numbness and pain into the little finger from compression of a branch of the ulnar nerve), carpal tunnel syndrome (numbness and pain into the thumb and forefinger from irritation of the median nerve at the wrist), and DeQuervain's tenonsynovitis (inflammation of the tendons that move the thumb felt laterally at the base of the thumb).  However, the pain that you are describing is not a common problem seen in cyclists or triathletes. 

Your question did not give background information on things that you have tried to help the problem, or on your cycling experience.  I wonder if you increased your cycling a few hours a week to 3-4 hours per day now that you have a new bike.  You should ideally increase your training by less than 10% per week to allow you body to adapt properly.  Perhaps just backing down on your road mileage for a week or so might alleviate the pain.  You should also consider icing, wearing gloves when you ride, trying an anti-inflammatory such as ibuprofen if you do not have any medical contraindications.   It sounds like you have adjusted your shifters, but perhaps the pain is simply from the load on your wrists.  You could try to spend more time in your aerobars.  You should also make sure that your seat is not pointed too far downwards, as this may overload your wrists.  Finally, perhaps a basic wrist splint might also alleviate some pain.

Although your problem is not common, it does not sound like something concerning that would result in long term problems.  However, I am not sure it will go away by simply increasing your mileage.  Consider trying some of the suggestions that I have made if you have not already done them.   If there is no improvement, I advise making an appointment with a clinician who understands cycling so he/she can do an exam and perform radiographic testing as indicated.

Andrew Getzin, MD
Cayuga Sports Medicine
Ithaca, NY
Member AMSSM

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date: September 13, 2007