Member Case Study: Pointer Finger Pain While Riding

author : AMSSM

comments : 0

After riding my bike sometimes I will develop a very sharp intense pain in the first joint of my pointer finger. It seems to happen randomly and it lasts for anywhere from several minutes to an hour.

Member Question from faydre
So I have a very strange pain. After riding my bike (a Specialized Dolce Elite), sometimes I will develop a very sharp intense pain in the first joint of my pointer finger. It seems to happen almost randomly and it lasts for anywhere from several minutes to an hour or more. The only thing I can say for sure is that it seems to be related to riding my bike. Any suggestions?

Answer from John K. Su, MD MPH FAAFP

Member AMSSM

First, let me assume there was no trauma, no acute injury, no swelling, no locking/catching, no night pain, and that the pain only occurs with cycling. If any of these assumptions are false, you should see a physician to have your hand and fingers examined for problems that may not be related to cycling.

Finger and hand pain are fairly common in cycling. Much of it is easily correctable with little expense and just a few changes to your bicycle fit and equipment.  Usually pain, numbness, or tingling that involves the 1st, 2nd, and some of the 3rd digit (thumb, index, and part of the middle fingers) is caused by carpal tunnel syndrome. If your wrists are extended (bent up) for extended periods of time (due to your handlebar and stem being too low), that can irritate and compress the median nerve causing these symptoms. If the 4th and 5th digits (ring and pinky fingers) are primarily affected, it is compression of the ulnar nerve that is usually the culprit. The ulnar nerve enters the wrist and palm towards the ulnar ("pinky") side of the hand. Compression occurs especially when riding on the "hoods," a popular position, but puts pressure on the ulnar side of the palm.

Also, is it your right or left pointer (index) finger? Is it related to shifting or braking or reaching for the shift or brake lever?

Since you are riding a Dolce Elite, I presume you are a female rider. The Dolce Elite, an excellent bicycle by the way, does have some well thought out and appropriate gender related equipment changes – appropriate length crankarms for frame size, shorter top tubes for shorter torsos, shorter stems for shorter reach, and narrower handlebars for narrower shoulders. However, just as with any bike and rider, male or female, a good bike fitting is very important.

I would recommend a good bike fit, either by a Sports Medicine physician or physical therapist that is experienced with cyclists and bike fit; or by a professional bicycle fitter usually referred by a good bicycle shop. Often times, a quick fit when you first purchase a bike is not adequate and may need quite a bit of adjustment especially if you are getting into longer cycling/triathlon distances. Bicycle fits range from free when you purchase a bicycle to $100 and over for more comprehensive evaluations.

But before the bicycle fit, consider the following suggestions that you can try yourself to relieve your hand/finger pain:

1. Raise your stem. (free)
   • Too much pressure on the hands occur if your handlebar is too low relative to your seat.
   • You can do this by "flipping the stem" so that if it is angled down, remove the stem cap, remove the stem and re-install the stem so it is angling upwards.
   • If there are spacers above the stem, place those below the stem to raise the stem and thus the handlebar.
   • If you are un-familiar with stem/headset adjustment, have a professional do this.
    

2. Angle your handbars up. (free)
   • Sometimes the handlebars (and levers) are rotated too forward, putting pressure on the hands and making it more difficult to reach the shift/brake levers.
   • Just loosen the stem clamp and rotate the handlebars upward (shift/brake levers up toward you).
    

3. Move the seat back (free)
   • The idea is to shift your center of gravity back so there is less pressure on your hands. Loosen the bolts clamping your seat rails and move the seat back 0.5-1cm. It may seem like a small amount but make a big difference in your weight balance.
   • This may require lowering your seat as well. And it will slightly increase your reach to the handlebars, which could require a shorter stem (if tips #1 and #2 don't do the trick).
    

4. Let some air out of your tires. (free)
   • If you are a light woman, tire pressure over 100-120 psi is probably overkill and can lead to a harsh ride with more shock delivered to your hands and wrist (not to mention your back side). Try dropping to 80-90psi with little loss in performance and much improved comfort.
    

5. Purchase and install Specialized's Shimano Lever shims that shorten the reach to the brake/shift levers. ($10)
   • Very easy to install and it will make reaching the brake/shift levers much easier and thus improve comfort and safety, especially when riding in the drops of the handlebars.
   • There are different shims for the different Shimano levers (Tiagra/105/Ultegra/Dura-Ace) so make sure you get the right ones from your Specialized dealer.
    

6. Increase handlebar padding ($10-15)
   • You can either just double wrap over your existing bar tape (as some of professional cyclist do for races in Europe that go over cobblestones) or switch to bar tape with gel for additional cushioning ($10-15).
    

7. Padded gloves. ($15-30)
   • These should specifically have cushioning in that ulnar or "pinky" side of the palm. Specialized makes a "Body Geometry" line of gloves that are physician designed to specifically address the ulnar nerve compression issue. But other brands (ie. Pearl Izumi) also make outstanding padded gloves.

Good luck and happy and safe riding.

John K. Su, MD MPH FAAFP
Kaiser Permanente LA Sports Medicine
Clinical Instructor, UCLA School of Medicine
Medical Director, Ford Ironman 70.3 California

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date: March 19, 2009