What is the Carpal Tunnel?
The carpal tunnel is the term for the space on the palm side of the wrist through which the tendons that flex the fingers and wrist, and the median nerve pass. This space is formed by the semicircle of wrist bones (known as the carpus) and a strong ligament as a roof across the top.
What's the median Nerve?
There are three main nerves that supply the arm: the ulna, radial and median. They all come from the neck and take a different course down the arm giving sensation to different areas of the arm and supplying different muscles. The medial nerve goes across the front of the shoulder, down the middle of the front of the upper arm, across the front of the elbow, down the front of the middle of the forearm, through the carpal tunnel to the hand.
The median nerve:
- Supplies the sensation to the thumb, 1st, 2nd finger and the thumb side of the ring finger on the palm side of the hand.
- Works a muscle called pronator teres. If you are sitting with your elbows bent and your palms facing the ceiling then turn your palms down to the floor it is pronator teres that does this.
- Works the muscles in the pad of the thumb
So what's Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is compression of the median nerve as it passes through the carpal tunnel at the wrist.
What are the Symptoms of Carpal Tunnel Syndrome?
Because Carpal Tunnel Syndrome is caused by pressure on the median nerve as it passes through the tunnel, the main symptom is pins and needles and/ or numbness in the area of the hand that the median nerve supplies i.e. the thumb, 1st, 2nd and thumb side of the third finger on the palm side of the hand.
Shooting pain may sometimes be felt going up the course of the nerve i.e. shooting up the forearm
Symptoms are often worse at night and during the day when lifting or griping something.
What can I do to get back to pain free cycling?
Check the tilt of your saddle
If the saddle is tilting forwards more weight is transferred through onto your hands. Put a spirit level on your saddle and adjust it so its flat.
Check the height of your bars
If the bars are too low more weight is transferred to the hands. Basic bike set up
Look at your hand position on the bars
If you ride with your wrist bent back so you can keep a couple of fingers on the brakes try tipping the bars forward a bit to take the wrist into a more neutral position
Change your hand position frequently
If using straight bars consider fitting some bar ends some bar ends and move your hands across to them and back about every 15 minutes. Drop bars enable you to change your wrist position; again try to do so every 15 minutes or so.
Strengthen your core muscles
Strong core muscles mean you can support your trunk better and don't have to transfer as much weight through your wrists on to the bars.
There is plenty of research that shows in an occupational setting repeated hand/ arm vibration increases the risk of developing carpal tunnel. There's no empirical evidence that vibration through the handlebars whilst cycling causes an increased risk, but it you are struggling with CTS it could be worth trying gel gloves or front suspension.
Take frequent breaks
After all what else are tea shops and pubs en route for?
It still hurts, what next?
Alter other activities that are putting the wrist in a compromised position
Analyze what else you are doing day to day that is putting the nerve on a stretch - poor posture at the computer is a common problem. Computer work can be such a pain
Check the symptoms aren't coming from somewhere else
Nerve compression at the neck can refer pain and pins and needles to the hand. Other pathologies such as diabetes or hypothyroidism can be the underlying cause of carpal tunnel syndrome
Get some treatment
Try some ice and do some specific exercise: Nerves are inelastic and cannot be stretched. An irritated nerve can become very painful if repeatedly pulled on, however nerves do like movement and will respond well to been gently glided in and out of the tunnel with specific exercises.
Disclaimer: The information on this page is written to help you understand your injury. There are many possible causes for hand pain and should you have any concerns you should always seek advice from a qualified health professional such as a Chartered Physiotherapist or your GP.