Carpal Tunnel Syndrome on the bike
Here’s a disclaimer first: this blog post is merely a telling of my experience with suffering from Carpal Tunnel Syndrome (CTS) while riding my bike. I am not a doctor, nor a medical expert. This blog post is not meant to diagnose anyone/anything - it is purely the journey I have taken with CTS.
A couple of years ago when I started going on more and more bike rides for fun, I pretty quickly noticed a tingling feeling in my fingers. More specifically in my thumb, pointing finger and middle finger. At first, I did not think much of it as it wasn’t all too bad. When taking my hand off the handlebars and shaking it around, the tingling usually would go away pretty fast. It was only after a while that I noticed that the tingling feeling would also go over into a numbness.
The first time I ever heard of Carpal Tunnel Syndrome, was when I visited the chiropractor during the first lockdown in 2020. At the time, I was experiencing very strong cramps in my left hand when sleeping. It would feel like a burning feeling, as if someone planted a bunch of knives in the palm of my hand and it would keep me up at night. The chiropractor suggested CTS but wasn’t completely sure because the cramps were located in the centre of my hand and that, apparently, was a bit atypical. The name stuck with me, but for a long time I did not think it was the correct diagnosis. After a couple more sessions with the chiropractor the cramps calmed down and so I thought the origin of problem was rather situated in my neck or back.
An extra thing that did not convince me of CTS from the beginning was that the cramps at night and the tingling feeling I would get from riding my bike felt unrelated to each other. Even when both symptoms got more and more prominent, I could not find a relation between them.
A quick Google search taught me that something like a bike fit exists and more importantly, that a proper riding position has a big influence on what body parts take most of the pressure while riding. In the next years, I went back and forth between lots of tweaking my riding position: tilting my handlebars, shortening the stem, changing saddles, changing pedals, changing handlebars, moving the saddle up and down, back and forth, and I even went to a physiotherapist to get my position checked out by a professional. As it turned out: my father’s old bike was too big for me and the more I tweaked, the less my position was worthy of the word ‘comfortable’.
Even when my (dad’s) old road bike got replaced with a gravel bike that was actually my size and fully set up so that I had a comfortable riding position, the numb hands still remained. Also on my commuter and on my mountain bike that would later follow, the saga continued. I changed grips, raised the stem, changed handlebars - basically the whole shebang - but alas.
When planning our trip to the North Cape, which would mean roughly 50 days in the saddle, I realised it could not continue like it was. After a talk with my general practitioner, she referred me to a neurologist to get an actual diagnosis. The neurologist thought of CTS too and let me get an ultrasound of my wrists and an EMG test. The first one was to get a vision on the inside of my wrists, the latter to check the response of the nerves that run from my neck, through my wrists, to my fingers. Not even a split second into the EMG test and the diagnosis was as clear as could be: Carpal Tunnel Syndrome it was.
Now, I hear you wondering: what exactly is CTS? To be able to explain, it’s important to note that there are two important nerves that start from the neck, run through the arms, all the way to the fingers. These are the Medianus nerve and the Ulnaris nerve. The Medianus runs through a little tunnel inside the wrist and goes to the thumb, pointing finger, middle finger and half of the ring finger; the Ulnaris nerve goes to the ring finger and the pinky.
Often times the Medianus nerve gets jammed inside your wrist because of a variety of reasons. Wether it’s from working at a desk and having your wrists bent all day or riding your bike for hours and putting pressure on it from holding your handlebars, both the tunnel that gets more narrow (from your wrist being bent) or the pressure from leaning on your hands cause tingling fingers (or worse: numb hands).
For many people it helps to change their working setup, get some rest, go to a physiotherapist or get some medications. However, in more severe cases, the final solution is getting surgery.
Because I got the diagnosis only 3 weeks before leaving on our trip to the North Cape, the neurologist suggested a more temporary solution, which was injecting medicines (based on cortisone) directly in my wrists, in order to calm down the inflammation in my wrists. It is advised to only get this treatment once, as it is not a sustainable solution. The effects lasted as long as our trip - I could ride most of the time without tingling fingers or numb hands! ln total, I had some tingling for maybe 30 minutes on the whole trip. Only in the last days, I noticed the medicines were working out.
After the trip, I was a bit desperate with what to do because I didn’t want the injections another time and the surgery seemed scary to me. After talking to my GP, she reassured me that it is somewhat the easiest surgery for a surgeon to perform.
In november 2023 I had the surgery done, exactly two months before our trip to South-America. At first, the surgeon was hesitant because it usually takes 3 months for your hand to fully recover, but because of the seriousness of the pain it caused and the trip in foresight, there was basically no other option. In the surgery, they cut open a little ligament so that the nerve would get more space. It took about 20 minutes and you’re not even under full anaesthesia. They let you watch what they are doing on a monitor and though that might sound a bit scary, it was actually informative.
After the surgery, my cramps at night went away immediately. I took a month off from biking (not even for commuting) so I could let my hand rest. Then the doctor gave me a go and in the month after, I did not have any tingling or numbness in my hand. Of course I will need to see how it goes during our bikepacking adventure in South-America - I will try to write an update on this subject when we are a couple of weeks into our trip.