ARM PUMP OR CARPAL TUNNEL SYNDROME?

PART 1

I'm 51 years old and I've been riding and racing for a long time. Racing helps keep me fit and felling younger than I am. It does, at the very least, keep me in better physical condition than golf or poker tournaments. However, racing motorcycles does take a toll over time. In my decades or riding and racing, I have collected quite a range of injuries, broken bones, and more than a half dozen orthopedic surgeries. All of these boo–boos get better, to varying degrees, and you always learn to ride around whatever little limitations you have left after recovery from a serious injury.

I'm not complaining. Far from it! I still ride and race and do pretty well at it. Most of all, it's still really fun, and I'm not ready to give it up. Ibuprofen has become a mandatory food group on race day, and I have learned that well tuned suspension is critical to keep the bike from beating me up over a long race. I have found ways to compensate for past injuries that never quite healed 100%, but in the last few years, I have started having problems with my hands going numb while racing, and no matter what I have tried, it just keeps getting worse.

I have read a lot about arm pump and various cures, and I've tried them all. I tried various forearm exercises, spray on cures you apply to your forearms before a race, aspirin to thin my blood, all sorts of other stuff, but none of these things had much positive effect, if any. The best thing I found was the good old ibuprofen, an anti–inflammatory, but it only helps a marginal amount.

Arm pump is a condition where the muscles in the forearms are working so hard they swell with blood to the point that they constrict blood flow to the hands and forearm muscles. Gripping the bars continuously is an isometric exercise, not a muscle shortening and lengthening exercise. Continuous isometric muscle contractions do not allow the blood to move in and out of the muscles to bring in oxygen and flush out lactose.

Ever see those guys shaking out their hands in a race? Trying to get blood flow back in there? Most racers I have talked to think that forearm pump restricts the flow of blood to the hands and fingers, so the hands start to tingle, which gets progressively worse until they are just numb, like when you sleep on your arm wrong and you wake up with it all numb and tingling. So they shake out their hands, which does release the isometric contraction (gripping the bar) and allows blood to flow to the hands, and theoretically the shaking speeds the blood flow, reducing the numbness.

Arm pump can be caused or at least worsened by a lack of arm training and muscle development, improperly set up bars/levers, improper riding position, and the most famous one – keeping a "death grip" on the bars.

Working at KTM World and Highland Park means I ride fairly often, and do a lot of physical work cutting trails and such, so I do not consider my problem to be a lack of forearm physical conditioning. My grip strength is very good from a lifetime of riding, and wielding a machete and chain saw on a regular basis helps too.

This year in particular the numb hands have become much worse, and I have tried to ride around it, but this has become a difficult, if not dangerous task. They start to go numb usually about halfway through the first lap at a GNCC or Hare Scrambles, and by the end of the first lap, I cannot ride 110% anymore. Not even 100%. More like 80%, because you have to concentrate so hard on keeping your hands on the bars. The amount of concentration is enormous, and at 51, I only have a limited amount of concentration left in my feeble old brain! Really, it takes a huge amount of concentration to keep your hands firmly griping the bars and operating the controls when you can't feel anything with your hands. You can tell your hand is anchored to something, but you can't actually feel the bars. If you loose your concentration for a split second in a rough section, a hand will fly off the bar when you hit something at speed, the result being a near crash, or sometimes one of those spectacular high speed over the bars crash. Some of you reading this know what I am talking about.

In addition to not being able to feel the bars, I can't feel the front brake lever or clutch lever. So the "ride around" for that is always keeping a finger or two on the levers in sections of the race course where you need to use them a lot. Fast sections, like running WFO across a field, don't require the brake or clutch lever, and you need all your fingers on the bars to hold on when approaching the end of top gear. And you need to REALLY concentrate on keeping your hands on the bars in those super fast sections. I can tell you that it is not desirable to have a hand fly off the bar while running wide open in top gear.

Eventually you have to downshift and use the brakes, and that is the real tricky part. The "ride around" for that is looking at the levers and your fingers to make sure you have your fingers on the levers before you need to use them. So just before it is time to jam on the brakes and start downshifting at the end of that WFO top gear field, you have to look at the brake and clutch levers to get your fingers on them properly. You sure can't feel the levers.

Using the front brake requires that you know ahead of time when you need the front brakes, so you can glance down and get your fingers on it, and it's the same with the clutch, although the clutch is not as critical as the front brake can be. If you don't glance down at the brake lever, it can be hit or miss getting your fingers on it, and that means emergency braking can be a hit or miss proposition. You may hit the tree, you may miss it.

I talked to a lot of people with similar numbness in their hands when racing, and most seem to think their problem is due to arm pump and loss of blood flow from constriction. At first, when it was coming on slowly, I assumed it was just arm pump not allowing the blood to flow to my hands, and if I stopped for a few minutes, like at an Enduro gas stop or reset, the numb hands would go away, like the blood was flowing again. However, I rarely had issues with arm pump in the past, so why had it become so bad now? I began to wonder if it was Carpal Tunnel Syndrome (CTS), but I did not know much about CTS.

Doing some internet research opened my eyes, and I found out that CTS is not about constricting blood flow, it's about constricting the nerves that run down your arms into your hands. In layman's terms, the nerves passing through the wrist into the hand go through the carpal tunnel, a narrow, rigid passageway of ligament and bones at the base of the hand that houses the median nerve and tendons. When the area becomes swollen by engorged blood vessels or inflamed from hard or repetitive use, pressure is put on the nerves running through the tunnel, particularly the median nerve, which serves the palm side of the hand, thumb and fingers. With enough pressure, the nerves are constricted and your hands go numb. One of the causes I found in my research on CTS was "repeated use of vibrating hand tools". I guess holding onto a vibrating and jerking motorcycle handlebar for 40 years qualifies.

OK, it now seems like CTS is a better diagnosis for my numb race hands than arm pump, and I finally spoke to one racer that had CTS surgery, and he said it fixed his numb hands. Bingo. I called my orthopedic surgeons office and set an appointment with the CTS specialist.

At the doc's office, they asked some questions about my hand numbness, and as much as I hated to mention the "I race motorcycles" thing, that's the only time it really is bad, so I told the truth – I race motorcycles. You know how a lot of doctors look at you when you injure yourself and tell them you did it on a motorcycle. It pisses me off a bit, since I'm sure they go snow skiing, or fly their single engine doctor killer planes, or do something else that has a certain amount of risk to it. But I was spared the "look" and any lecture about how dangerous motorcycles are, and I actually got a chuckle out of her when she was looking at my medical history and saw all the previous orthopedic surgeries on various body parts. "You seem to be in great shape, but I see here it's all due to modern medicine!"

She took me through some tests, but it did not take long to see that CTS was the problem. The first test was the Tinel test, and the doc tapped on the median nerve in my wrist, then asked if I could feel tingling in my fingers when she was tapping. For me, it was like hitting your funny bone – big tingling sensation every time she tapped on the nerve. She did a few more quick tests, but from my description of the problem, and the hugely positive results from the tests, we went on to an electrodiagnostic test, which checks nerve conduction by placing electrodes on the forearm and finger tips. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. My test showed 12% nerve damage!

That was it for me. I need to get this taken care of ASAP. My right hand is worse, so it's getting done first, and we are doing Open Release Surgery, the traditional procedure used to correct carpal tunnel syndrome, consisting of an incision about 2 inches long at the wrist/palm juncture, then cutting the carpal ligament to enlarge the carpal tunnel. I have the surgery set for Monday, Sept 24 – right after our KTM World and Highland Park open house and KTM demo day on Sept 22, and the SETRA Hare Scrambles race on Sept 23. Hey – I gotta get in some riding before I have to sit out doing rehab!

After the surgery, I'll write some more about how it went, how fast it heals, and how well it works, so anyone with numb hands that is interested in CTS surgery can read about it from a racer's perspective.

Paul Wright