3/25/2009 1 Nerve Injuries in Nerve Injuries in Cyclists Cyclists Alison Brooks MD MPH Alison Brooks MD MPH UW Cycling Symposium UW Cycling Symposium March 3, 2009 March 3, 2009 “Compressions of a Cyclist” “Compressions of a Cyclist” “Compressions of a Cyclist” “Compressions of a Cyclist” “Compressions of a Cyclist” “Compressions of a Cyclist” “Compressions of a Cyclist” “Compressions of a Cyclist” Overview Overview Nerve Injury 101 Nerve Injury 101 3 points of contacts 3 points of contacts Ulnar neuropathy (handlebar) Ulnar neuropathy (handlebar) Pudendal neuropathy (saddle) Pudendal neuropathy (saddle) • Erectile dysfunction Erectile dysfunction Foot paresthesias (pedal) Foot paresthesias (pedal) Nerve Injury Nerve Injury Neuropathy Neuropathy : deranged function and structure of : deranged function and structure of peripheral nerves peripheral nerves Sensory: touch, pain, temperature Sensory: touch, pain, temperature Motor: muscle contraction Motor: muscle contraction Mechanism Mechanism • Compression (ischemia)* Compression (ischemia)* • Stretch Stretch Nerve Injury Nerve Injury Nerve contains neurons and blood vessels Nerve contains neurons and blood vessels Susceptible to compression Susceptible to compression Pressure level Pressure level Duration Duration Nerve Injury Nerve Injury Nerve intact but not functional Nerve intact but not functional Mildest form of injury Mildest form of injury Focal demyelination Focal demyelination Impaired conduction Impaired conduction • Paralysis of body part Paralysis of body part • Sensory deficits Sensory deficits
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Transcript
3/25/2009
1
Nerve Injuries in Nerve Injuries in
CyclistsCyclists
Alison Brooks MD MPHAlison Brooks MD MPH
UW Cycling SymposiumUW Cycling Symposium
March 3, 2009March 3, 2009
“Compressions of a Cyclist”“Compressions of a Cyclist”“Compressions of a Cyclist”“Compressions of a Cyclist”“Compressions of a Cyclist”“Compressions of a Cyclist”“Compressions of a Cyclist”“Compressions of a Cyclist”
�� Degree of injury: amount, durationDegree of injury: amount, duration
�� Nerve must regenerate (up to 12 weeks)Nerve must regenerate (up to 12 weeks)
�� No ongoing compressionNo ongoing compression
�� Check bike fit first (saddle height, position)Check bike fit first (saddle height, position)
�� Equipment changesEquipment changes
�� Controversial link between ED ~ cyclingControversial link between ED ~ cycling
References
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�� Sanner WH and O’Halloran WD. The Biomechanics, Etiology, and Sanner WH and O’Halloran WD. The Biomechanics, Etiology, and Treatment of Cycling Injuries. J Am Podiatr Med Assoc 2000; 90(7):354Treatment of Cycling Injuries. J Am Podiatr Med Assoc 2000; 90(7):354--376376
�� Kennedy J. Neurologic Injuries in Cycling and Bike Riding 2008; 26:271Kennedy J. Neurologic Injuries in Cycling and Bike Riding 2008; 26:271--279279
�� Silberman MR e al. Road Bicycle Fit. Clin J Sport Med 2005; 15(4): 271Silberman MR e al. Road Bicycle Fit. Clin J Sport Med 2005; 15(4): 271--276276
�� Asplund C et al. Genitourinary Problems in Bicyclists. Curr Sports Med Rep Asplund C et al. Genitourinary Problems in Bicyclists. Curr Sports Med Rep 2007; 6:3332007; 6:333--339339
�� Campbell WW. Evaluation and Management of Peripheral Nerve Injury. Clin Campbell WW. Evaluation and Management of Peripheral Nerve Injury. Clin Neurophysiology, 2008; 119:1951Neurophysiology, 2008; 119:1951--19651965
�� Taylor JA et al. Bicycle Riding and Its Relationship to the Development of Taylor JA et al. Bicycle Riding and Its Relationship to the Development of Erectile Dysfunction. J Urology 2004; 172:1028Erectile Dysfunction. J Urology 2004; 172:1028--10311031
�� Sommer F. et al. Impotence and Genital Numbness in Cyclists. Int J Sports Sommer F. et al. Impotence and Genital Numbness in Cyclists. Int J Sports Med 2001; 22:410Med 2001; 22:410--413413
�� Schwarzer U et al. Cycling and Penile Oxygen Pressure: the type of Saddle Schwarzer U et al. Cycling and Penile Oxygen Pressure: the type of Saddle Matters. Europ Urology 2002; 41:139Matters. Europ Urology 2002; 41:139--143143