10 Most Common Bicycling Injuries

Injured Wrist

These are very common bicycle injuries. Probably the most common wrist injuries are due to going over the handlebars or falling forward and to the side. It is a natural act to put your outstretched arm in front to break the fall. Unfortunately, usually the wrist is broken. In fact, frequently in terms of recreating an accident, usually a broken wrist is a clear sign that probably the PT was conscious when he/she fell specifically because he/she was conscious enough to put their hand/arm out to break the fall. If the PT was unconscious during the fall – he/she would NOT be attempting to break the fall and would have different injuries – like a broken nose/cheek bones/broken teeth, etc.

Just like with a broken clavicle, a broken wrist/arm/elbow is a painful injury. Further, these injuries are usually due to some sort of accident – or at least the bicyclist went down. Therefore, there is a very real possibility of a head/spinal injury or other injuries that are “masked” by the pain of the broken bone. After doing scene safety, ABCs, head to toe, then place the PT in a position of comfort and start your primary & secondary assessments.

If nothing else is wrong, the chief complaint is the suspected broken bone. If you have splinting material and triangular bandages – splint the wrist/arm and immobilize with the triangular bandages. In terms of splinting – a simple rule – if a bone is broken – then immobilize/splint the joint above and below the site of the broken bone. If it is a broken joint (wrist/elbow) – then immobilize/splint the bone above and below the joint as well as the joint. REMEMBER – whenever splinting – do CMS prior to splinting and after splinting (re-visit broken clavicle for more on CMS). When splinting (especially broken wrist) leave space in the splinting process so that a radial pulse can be taken on the injured/splinted limb.

I usually use either a SAM splint or a wire splint to immobilize the limb/joint. Wire splints take up a lot less space and weight less than SAM splints. They also cost significantly less money – therefore, many riders carry a wire splint. Especially with a wire splint but also with a SAM splint – be sure and pad the limb in the splint. Movement is pain and any areas that are not properly padded may slip or allow movement. Especially if you have a bone that is completely broken in half – you want NO MOVEMENT while it is being splinted and/or once it is splinted. Movement is painful but movement can also cause nerve damage and/or cut off or sever circulation. Thus making a simple fracture into a major medical emergency. You can use clothing/jackets/arm warmers/bandages/etc. to pad the injury. I wrap the splint with roller bandages.

Do CMS before and after splinting.

Immobilizing – if you have splinting material – the splint itself is part of immobilizing. Then complete the immobilization with a sling and swath. Tight is better – movement is pain. If you do not have splinting material – it is possible to use the triangular bandages to immobilize the injured limb with a basic sling and swath. Be careful and keep in constant contact with PT on levels of pain, what works and what does not work on immobilizing; pain level; numbness; and of course circulation issues.

Do CMS before and after sling and swath.

Learning how to splint and immobilize takes training and practice. Splinting incorrectly CAN become an example of First Aid actually making the PT worse instead of better. So, take a course and learn how to splint correctly. One last thing on splinting – bend the SAM or wire splint or “mold” the splint to align with the limb so that the splint supports the limb. Do the bending/molding of the splint around the good limb or the un-injured limb. After correctly molding the splint to the good limb – then, bring it over to the injured limb and it will probably be almost a perfect fit. Thus, saving the PT some pain while you mold/bend the splint around his/her injured limb.

How do the PTs break his/her arm – or Mechanism of Injury. By far, the most common accident is falling forward and putting your arm out to break the fall. Second, is probably falling directly to the side, usually as a result of not unclipping from the bike cleat and then falling on your side. Especially if there is a curb or a log/rock/whatever and PT falls directly with the radius/ulna-forearm bones/elbow/long bone-humerus bone taking a direct hit with all of PT’s weight falling on a blunt or sharp object. Then of course, there is being hit by another bicyclist or a car – whatever. Blunt force trauma with the bone/joint of the arm taking the direct blunt force. Those are the most common break scenarios that I can come up with. I am sure I am only scratching the surface. As they say, truth is stranger than fiction and bicycle injuries are no exception.

Just to be on the safe side – assume that the bone/joint is broken. Possibly, it is sprained or just bruised. However, we are not doctors nor do we have x ray vision. If a PT is suspected of having a broken limb – he/she needs to go to a hospital and get an x ray. DO NOT LET THEM RIDE HIS/HER BIKE. You will probably be surprised at how many bicyclists want to ride even with a broken wrist/arm. If the PT is presenting with circulation issues/significant nerve damage – immobilize and get them to a hospital. If a hospital is too far, consider calling 911. Circulation and nerve damage issues should be taken serious.

Take a course to learn how to splint/immobilize/pad injuries/CMS/etc. Accidents happen – know what to do.