Ramunas Navardauskas of Lithuania took the lead in the Giro d'Italia after his Garmin-Barracuda squad won the team time trial in the fourth stage Wednesday.
Previous leader Taylor Phinney visibly struggled with a swollen right ankle following a crash on Monday. The American BMC rider went off the road at one point onto grass and nearly fell into a ditch.
Garmin clocked 37 minutes, 4 seconds over the mostly flat 33-kilometer (21-mile) route in Verona - the first stage back in Italy following three legs in Denmark. Katusha finished second, 5 seconds behind, and Astana and Saxo Bank were next, both 22 seconds back.
Garmin riders are 1-2-3-4 in the overall standings, with Navardauskas 10 seconds ahead of American sprinter Tyler Farrar and South African veteran Robert Hunter, with overall contender Ryder Hesjedal of Canada fourth.
Alex Rasmussen, who entered third overall, couldn't keep up with his Garmin teammates and dropped in the standings.
Phinney, who needed three stitches to close a wound to his right ankle on Monday, dropped to fifth, 13 seconds behind. After going off road, he had to slow for a moment to clean a clump of grass off his shoes, but a weed remained attached to his bike.
"I didn't have anything today,'' Phinney said.
"The team waited for me a couple times... Luckily I didn't fall today, too. I'm upset, there's not much else to say. I didn't have any power.''
BMC finished 10th, 31 seconds behind Garmin.
"I have to thank the team, because they could have left me behind, but they brought me to the finish,'' Phinney said.
Navardauskas also struggled at times, especially in the final third of the time trial, but he managed to stay with his teammates.
"I'm so happy to stay with these guys,'' he said.
"I was so tired with 10 kilometers to go.''
Among pre-race favorites, Joaquin Rodriguez is 30 seconds back, followed by Roman Kreuziger (40 seconds behind), two-time winner Ivan Basso (47 seconds), Frank Schleck (1:09), 2004 winner Damiano Cunego (1:19) and defending champion Michele Scarponi (1:22).
Stage 5 on Thursday is a 209-kilometer mostly flat leg from Modena to Fano on the Adriatic coast, before the first hilly stages Friday, Saturday and Sunday.
The race ends May 27 in Milan.