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 struggled with a swollen right ankle following a crash on Monday. The American rode off the road at one point onto grass and nearly fell into a ditch.
Garmin clocked 37 minutes, 4 seconds over the mostly flat 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.
Phinney, who needed three stitches to close a wound on his ankle 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, especially in the final third of the time trial, but he managed to stay with his teammates.
The fifth stage Thursday is a 129-mile flat leg from Modena to Fano on the Adriatic coast. The hilly stages begin Friday, Saturday and Sunday.
The race ends May 27 in Milan.