What is Cyclists’ Palsy (Handlebar Palsy)?
Cyclists’ Palsy is a nerve injury at the wrist to the ulnar nerve that can occur in cyclists, both road and mountain biking. At the wrist on the little finger side, the ulnar nerve travels through a tunnel called Guyon’s Canal. In this canal the ulnar nerve divides into branches that provide sensation to the little finger and muscle control of several muscles in the hand responsible for fine motor control and dexterity. This injury to the ulnar nerve occurs due compression of the nerve at the wrist while gripping the handlebars of a bicycle.
Symptoms of Cyclists’ Palsy
Cyclists’ Palsy will cause symptoms of weakness and clumsiness of the hand, especially noticeable in use of the hand for fine motor control actions or forceful pinching. Typing on the computer or playing the piano may also present difficulty. Less commonly, the hand will have decreased sensation in the form of numbness and/or tingling in the little finger.
Common Causes of Cyclists’ Palsy
Not surprisingly, Cyclists’ Palsy generally occurs in people who engage in frequent cycling. Road cycling and mountain biking both present the risk of developing Cyclists’ Palsy. When a hand is gripping the handlebars of a bicycle, the wrist is bent back (extended), which puts pressure on the nerve in Guyon’s Canal. The vibration from the road or trail can further irritate the nerve. Cyclists’ Palsy may develop after frequent cycling over several weeks, or even after a single session.
Diagnosis of Cyclists’ Palsy
Diagnosing Cyclists’ Palsy is based on speaking with you and a careful physical exam. X-rays are performed to evaluate for possible bone abnormality in the wrist along the path of the nerve. A nerve conduction study (NCS) may be obtained to measure the severity of injury to the ulnar nerve. MRI is sometimes used to evaluate cases where another source of compression of the ulnar nerve at the wrist needs to be investigated, such as a cyst or fatty growth.
Treatment Options for Cyclists’ Palsy
The treatment of Cyclists’ Palsy generally involves temporary bracing, anti-inflammatory medication, and hand therapy. Patients with mild cases may continue to cycle while optimizing the ergonomics of their bicycle, ranging from seat height, handlebar thickness, aero bars and wearing padded gloves. Sometimes a period of rest with refraining from cycling is required to allow the nerve to heal. Severe cases that do not respond to conservative treatment may benefit from surgery to decompress the nerve.
Cyclists’ Palsy is a common condition amongst people who enjoy cycling, in whatever form that may be. Obtaining a prompt diagnosis and treatment after the onset of symptoms will allow more rapid rehabilitation and get you back in your game faster. Call Dr. Pruzansky at 212-249-8700 to schedule an appointment.