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Cyclists Hand: Handlebar palsy

by Jane Hodgson 12 June 2009


Summary:

Ulnar neuritis at the wrist is also referred to as handlebar palsy, cyclist palsy, or ulnar neuropathy. Symptoms include pins and needles and pain in the hand.

What is handlebar palsy?

Handlebar palsy is another name for irritation of the ulnar nerve

What's the ulnar Nerve?

There are three main nerves that supply the arm: the ulnar, radial and median. They all come from the neck and take a different course down the arm giving sensation to different areas of the arm and supplying different muscles.

The ulnar nerve goes down the inside of the upper arm, crosses behind the medial epicondyle of the elbow (this is what hurts so much and causes pins and needles in your hand when you bang your funny bone) The nerve then carries on down the little finger side of your forearm and passes into the hand between two of the wrist bones that are called the pisiform and the hamate and under a strong ligament. It is in this canal that that the nerve often has pressure on it

The ulnar nerve:

  •       Supplies the sensation to little finger and the little finger side of the ring finger.
  •       Works muscles called flexor carpi ulnaris and flexor digitorum profundus. These are two of the muscles that act to flex (bend) the fingers and wrist.
  •       Works muscles called flexor digiti minimi and adductor digiti minimi which move the little finger

So what's ulnar neuritis?

Ulnar neuritis simply means irritation of the ulnar nerve. Irritation can happen anywhere along the course of the nerve, but the most common sites are where the nerve leaves the neck, as it passes around the elbow and as it passes through the canal into the wrist.

The most common site of irritation in cyclists is where the nerve passes through the canal into the wrist because the hand position on the handlebars puts the nerve on a stretch and compresses it.

What are the Symptoms of ulnar neuritis?

  • Pins and needles or numbness in the little finger, the little finger side of the ring finger and the outside border of the hand
  • Pain on activity that involves the little finger muscles working hard e.g. pinch grip, climbing, playing the piano
  • A feeling that the hand is "clumsy"

What can I do to get back to pain free cycling?

Check the tilt of your saddle

If the saddle is tilting forwards more weight is transferred through onto your hands. Put a spirit level on your saddle and adjust it so its flat.

Check the height of your bars

If the bars are too low more weight is transferred to the hands. See Basic bike set up 

Look at your hand position on the bars

The nerve is most stretched and therefore most compromised when the wrist is extended (pulled back) and deviated towards your thumb: this is the position that the wrist is in if you ride with your hands on the outside of drop bars.

Make sure you are not resting on the nerve

If you rest the little finger side of the wrist on the bars you will be squashing the nerve between the bars and bone.

Strengthen your core muscles

Strong core muscles mean you can support your trunk better and don't have to transfer as much weight through your wrists on to the bars.

Vibration

There is research linking vibration and ulnar neuritis in drivers. Whilst there's no empirical evidence that vibration through the handlebars whilst cycling causes an increased risk of ulnar neuritis if you are getting symptoms it could be worth trying gel gloves or front suspension

Take frequent breaks

After all what else are tea shops and pubs en route for?

It still hurts what next?

Alter other activities that are putting the nerve in a compromised position

Analyze what else you are doing day to day that is putting the nerve on a stretch - poor posture at the computer is a common problem. 

Check the symptoms aren't coming from somewhere else

Nerve compression at the neck can refer pain and pins and needles to the hand. Other pathologies such as diabetes or hypothyroidism can be the underlying cause.

Get some treatment

Try some ice and do some specific exercise:  Nerves are inelastic and cannot be stretched. An irritated nerve can become very painful if repeatedly pulled on, however nerves do like movement and will respond well to been gently glided in and out of the tunnel with specific exercises.


Disclaimer: The information on this page is written to help you understand your injury. There are many possible causes for hand pain and should you have any concerns you should always seek advice from a qualified health professional such as a Chartered Physiotherapist or your GP.

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About the author

Jane Hodgson - Chartered Physiotherapist Jane Hodgson Jane specialises in lower body injuries and has raced competitively in running, orienteering and adventure racing.

Did you know

The wrist is a more common site of injury in cyclists than the knee.


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