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Cycling Injuries: A Quick Guide on Cyclist's Palsy or Handlebar Palsy

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It is quite common for cyclists to experience numbness, pain or a tingling sensation in their hands or fingers at some point in time or the other. This at times can be associated with the feeling of weakness or clumsiness. So, what is that? How long does cyclist palsy last? Well, this condition is referred to as Cyclist’s palsy. In this article, we are going to be looking at the causes, symptoms along with prevention tips and treatment of this condition.

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What is Cyclist’s Palsy

Cyclist’s palsy also referred to as handlebar palsy or ulnar neuropathy is a common condition seen in mountain bikers and road cyclists. This palsy is a nerve injury at the wrist which can cause persistent clumsiness and weakness in the cyclist’s wrist and particularly thumb. Individuals with this condition would generally notice problems with fine finger movements like pinching, playing the piano or while typing on the keyboard. This condition can result from multi-day road cycling events or a single day of mountain biking.

What is cyclist's palsy
Cyclist's Palsy Diagram

Typically the ulnar nerve becomes compressed and irritated in the wrist within the Guyon's canal. This happens due to the pressure exerted on the hands on the handlebars. Now, this gets intensified even more when you are riding on a rugged and difficult terrain. More than often it has to do with the way the cyclists grips the bike’s handles and how much pressure they put on their wrists and palms according to the position of the seat and the pedaling style. Guyon canal syndrome is not threatening, but it does restrict the hand’s mobility and that can have a negative impact on the most basic daily activity.

Causes of Cyclist’s Palsy

Palsied cyclists generally develop the condition during prolonged cycling and can it can occur in both road cyclists and mountain bikers. The position of your hands while you are holding the handlebar would place pressure on the ulnar nerve in the wrist. This stress combined with the vibrations from the road or trails is enough to cause nerve damage in hand. This is especially true when you are cycling downhill as a large amount of your body weight would be supported by your hands. This can, therefore, lead to a higher Guyon’s canal in the wrist.

Other factors which can cause cyclist's palsy are improper fit of the bike, general fatigue that can cause an increased weight bearing on the hands, wearing ill-fitted or worn-out gloves, using worn-out handlebar paddings, not changing the grip of your hands regularly, malposition of the saddle and improper size or shape of the handlebar.

Symptoms of Cyclist’s Palsy

The symptoms of cyclist’s palsy are ought to differ in different people. It basically depends on whether only the ulnar nerve has been impacted, or only the deep motor branch, or both. Treatment would be dependent upon the severity of nerve damage in hand. The general symptoms experienced by people are the inability to perform fine movements like pinching or typing on a keyboard, clumsiness in finger and hand movement and numbness in the palm. Some experience a loss of strength in fingers after cycling.

Compression of the sensory branch of the ulnar nerve will present itself in sensory disturbances, such as numbness and tingling in the ulnar innervated areas of the affected hand. These symptoms are easily recognizable and often go away within a day or two.

However, compression of the deep motor branch of the ulnar nerve will present itself in motor deficits, such as clumsiness, weakness and possibly motor limitation because of loss of muscle function in hand. The symptoms of these are less distinguishable and in case no sensory fibers have been affected equally, the patient would continue to cycle with an on-going compression of the motor branch. They might not realize that they have an underlying injury until a serious one happens.

In case of Guyon's canal syndrome, proper and timely treatment is required. Depending on the severity, the handlebar palsy recovery can take a few weeks or some months. In case of cyclist's palsy, if the patient doesn’t receive proper treatment, the ulnar nerve entrapment might cause paresthesia of the hand muscles innervated by the ulnar nerve or atrophy of the intrinsic hand muscles which would be permanent.

Prevention of Cyclist's Palsy

Listed below are a few cyclist's palsy prevention tips that you can follow.

Invest In Foam-Coated Handles

Foam handles
Use Softer Foam Handles Instead of the Gripped Type

Invest in a foam-coated custom-made handlebar for your bike. The people who design it for you would first assess your hand position and grip on the handles on a stationary bike. The result would then be used so as to create an ergonomic model which would provide you optimal comfort, safety, and protection. Cyclist's palsy isn't something that should be ignored and if you begin noticing the symptoms, it would be best to take appropriate steps.  

Padded Gloves could be Beneficial

For palsied cyclists, handlebar palsy gloves are a very beneficial thing. Gloves are in fact recommended to cyclists to prevent numbness in hands or thumb palsy due to cycling for prolonged hours. Superior quality gloves absorb the sweat and thereby prevent hands from slipping off the handles. This means that there is a reduced chance of you suffering an injury.

Padded gloves
Padded Gloves Put Less Pressure on Your Hands

The cycling gloves have a fair amount of padding in it and this spreads the pressure on your hands. The cycling gloves have been created specifically to offer protection to your hands and wrists which receive full blast of the shock while riding the bike.

Read Cycling Gear: Biking Gloves Guide for A Better Grip for information on what gloves to buy!

Keep Changing your Grip Position Regularly

Then you are riding your bike, it is quite obvious for you to apply pressure on your wrists and hands to ride faster. But it is indispensable to stop applying pressure continuously on your palm, wrist or thumb to reduce the chances of cyclist's palsy. The easiest way to achieve that would be by changing the position of your grip from time to time. Also, spend adequate time in research and find out about the best kind of grips for uphill/downhill, flat road and for off-road cycling. As a prevention measure, you can try doing some ulnar nerve exercises to strengthen your tendons and nerves.

Treatment of Cyclist's palsy

The very first thing that you should do is take a break from cycling for a few days. The cyclist's palsy recovery time is short if the condition is not too severe.

While you are recovering, get your bicycle or handlebar adjusted to prevent another occurrence. However, if the symptoms still persist, you could take over-the-counter non-steroidal anti-inflammatory drugs. It might help in reducing the inflammation and swelling in hand which is the main cause of the pressure that is being placed on the nerves.

If any kind of improvement is still not noticed, consulting your doctor would be the best possible solution. For the identification and proper diagnosis of the ailment, it is indispensable to recognize the signs and symptoms. The doctor would assess your ability to adduct your thumb. In case any weakness is noticed, it could be because of paralysis of adductor pollicis.

After the initial assessment, additional imaging like ultrasound, CT-scan or MRI could be conducted to help confirm the diagnosis and thereby determine the location of the compression. If the patient indicates the region where there is an abnormal feeling and this region is maximum 6 cm above the wrist, then we can be sure that it involves Guyon canal syndrome. But, if it is situated more than 6 cm above the wrist, then it involves a cubital tunnel syndrome. 

When the exact spot where the patient feels numb on the hand can be determined, doctors can differentiate easily between a carpal tunnel syndrome and Guyon's canal syndrome. This, therefore, means that determining the exact spot of compression is crucial. In the first stage, the doctor might administer a local injection with corticosteroids directly into the Guyon’s canal. However, in serious cases, after assessing the degree of nerve injury through an examination called nerve conduction testing, the doctor might recommend surgery to restore the complete functionality of the nerve.

Managing Cyclist's palsy

Cyclist's palsy is a kind of neuropraxia and can lead to temporary motor paralysis with minimal sensory and autonomic function loss. You can try ulnar nerve exercises or consult a physiotherapist. Heat and cold therapy might be used by the physiotherapist to improve your condition. Other techniques like low-level laser, electric stimulation, ultrasound and soft tissue techniques would also aid in improving the condition. You could try exercises like finger squeeze, finger bending, and grip strengthening so as to strengthen the hand muscles. By assessing your condition, the physiotherapist may suggest other exercises as well.

Summing Up

As seen above, cyclist’s palsy isn’t something that you should ignore as if not looked into, it can become quite serious. Therefore, you need to make sure that you are riding a bike that has been adjusted according to the size and weight of your body. If not, it can lead to a lot of issues in the long run.

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