7 Ways to Prevent and Treat Cyclists Palsy

Bicyclists often suffer from pain, numbness and tingling in their hands and fingers. There can be an associated feeling of weakness of hand grip or clumsiness of the hand. These symptoms have been called "Cyclist's Palsy" or "Handlebar Palsy".

Anatomy and Epidemiology

What causes numbness in the hands while cycling?

The cause of these symptoms is the compression/entrapment and subsequent inflammation of the ulnar nerve at Guyon's canal (pinky side of the palm), or of the median nerve at the center of the wrist (also called Carpal Tunnel Syndrome, CTS). Deciding which nerve is affected is determined by the distribution of one's sensory and motor symptoms.

Ulnar nerve compression usually causes sensory symptoms in the pinky finger and pinky side of the ring finger. Motor symptoms include clawing of the fourth and fifth fingers, weak hand grip and pinching with the thumb.

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CTS causes sensory symptoms in the thumb side of the ring finger; long and index fingers; thumb and motor symptoms of weakness of hand grip; raising the thumb straight up from the palm; and squeezing between the thumb and pinky finger. If left untreated, the nerve compression and inflammation could worsen. This could result in the persistence of symptoms even when you're not on the bike. Sufferers of CTS may also complain of nighttime symptoms.

Patterson et al (2003) reported that 23 of 25 road and mountain cyclists developed sensory and motor symptoms of ulnar and median nerve irritation after riding 600 miles. Akuthota et al (2005) prospectively found electro-diagnostic changes in the ulnar nerve following a 6-day, 420-mile road bike ride. Furthermore, Slane et al (2011) has shown that riding in the drops with the wrist extended for prolonged periods of time caused the most pressure on the ulnar nerve.

Treatment and Prevention

Minimizing direct pressure on the ulnar nerve, the median nerve and traction of the nerves (usually with wrist extension) is the best way to prevent and treat compression and inflammation of the nerves.

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Here are a few treatment and prevention tips you can use:

1. Lower and shift your seat backward to reduce the forward position of the upper body. This allows for less transfer of weight onto the arms and hands.

2. For road cyclists: Use a thicker foam-type handle bar tap to allow for more shock absorption. Change hand position frequently, and avoid riding in the drops.

3. For off-road and mountain biking: Adjust the shock absorption of the front shocks. Rotate the brake levers down to reduce extension of the wrist.

4. Wear gloves with padding in the area of the Guyon's Canal. Slane et al (2011) has shown that wearing gloves can reduce the pressure on the ulnar nerve by 10 to 28 percent.

5. Oral and topical non-steroidal anti-inflammatory medications (NSAIDs) can be taken/applied to reduce inflammation.

6. If symptoms seem to be more related to Carpal Tunnel Syndrome, wrist splinting could help.

7. If other treatments fail, a doctor might try a corticosteroid injection of the Guyon's Canal or carpal tunnel.

If one's symptoms persist despite the above measures, then electrodiagnostic testing (nerve conduction testing) can be performed to assess the degree of nerve injury. Surgical decompression of the nerves may need to be considered if more severe nerve injury is found.

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