Toolbox: Numb Hands and Cyclist’s 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 numb 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 and motor symptoms including clawing of the 4th and 5th fingers, weak hand grip and pinching with the thumb. CTS causes sensory symptoms in the thumb side of the ring finger, long and index fingers, and 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 worsen, resulting in the persistence of symptoms even when not bicycle riding. Morever, sufferers of CTS may also complain of night-time symptoms.
Patterson et al (2003) reported that 23 of 25 road and mountain bicyclists developed sensory and motor symptoms of ulnar and median nerve irritation after riding 600 miles. Akuthota et al (2005) prospectively found electrodiagnostic 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 and 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 and median nerve and traction of the nerves (usually with wrist extension) is the main way to both prevent and treat compression and inflammation of the nerves. Strategies include:
1. Lowering and shifting one’s bicycle seat backward to reduce the forward position of the upper body and thus less transfer of weight onto the arms and hands.
2. For road bicycling: Using thicker foam-type handle bar tap to allow for more shock absorption, changing one hand position frequently, and avoiding riding in the drops.
3. For off-road and mountain biking: Adjust the shock absorption of the front shocks and rotating the brake levers downward to reduce extension of the wrist.
4. Wearing 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%.
5. Oral and topical non-steroidal anti-inflammatory medications (NSAIDs) can be taken/applied to reduce inflammation.
6. If one’s symptoms are more related to Carpal Tunnel Syndrome, wrist splinting can be tried.
7. 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.
WRITTEN BY: Dr. Victor Lun, MSc., MD, CCFP, Dip. Sport Med (CASEM) is a Sport Medicine physician who practices at the University of Calgary Sport Medicine Centre. He is the team physician for several the winter and summer sport Canadian national sport teams.
Medical Advice Disclaimer
The information included in this article is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult their healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this article does not create a physician-patient relationship.