After a ride on your bike, have
you experienced numbness, tingling, or pain in your arm, hand, wrist, or
little finger? If you have, you could be suffering from an overuse injury.
Approximately one-third of all bicycling overuse injuries involves the
hands. The 2 most common are handlebar palsy and carpal tunnel syndrome.
By making some adjustments to your bike and by wearing some protective
equipment, you can prevent these injuries from occurring.
neuropathy, known to cyclists as handlebar palsy, is caused by compression
of the ulnar nerve at the hand and wrist (Fig. 1). The ulnar nerve controls
sensation in your ring and little finger and controls most of the muscular
function of your hand. Compression of the ulnar nerve is a common problem
for competitive and recreational cycle enthusiasts, alike. Compression
is the result of direct pressure on the ulnar nerve from the grip on the
handlebars. Often, the nerve may be stretched or hyperextended (extension
beyond its normal limit) when a drop-down handlebar is held in the lower
position. The pressure placed on the ulnar nerve results in numbness and
tingling in the ring and little fingers or hand weakness, or a combination
of both. Symptoms can take from several days to months to resolve, but
surgical treatment is rarely necessary. Rest, stretching exercises, and
anti-inflammatory medications, such as aspirin, usually help relieve the
symptoms. Applying less pressure or weight to the handlebars and avoiding
hyperextension can help to prevent a recurrence.
Carpal tunnel syndrome
it is less common than handlebar palsy, carpal tunnel syndrome (compression
of the median nerve at the wrist) is another overuse injury that cyclists
often experience (Fig. 2). Injury often occurs when a cyclist holds the
handlebars on top and applies pressure directly on the median nerve. Symptoms
include numbness and tingling in the thumb, index, middle, and ring fingers
and weakness of the hand. Symptoms usually resolve quickly once you stop
cycling for a short period of time. Although handlebar pressure contributes
to these symptoms, there can be other causes for hand pain and numbness;
therefore, an evaluation for other possible causes of carpal tunnel syndrome
should be performed by your health-care professional.
You can overcome or prevent overuse
injuries altogether by making some adjustment to your equipment and behavior.
Adjusting the handlebars, the seat, and the pedals to your fit is the key
to preventing most overuse injuries. Adjust the bike so you sit in a more
upright position, taking the weight and pressure off your hands and wrists.
Take a rest during long rides and change your hand position on the handlebars
often. Shift your weight from the center of your palms to the outside edge
of your palms as often as possible. Wear padded gloves and add handlebar
padding to your bike to help protect your hands from injury. The padding
absorbs the shocks and jolts from the road, limiting the stress transmitted
to your hands. Your hands will also be able to handle the stress from the
roads much better if you complete a short session of hand and wrist stretches
before hitting the road.
Most often, overuse injuries experienced
by cyclists stem from a lack of specific preparation. With the proper training
and equipment, you can minimize the risk of these hand injuries.
David C. Rehak, MD
Hems TE, Simpson H. Prevention of
hand injuries in cycle accidents. J Trauma. 992;32:683-685.
Ellis TH, Streight D, Mellion MB.
Bicycle safety equipment. Clin Sports Med. 1994;13:75-98.
Richmond DR. Handlebar problems
in bicy-cling. Clin Sports Med. 1994;13:165-173.