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.

Handlebar palsy
Ulnar 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
Although 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.

Prevention
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
Columbus, Georgia

Further Reading

1. Hems TE, Simpson H. Prevention of hand injuries in cycle accidents. J Trauma. 992;32:683-685.
2. Ellis TH, Streight D, Mellion MB. Bicycle safety equipment. Clin Sports Med. 1994;13:75-98.
3. Richmond DR. Handlebar problems in bicy-cling. Clin Sports Med. 1994;13:165-173.