Handlebar Hazards

As training begins for the upcoming MS150, we thought we’d talk about some of the common overuse, or repetitive stress, hand and wrist conditions affecting cyclists.  By discussing some of these conditions and ways to reduce your risk, hopefully we can ensure pain free cycling and play a hand in many successful rides.

How Repetitive Stress Occurs
Avid cyclists competing year round in weekend rides and races tend to experience various types of overuse strains and stress associated with such a sport – nearly one-third of these

Hyperextended Wrist

affect the hand and upper extremity.  Despite the best equipment and preventive measures, the jarring vibration of a rough terrain, handlebar hand positioning for hours at a time or tense ride into the wind can result in such repetitive stress conditions as carpal tunnel syndrome or handlebar palsy (also known as ulnar neuropathy).  Cold weather also makes tissue more distensible and may slightly increase risk for carpal tunnel syndrome as well.

Carpal Tunnel Syndrome

Hyper Flexion of Wrist

One of the most common tendinopathic conditions associated with overuse activity and repetitive stress in the hand and wrist is Carpal Tunnel Syndrome (CTS).  CTS is the result of irritation and swelling, which causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes. CTS is one of the most common overuse hand and wrist conditions affecting cyclists. When the median nerve becomes irritated in this inflamed and compressed tunnel, numbness, pain, tingling and weakness may result in the thumb, index and middle fingers – causing discomfort and affecting a cyclist’s ability to even shift gears with the affected hand.  Resting periodically and stretching the hands, changing grip to reduce hyperextension and hyper flexion may help during the ride, but ongoing pain may require treatment – which is generally nonsurgical and may entail night bracing and/or injection therapy.  CTS pain remaining unresolved following nonsurgical treatment may require a minimally invasive Endoscopic Carpal Tunnel Release.

Handlebar Palsy (Ulnar Neuropathy)
Handlebar palsy, known medically as ulnar neuropathy, is another common overuse or repetitive stress condition affecting cyclists.  It is the result of direct pressure placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.  The ulnar nerve controls sensation in the ring and little fingers as well as the muscular function of the hand.  Compression of it may result in numbness and tingling in the ring and little fingers and/or hand weakness. Nonsurgical treatment such as rest, stretching exercises, and anti-inflammatory medications can generally resolve this condition.

These overuse, repetitive stress conditions affecting bicyclists also often affect motorcyclists – as the continuous vibration of the motorcycle causes the same type of conditions long rides and regular bicycling can cause.

Reducing Your Risks
Decades of cycling enthusiasts have contributed to an array of preventive cycling gear and recommendations for reducing a fellow cyclist’s risk for such conditions.  These include everything from basic and specialized gel cycling gloves to additional handlebar padding and adjustments in handlebar height and overall bike fit specific to each rider.

Applying less pressure or weight to the handlebars and avoiding hyperextension and hyper flexion, along with frequent adjustments to grip and position on the handlebars, should reduce risk for carpal tunnel syndrome and handlebar palsy.

Figures source:  http://www.hughston.com/hha/a_15_3_2.htm