Handlebar Palsy: A cause & intervention for ulnar neuropathy.

Written by April Meyer, MOTR/L

Virtual Hand to Shoulder Fellow ‘20/’21

For the past year, I’ve been training to ride my bike 3,100 miles across the US coast to coast with 170,000 ft of vertical ft, 24/7, rain or shine on an 8-person relay team with a target date of 7.5 days or less. Why would I embark on such a crazy endeavor, you ask? I'm part of an amateur cycling team whose aim is to raise suicide awareness and prevention to a worsening epidemic gripping our nation as it is now the 10thleading cause of death in the US and has been on the rise amid the Pandemic. We are Team Suicide Prevention.

Any athlete, whether professional or amateur, often faces physical challenges at some point due to the physical demands we’re repeatedly placing on our bodies. For myself, I’ve been an avid cyclist for almost seven years and have often struggled with various ailments, but nothing more prevalent than ulnar neuropathy. This nerve condition, also known as "handlebar palsy," affects the ulnar nerve distribution, which runs along the inside (medial) part of your arm, forearm, and distally down into the wrist/hand (Jafarnia, 2021). Cyclists spend hours sitting on their bikes each week gripping or resting on the handlebars with repeated vibrations absorbing into their hands. Over time, this can cause nerve irritation/inflammation anywhere along the nerve distribution. In addition, the ulnar nerve innervates part of the thumb, the ring and small fingers, and the hand's intrinsic muscles, which can manifest as numbness, tingling, pain, and/or weakness. If left untreated for long periods, an individual can lose their ability to grip not just their handlebars and ride safely, but the ability to perform everyday activities leading to loss of function. Although this is often associated with cyclists, this is not a syndrome isolated to these athletes alone but can develop in the general populace. Work-related trauma or repetitive motion from straining one’s arms, lifting weights, assembly line workers, heavy keyboard users, handling heavy machinery, and using power tools can also elicit these symptoms.

The good news is this condition can be treated. In the early stages of this syndrome, ceasing the aggravating activity altogether is best. However, individuals typically develop this condition due to overuse from the activities they repeatedly engage in, whether for work or enjoyment (i.e.typing, using machinery or riding your bike), so simply “quitting” isn’t practical. Therefore, activity modification becomes a critical intervention as well as other conservative measures. To treat my ulnar neuropathy, I have strengthened my core (decreasing the compression caused by leaning into the handlebars). I use gel padding underneath my bar tape and padded gloves to help absorb the shock and vibration transference from the road. In addition, I frequently perform ulnar nerve glides. When my symptoms are exacerbated, I typically wear an anti-flexion elbow splint at night and avoid sleeping on my side to prevent compression and further irritation of the nerve. Although the above list has helped me as a cyclist, those techniques are not exclusive to the sport. According to Poretto-Loehrke (2011), nerve glides, anti-flexion elbow devices, and activity modification coupled with therapy can decrease or eliminate symptoms and work towards restoring function. If conservative treatment such as these fails, surgical intervention can be discussed with a specialist.

There were times while I was training for this endeavor, I thought to myself, “this is crazy; who does this kind of thing?" Especially when you’re fighting against so many challenges. I broke my shoulder during a training ride a few months leading up to the race and was confined to a stationary bike for nearly 4 months. I had shoulder pain, ROM limitations, weakness, cubital tunnel syndrome, and secondary back pain caused by the fracture as a chain effect. But when the cause is greater than yourself, the motivation is stronger. As we rode our bikes 3,100 miles across the United States, I had a chance to share my story and spread hope to others suffering in silence or who have lost someone to suicide. I am proud to say despite record-breaking heatwaves, riding in all of the elements 24/7, with severe sleep deprivation, and the countless logistical challenges, our team successfully finished in 7 days, 19 hours, and 34 minutes. But our greatest achievement is the lives we touched along the way.

If you or someone you know is struggling, please reach out. There are mental health resources available to anyone, but so many choose to suffer in silence because of our society's stigma on seeking help. I guarantee if you reach out, you’ll see that even strangers care. To learn more about me or any of my teammates’ stories, or to donate to our cause, visit us at: www.teamsuicideprevention.com

1. Porretto-Loehrke A, Soika E. Therapists management of other nerve compressions about the elbow and wrist. IN Skirven, TM, Osterman Al Rehabilitation of the Hand and Upper Extremity 6th ed. Mosby 2011.

2. Jafarnia, Korsh. (2021) Hand, Wrist, and Elbow injuries and Conditions. “A Roadmap to Staying Pain-Free on Long Rides.” Retrieved from https://korshjafarniamd.com/blog/category/hand-wrist-conditions/repetitive-stress-conditions-hand-wrist-conditions/handlebar-palsy/