Ulnar nerve

The effect of long distance bicycling on ulnar and median nerves

Acknowledgements

Venu Akuthota, MD
Christopher Plastaras, MD Kristin Lindberg, MD Joel Press, MD Cyndi Garvan, PhD

Overview

Cyclist palsy

History Anatomy Classification Etiology Other studies / reports Our study

Electrodiagnostic data

Cyclist palsy

Also known as Handlebar palsy

Compression or entrapment neuropathy of ulnar nerve at or distal to Guyons canal at the wrist

Cyclist Palsy - History

1896 - Destot

Ulnar neuropathy in cyclists first described Paris-Brest-Paris 1200 km bicycling race.

European journals 1970s American journals

Guyons Canal Anatomy

Ulnar Border

pisiform bone and FCU tendon

Radial Border

Hook of Hamate

Floor

Pisohamate ligament

Roof

Palmer carpal ligament Palmaris brevis muscle

Branches:

Dorsal ulnar cutaneous Superficial Sensory branch Deep branch Branch to hypothenars

Deep motor branch

Anatomy

Location of compression:

Within Guyons canal

Distal to canal

Wus Classification Ulnar nerve compression at the wrist

Type Fibers Affected Mixed
Sensory Motor

Location Proximal to or within Guyons canal

At wrist, just distal to branch to palmaris brevis muscle Proximal to the branch to the hypothenar muscles

I
II III

IV V

Motor Motor

Distal to the branch to the hypothenar muscles Proximal to the branches to the first doral interosseous and adductor pollicis muscles

Etiology: Cyclist palsy

Chronic repetitive trauma

Chronic pressure Vibration

Hyperextension

Cycling specific factors

Long biking excursions

Hand position Hyperextension of wrist Forward weight shift

Symptoms

Pain Paresthesias Numbness Weakness

Background

Eckman 75 3 case reports of ulnar neuropathy at the wrist in cyclists Jackson 89 20 long distance cyclists 9 with symptoms Normal NCS of median and ulnar sensory & motor studies Wilmarth 88 Ulnar sensory nerve conductions while within normal limits in cyclists did vary signficantly compared to noncyclists. Patterson 03 92% (23 out of 25) cyclists had either motor or sensory symptoms after a 600 km ride.

The effect of long distance bicycling on ulnar and median nerves:

An electrophysiologic evaluation of cyclists palsy

Objective:

To objectively quantify changes in the ulnar and median nerves associated with a long distance multi-day cycling event.

Design:

A prospective cohort study

Subjects

14 adult subjects

Total of 28 hands Seven men, seven women 6 day 420 miles (Avg - 70 miles. Max - 85.9 miles) Flat and rolling terrain on asphalt & chip-coat roads

Bike tour

Nerve Conduction Studies Pre & Post Ride

Ulnar motor (Dual Channeled)

abductor digiti minimi first dorsal interosseus

Median motor

abductor pollicis brevis

Ulnar sensory

little finger

Median sensory

index finger

Questionnaire

Post ride Demographics Experience level Hand positions

Symptoms experienced during ride

Onset motor latencies

p = 0.5020 p = 0.2357 p = 0.0044
p < 0.0001

5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0

3.7 3.45 3.1 3.0 3.5

3.7

Before After

0.45

0.72

Median

Ulnar to ADM

Ulnar to FDI

FDI - ADM

Peak sensory latencies

p = 0.31 p = 0.6466

5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0

3.3 3.15

3.2

3.1

Before After

Median

Ulnar

Ulnar nerve results

Motor Studies

FDI & ADM within normal ranges

Comparison of Pre/Post

Significant Differences FDI FDI ADM

Median nerve results

Median nerve palsy due to cycling is rare.

No significant difference between the hands before or after the ride for median motor or sensory. Pre-ride 3/28 hands with onset > 4.2 msec Post-ride all three with increases of latency Post-ride 1 hand with 3.9 msec to 4.8 msec

Discussion

Changes occur in the deep branch of the ulnar nerve

Despite usual preventative measures Sub-clinical changes

Pre-existing nerve abnormalities may be exacerbated

Limitations

Small sample number Lack of temperature measurement Technical errors

Submaximal stimulation Distance differences

Same electromyographer performed all examinations

Conclusions

Cyclist palsy or handlebar palsy is a compressive neuropathy of the ulnar nerve seen in cyclists
Early recognition of symptoms & intervention with rest & cessation of biking, then modification of equipment and alteration in riding style is important for the avoidance of nerve damage

Conclusions

Significant changes can occur to the deep branch of the ulnar nerve
May cause or exacerbate symptoms of carpal tunnel syndrome