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What is Handlebar Palsy?

Updated: Jun 14

An anatomical diagram of nerve branches supplying sensation and muscle innervation to the hand

Handlebar or cyclists' palsy is a condition resulting from compression of a nerve in the front of the wrist. Unlike carpal tunnel syndrome which involves compression of the median nerve in the middle of the wrist, handlebar palsy is a far less common condition involving the ulnar nerve on the little finger side of the wrist. It is also known as Guyon's Canal Syndrome or Ulnar Tunnel Syndrome, as the nerve is compressed as it passes through a narrow space called Guyon's canal.

What are the signs and Symptoms of Handlebar Palsy?

Someone with handlebar palsy may experience some or all of the following symptoms depending on the precise location where the nerve is compressed:

  • pins and needles/tingling or numbness in the ring and little finger

  • pain or burning in the ring and little finger

  • hand cramps

  • weakness of grip

  • muscle wasting on the little finger side of the palm may be present in advanced cases

  • the ring and little finger may curl (claw) in advanced cases

What Causes Handlebar Palsy?

Both road and mountain bikers are susceptible to handlebar palsy, due to the pressure from an extended wrist resting on the handlebars. Vibration travelling up through the bike may also further irritate the nerve. You don't have to be a cyclist to suffer from compression of the ulnar nerve at the level of the wrist. Other causes can include the presence of a small cyst (ganglion) within the canal containing the nerve, a fracture of one of the bones which forms the canal, or arthritis close to the canal.

How is Handlebar Palsy / Guyon's Canal Syndrome Diagnosed?

The condition is usually diagnosed by a thorough assessment from a hand therapist or hand surgeon. An MRI is sometimes used to look for a ganglion cyst or tumor within Guyon's canal.

How is Handlebar Palsy Treated?

Treatment for handlebar palsy depends on the severity of symptoms. In very mild cases, some people may see improvements by simply adjusting their bicycle ergonomics. This might involve adjusting the height and tilt of the saddle to reduce pressure on the hands, changing handlebar position and thickness, and/or wearing padded cycling gloves. If the compression is more severe, a period of rest in a wrist splint may be needed to help the nerve to recover. Our hand therapists can also provide gentle exercises to improve the ability of the nerve to slide through the area where it is being compressed and will provide modalities for pain relief. In severe cases, especially where there is something pressing on the nerve such as a ganglion cyst in Guyon's canal, surgery is required to relieve the pressure on the nerve.

Of course, there are many other possible causes of pins and needles in the hand, including carpal tunnel syndrome, cubital tunnel syndrome, Lacertus syndrome and nerve compression at the cervical spine, so it is important to get an accurate diagnosis, so that you receive the appropriate treatment. Nerve compressions rarely go away on their own, so if you have pins and needles or numbness in your hand it is important to seek early diagnosis and treatment.

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