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When we think about nerve compression in the wrist, most people tend to think of carpal tunnel syndrome, but there are other kinds of compressive injuries which might be causing your wrist pain. If you're a cyclist or ever hopped on a bike for a long spin and felt a numbness or tingling in your pinky and ring fingers, you might be dealing with something called handlebar palsy. Unlike carpal tunnel which affects the median nerve, handlebar palsy affects the ulna nerve, which sits more laterally, or out towards the pinky aspect of the wrist. When speaking about nerve irritation or injuries, we typically call them neuropathies, hence, handlebar palsy is also known as ulna neuropathy, or cyclist's palsy. Let's take a closer look at this common condition, and see what options are available for you!

What Does It Feel Like?

Nerves are responsible for two key functions, sensation and motor control. Taking this into consideration, symptoms like pain, numbness, tingling, pins-and-needles and weakness in the ulna nerve distribution below the site of compression are quite typical of handlebar palsy. In severe cases, muscle wasting or motor incoordination can occur too.

Diagnosis and Imaging

At Spectrum, nerve compression injuries present to us daily. They come in many forms, such as the more famous sciatica, disc bulges, carpal tunnel syndrome, and plenty more. Handlebar Palsy is on the rarer end of the scale, but nonetheless something we come across often. Diagnosis is usually made by a combination of thorough history taking and special hands on testing. In some cases, we might want to image the area for best understanding of the anatomy and to rule out other causes of symptoms:

• MRI (Magnetic Resonance Imaging): the gold standard for soft tissues; shows nerve swelling, compression sites, or anomalies like tumors or aneurysms in Guyon's canal.
• Ultrasound: quick and non-invasive; visualises the nerve in real-time and checks for blood flow issues (e.g., ulnar artery problems).
• CT Scan: Good for bones; detects fractures or bony spurs pinching the nerve.
• Electrodiagnostic Tests: not imaging per se, but crucial in measuring nerve signals to pinpoint damage levels and differentiate from elbow issues or neck problems. This is a more advanced investigation, and not one we typically send for in the early stages.

In any case, early diagnosis is critical to give the best chance of reversing symptoms and avoiding long-term neurological damage.

How Does Handlebar Palsy Happen?

As we highlighted, the population of people this tends to affect is cyclists. So, using cycling to paint the picture: leaning forward with your weight on the handlebars causes compression through the Guyon's canal (where the ulna nerve travels through the wrist into the hand). Over time, constant pressure and vibration can impact the ulnar nerve against the bones and ligaments in your wrist. It's like pressing on a garden hose; the flow gets restricted, and things go numb downstream.

Other culprits outside of cycling include:

• Prolonged gripping: holding the items tightly, such as tradies or manual labourers who rely on gripping.
• Prolonged typing: keeping pressure over the canal of Guyon at your work desk is another method we've noticed in patients developing Handlebar Palsy.
• Pre-existing issues like arthritis, diabetes can make you more prone to this condition.

We need to keep aware that this is rarely a sudden onset and tends to creep in over time. If you have any symptoms, Spectrum recommends that you seek assistance to get on top of your condition. Let's take a look at how we at Spectrum can help you if you are experiencing any symptoms of Handlebar Palsy.

How Can Spectrum Help You?

So, we suspect Handlebar Palsy is the cause of your symptoms, what exactly can we do about it? Spectrum specialises in conservative care, and in most cases, this condition can respond well to our care. Conservative care translates to non-operative approaches. Here, we like to use a combination of hands-on and exercise to help get you back to your best:

• Pain management: at Spectrum, we can use our advanced technology available to us, for example the Game Ready hot and cold contrast system, which blends the advantages of heat, cold and compression therapies.
• Manual therapies: such as dry needling, soft tissue massage, cupping, joint mobilisation and many more, are options to help you manage symptoms and restore function at the wrist, elbow and shoulder joints.
• Taping and protection: sometimes, people want to keep cycling or need to keep working through their injury. In those cases, there are some taping strategies or padding strategies we can use to tape some pressure away from the sore spot. If these aren't protective enough, splinting of the area can be arranged.
• Rehabilitation: targeted exercises to strengthen the elbow, wrist and shoulder muscles are vital to returning to normal function.
• Ergonomic advice: whilst we aren't technically bike fitting specialists, we can reply on our Spectrum network to help you speak to the best in the business for bike fittings and ergonomic advice!

Further Management Strategies

In some cases, conservative care doesn't quite hit the spot. In these instances, there are other options we can help guide you through:

• Corticosteroid Injections: into Guyon's canal to minimise swelling around the nerve.
• Decompression Surgery: the surgeon opens the canal, releases tight ligaments, removes any compressive masses, and frees up space for the nerve.

Of course, surgery is not an ideal option for any injury, but our role doesn't stop even if that is the next step for you. Spectrum can help you manage your post-op health and work with you to regain function, strength and confidence in the affected area.