Wednesday, November 25, 2009

Biking Injuries: Handlebar Palsy - Riding my bike is bad for my wrist?

It is pretty hard to walk along the canal on a nice day in Ottawa and not see a herd of bicycles pass you along the way. Biking is becoming increasingly popular in both transportation and recreational settings. In China bicycling is the number one form of urban transportation.

Due to these reasons bicycling injuries are becoming more and more common. However, most of these injuries can be avoided with just a few simple tips or minor adjustments to a bicyclist form or bike.

"Handlebar Palsy" is a term used to describe a nerve injury which occurs to bicyclist. This injury is often caused by prolonged compression or repetitive damage consistently to the Ulnar Nerve in the wrist. This nerve runs along the outside of the wrist and can carry both motor and sensory components. Depending on where the nerve gets damaged can dictate which components are corrupted. (Observe Picture).

However, the motor branch of the nerve is most commonly affected. This means pain, numbness and tingling aren't presented as symptoms. However, muscles will begin to lose their strength and function leaving bicyclist curious of why an onset of sudden hand weakness has occurred.

Signs and Symptoms

Often cases of "Handlebar Palsy" occur in individuals who have performed an excessive amount of biking. Cases have been published on people biking across the country or going on biking trips. However, there is also cases of it occurring due to an acute direct trauma.

Symptoms include unexplained weakness, clumsiness and muscle atrophy of the hand. Patients have also reported not being able to perform normal hand functions such as playing piano or using surgical equipment.


Handlebar Palsy can often be avoided by a proper placement of one's wrist on the handlebars. Those suffering from HP will usually display a faulty grip position. This can include hyperextending the wrist which will apply tension to the nerve (Picture to the left). Furthermore, one may grip the handlebars in a position which leaves the ulnar nerve exposed to being compressed. Try gripping your handlebars with a neutral wrist and leave the outside of the hand exposed. (Picture to the right)

In addition, bicyclist should always be fitted by a professional to make sure thier seat, frame, handlebars and pedals are placed properly for them. Try adjusting your seatt to place you in a more upright manner and avoid applying pressure on your hands and wrist. Attempt to take frequent breaks whenever carrying out long bike rides. When riding constantly adjust your position on the handlebars avoiding a consistent compression point. Whenever possible one should attempt to distribute the weight along the outside of their hands rather then the center of their palms. Using bicycling gloves and soft gripping for handlebars can also help reduce the force of vibrations being transmitted to your hands. Lastly, attempt different hand and wrist stretches before going for a ride.

I think I already have this injury?

Get the possible injury assessed by a health professional. Attempt to find a professional in your area who has a specialty or interest in sports injuries. There are multiple more serious neurological conditions which can replicate this injury (ALS, MS) and shouldn't go ignored without being looked at.

Cases of handlebar palsy may take weeks to months to reside. However, bicycling should also be ceased until the nerve is given time to regenerate. This is a slow process (approx 1mm a month) and will be hindered if the nerve is still left exposed to consistent vibrations. After the injury is confirmed by testing and shown to resolve one should take precautions before returning to the bike. Strength of the muscles in the hands and wrist should be returned to full form and again the patients biking mechanics should be looked at.

In summary, multiple bike injuries can be avoided with simple precautions and changes in biomechanics. We often wear helmets to protect our head but forget about the other body parts which are crucial in our everyday life such as our hands. Dr. Wayne Button, BSc, D.C

Capitani D, & Beer S (2002). Handlebar palsy--a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking. Journal of neurology, 249 (10), 1441-5 PMID: 12382163


  1. Riding bicycles is the salvation in some countries like Japan which traffic is very congested and also the incredible amount of people walking along the place.

  2. Great post. In case if anyone getting involved in bicycle accidents you have to do:
    1) Ensure that you exchange details with the other party.
    2) Report the case to the police if they are not already aware of the accident. This can be of great importance if the other party does not cooperate during any claim.
    3) Ensure that you receive medical advice if you have suffered injuries in the cycle accident.
    4) If possible - take photos of the accident scene (or ask a friend to do so) to assist with any liability dispute.
    5) Obtain an estimate on your cycle damage OR find your original purchase receipt if the bike is beyond repair. A replacement cost estimate will suffice in most circumstances if the original receipt is unavailable. Cycle accidents can be very open to disputes on liability so you may need to prepare for the worst.