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The Effect of Long-Distance Bicycling on Ulnar and Median Nerves

An Electrophysiologic Evaluation of Cyclist Palsy

Venu Akuthota, MD^*,,, Christopher Plastaras, MD, Kirstin Lindberg, MD^,, John Tobey, MD, Joel Press, MD and Cynthia Garvan, PhD^||

From the Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado, the Rehabilitation Institute of Chicago, Chicago, Illinois, the University of Chicago Pritzker School of Medicine, Chicago, Illinois, and the ^|| University of Florida College of Medicine, Gainesville, Florida

^* Address correspondence to Venu Akuthota, MD, Anschutz Outpatient Pavilion, Box 6510, Mail Stop F712, Aurora, CO 80045-0510 (e-mail: venu.akuthota{at}uchsc.edu).

Background: Distal ulnar neuropathies have been identified in cyclists because of prolonged grip pressures on handlebars. The so-called cyclist palsy has been postulated to be an entrapment neuropathy of the ulnar nerve in the Guyon canal of the wrist. Previous studies utilizing nerve conduction studies have typically been either case reports or small case series.

Hypothesis: Electrophysiologic changes will be present in the ulnar and median nerves after a long-distance multiday cycling event.

Study Design: Cohort study; Level of evidence, 2.

Methods: A total of 28 adult hands from 14 subjects underwent median and ulnar motor and sensory nerve conductions, which were performed on both hands before and after a 6-day, 420-mile bike tour. A ride questionnaire was also administered after the ride, evaluating the experience level of the cyclist, equipment issues, hand position, and symptoms during the ride.

Results: Distal motor latencies of the deep branch of the ulnar nerve to the first dorsal interosseous were significantly prolonged after the long-distance cycling event. The median motor and sensory studies as well as the ulnar sensory and motor studies of the abductor digiti minimi did not change significantly. Electrophysiologic and symptomatic worsening of carpal tunnel syndrome was observed in 3 hands, with the onset of carpal tunnel syndrome in 1 hand after the ride.

Conclusion: Long-distance cycling may promote physiologic changes in the deep branch of the ulnar nerve and exacerbate symptoms of carpal tunnel syndrome.

Key Words: electrodiagnostics • ulnar neuropathy • cycling • nerve entrapment

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