What is Cyclist’s Palsy and why bikers should not take this lightly

First Bike Ride talked with Dr. JJ Pua, a hand surgeon, to tell us more about this medical condition. We are tackling this topic into two parts. First part discusses the signs and symptoms of Cyclist’s Palsy and the other half is about preventive measures and treatment.

“This is not something that people should take lightly,” Dr. Pua told First Bike Ride. “It’s not similar to a workout where you have the ‘no pain, no gain’ mentality or muscle soreness that you’ll just get used to.”

The problem is basically rooted in the wrist on the side of our palm opposite the thumb or the “ulnar side.” The nerve that is responsible for our ring and little fingers pass through this area. This nerve is called the “ulnar nerve.”

According to Dr. Pua, Cyclist Palsy develops because of repetitive strain or compressive injury to the ulnar nerve. If there is constant pressure over the ulnar side, the nerve gets impinged which eventually results in irreversible nerve injury.

You see, the nerve in this area can easily be injured because it doesn’t have any “protective cushion” like big muscles or thick fat layers.

“When you do cycling, take note of the position of the wrist, the design of the handlebar and the frequency of your activity,” he said. “Because of the constant pressure on this area of the wrist that is pressed against the handlebar, the nerve gets irritated. Once this happens, its two functions can be affected: sensation and motor strength.”

Prolonged nerve compression initially manifests as sensory problems. It can be a tingling sensation, pins and needle type of pain or numbness. Without preemptive or preventive measures, it can evolve into something permanent and severe.

“Symptoms may get worse like longer periods of numbness or tingling. You can feel it five times instead of the previous once a day sensation,” he said. “Or you can feel it even if you’re not cycling. What’s worse is when you can start to feel it for almost the whole day. Nerve cells can die.”

With time, if the nerves continue to get compressed, muscle strength problems can soon develop. Muscles on the ulnar side of the palm will get thinner and it’ll be now more difficult to move these two fingers which are concerned with power grip. It will also become harder to spread and move the fingers side to side as the muscles responsible for this become affected.

“As a result of the muscle strength imbalance, deformities will soon manifest, such as Claw Hand deformity,” he warned. Claw Hand deformity is a condition where your fingers get noticeably bent into a claw-like pattern.

“When motor problems appear and muscles start to shrink or get really weak, then recovery becomes difficult. Reconstructive surgery will be needed but still might not lead to a near-normal outcome,” Dr. Pua said.

So what should we do to avoid getting Cyclist’s Palsy? We’ll discuss Dr. Pua’s recommendations on the second part of this series.

If you’re experiencing problems with your body, it’s always better to consult your doctor and listen to medical advice.

Dr. JJ Pua is an orthopaedic hand surgeon at the University of Santo Tomas Hospital, St. Luke’s Medical Center – Global City and De Los Santos Medical Center.

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