April 2023 CME Activity: Physiatrist’s Guide to Cyclist Palsy A Narrative Review-Physiatrist’s Guide to Cyclist Palsy A Narrative Review

Physiatrist’s Guide to Cyclist Palsy A Narrative Review

Pdf Summary

Cyclist palsy, also known as ulnar neuropathy at the wrist, is a common condition among long-distance cyclists. It is caused by sustained compression of the ulnar nerve on the handlebars, leading to a variety of sensory and motor impairments. Electrodiagnostic studies are essential for accurate localization. Motor lesions sparing the hypothenar muscles are the most common among cyclists. This article provides a clinical approach to cyclist palsy and management strategies, including patient education, equipment changes, and adjustments to bicycle fit.<br /><br />Cyclist palsy can present with a wide range of symptoms depending on the location of the nerve lesion. The condition is differentiated from Guyon neuropathy, which specifically localizes to the anatomical canal across the wrist. Cyclists are at high risk for neuropathies in the hand and wrist due to their positioning on the bicycle. The true incidence and prevalence of cyclist palsy are unknown, but there has been an increase in cases due to the popularity of at-home stationary cycling during the COVID-19 pandemic.<br /><br />Electrodiagnostic studies are key in diagnosing cyclist palsy and ruling out other potential causes. The article outlines an electromyographic protocol for ulnar neuropathy at the wrist, including routine studies and additional tests to consider. Depending on the severity of symptoms, conservative management strategies such as patient education, equipment modifications, and frequent hand repositioning can provide significant relief. In cases where symptoms persist or there is intrinsic hand weakness, surgical intervention may be necessary.<br /><br />The article emphasizes the importance of early recognition and proper management of cyclist palsy to prevent further neurological damage. It highlights the need for a comprehensive approach that includes patient education, equipment adjustments, and regular follow-up. With proper care, most cyclists can achieve symptomatic relief and continue cycling without significant limitations.

Keywords

Cyclist palsy

ulnar neuropathy

handlebar compression

sensory impairments

motor impairments

Electrodiagnostic studies

motor lesions

Guyon neuropathy

COVID-19 pandemic

surgical intervention