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  Last updated: 8/29/2021

Hand (handlebar) & Shoulder Syndromes

There are several hand, wrist, and upper extremity injury syndromes associated with cycling.


If you are limiting riding as a result of wrist pain, this article is a nice summary of changes that might be of help.

  1. ride with a 15 - 20 percent backbend of the wrist - takes pressure off the carpal tunnel.
  2. reassess saddle positioning - the higher the saddle or the more the nose is pointed down, the more weight is shifted to your hands (and wrists).
  3. reassess the length of your handlebar stem - reaching too far for the handlebars will also put excess pressure on your wrists.
  4. handlebar width - if hand placement is significantly wider than your shoulders, you tend to roll the wrist outward, putting more weight on the area of the palm over the ulnar nerve (and 4th and 5th finger numbness becomes more common).
  5. tire pressure - lowering tire provides more shock absorption on rough roads. This may mean thinking about tubeless tires.

ULNAR NERVE NEUROPATHY (little finger and ring finger)

Numbness of the small and ring finger is the result of irritation of the Ulnar nerve. After leaving the side of the neck, the ulnar nerve then travels through the arm pit, down the arm to the hand and fingers. As it crosses the wrist, the ulnar nerve and artery run through the tunnel known as Guyon's canal. The cause of Guyon's Canal Syndrome includes trauma to the area, fractures of the bones that form the floor of the tunnel, and small, benign tumors of the nerve or surrounding tissues of the tunnel. Another common cause of this syndrome is from pressure of bicycle handlebars seen with avid cyclists. In that case it is overuse of the wrist, especially bending the wrist down (flexing) and out, or putting constant pressure on the palm. Road vibration transmitted through the handlebars may be the cause in some cases as well.

The symptoms begin with a feeling of pins and needles in the ring and little finger, starting in the early morning before waking. This can progresses to a burning pain of the wrist and hand, followed by decreased sensation and eventually clumsiness in the hand as the ulnar nerve also supplies many of the small muscles of the hand.

The diagnosis of Guyon's canal syndrome begins with a careful history and physical examination by your doctor. Compression can occur at several areas along the ulnar nerve, and your doctor will want to find exactly where the nerve is being affected. Electrical studies such as Nerve Conduction (which measures how fast nerve impulses travel along the nerve) may help to pin point your problem.

Treatment involves taking frequent breaks or limiting the amount of time you are performing tasks that require flexing and turning out the wrist, or place constant pressure on the palm. You will need to evaluate how you are gripping the handlebars, particularly how you are holding your hand in relation to your forearm, and consider a change in your riding/gripping style on the handlebars or hoods. Lowering your seat to take pressure off your palm or wrist may be of help. Also consider increasing the padding in your gloves or other measures to decrease the transmission of road vibration. A wrist splint may be worn at night to decrease aggravating the condition. Anti-inflammatory medications(such as ibuprofen or aspirin) may be helpful. And in extreme cases surgery may be necessary to cut the ligament that forms the roof of Guyon's canal to relieve the pressure on the nerve. The ligament will eventually heal back, but the canal will be larger than before thus providing more leeway in how you position your wrist.

MEDIAN NERVE NEUROPATHY (carpal tunnel syndrome; thumb and ring finger)

The most common surgical neuropathy is the compressive neuropathy of the Median Nerve as it passes through the Carpal Tunnel in the wrist Irritation at this level in the course of the median nerve causes numbness of the thumb and index fingers. As with Ulnar neuropathy, it can be aggravated by wrist position and road vibration, and the approaches to treatment are similar including changing the aggravating motion/position, anti-inflammatories, and ultimately surgery if all else fails.

Common fixes for both


Developing shoulder pain is a common complaint, especially on long rides. A common question I receive is similar to the following:

Q. We take a group of teens on a 400 mile bicycle trip every summer through our church. One of the teens has complained extensively about shoulder discomfort. What do you advise?

In this situation, shoulder pain on longer (than training) rides, the problem is generally due to placing too much weight on the hands and riding with straight elbows (rather than keeping them slightly flexed) which transmits more road shock to the arms and upper body. Solutions include:

Questions on content or suggestions to improve this page are appreciated.

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