Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Handlebar Palsy

SYMPTOMS

There is paraesthesia of the ulnar one and a half fingers and weakness and atrophy of the intrinsic hand muscles. It is common in cyclists and racket sport players.

AETIOLOGY

These symptoms are caused by chronic compression of the ulnar nerve in Guyon’s canal.

CLINICAL FINDINGS

There is a positive Froment’s sign and decreased sensation over the ulnaris nerve distribution area of the hand.

INVESTIGATIONS

Nerve conduction test is usually positive.

TREATMENT

Avoid further compression of the nerve by addressing technical aspects such as handlebar size and position, racket handle size, etc. NSAID and physiotherapy may be sufficient to relieve symptoms. A temporary brace may be useful. Surgery for release of the retinaculum is required in severe cases.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon and  hand specialist if there is long duration of progressive symptoms or if the diagnosis is not clear. Physiotherapy with stretching and training of hand muscle function is indicated.

EXERCISE PRESCRIPTION

Most sports can be maintained but avoid prolonged static dorsi-flexion such as holding a handlebar on a bicycle. After surgery the symptoms are usually relieved almost immediately and most activities can be back to normal within six weeks. Running, cycling and water exercises (when the wound is healed after surgery) are good alternatives to keep up general fitness. Gym training can be maintained.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and negative Froment’s sign.

DIFFERENTIAL DIAGNOSES

This is a clear clinical diagnosis.

PROGNOSIS

Excellent, if treated appropriately. If it is missed, surgery can be performed at a later stage.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>