Mateusz Gładysz FESSH prep

FESSH prep Compressive neuropathies Sport specific ulnar neuropathy

Ulnar nerve compression in athletes

Last reviewed v1.0

FESSH-021Compressive neuropathies●●○ intermediate

Regarding ulnar neuropathy in athletes, which of the following statements are true?

  1. 1.Cyclists are at increased risk of distal ulnar neuropathy because prolonged pressure on the handlebars compresses the nerve at Guyon's canal.

  2. 2.Baseball pitchers commonly develop ulnar nerve instability and irritation in association with repetitive valgus stress at the elbow.

  3. 3.Weightlifters are protected from cubital tunnel syndrome because muscular hypertrophy of the forearm flexors enlarges the cubital tunnel.

  4. 4.Padded gloves and altered grip position reduce ulnar nerve symptoms in cyclists by redistributing palmar pressure away from Guyon's canal.

  5. 5.Electrodiagnostic studies (nerve conduction studies and electromyography) are confirmatory rather than first-line investigations for athletic ulnar neuropathy and may be normal in early or dynamic disease.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-021
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Cyclists are at increased risk of distal ulnar neuropathy because prolonged pressure on the handlebars compresses the nerve at Guyon's canal.

    True

    Sustained handlebar contact and wrist hyperextension produce direct compression and traction of the ulnar nerve within Guyon's canal — the classical handlebar palsy or cyclist's palsy. Electrophysiological studies have documented measurable conduction changes in the distal ulnar nerve after prolonged riding.

    • Capitani D, Beer S. Handlebar palsy — a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking. J Neurol. 2002;249(10):1441-1445. PMID 12382163
    • Akuthota V, Plastaras C, Lindberg K, Tobey J, Press J, Garvan C. The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy. Am J Sports Med. 2005;33(8):1224-1230. PMID 16000656

  2. 2. Baseball pitchers commonly develop ulnar nerve instability and irritation in association with repetitive valgus stress at the elbow.

    True

    Repetitive valgus load during the late-cocking and early-acceleration phases of pitching causes ulnar collateral ligament attenuation and ulnar nerve traction. Ulnar nerve symptoms occur in a substantial proportion of throwers with valgus instability, and ultrasonographic subluxation or dislocation of the nerve is common in this population.

    • Aldridge JW, Bruno RJ, Strauch RJ, Rosenwasser MP. Nerve entrapment in athletes. Clin Sports Med. 2001;20(1):95-122. PMID 11227711
    • Dowdle SB, Chalmers PN. Management of the ulnar nerve in throwing athletes. Curr Rev Musculoskelet Med. 2020;13(4):449-456. PMID 32410148

  3. 3. Weightlifters are protected from cubital tunnel syndrome because muscular hypertrophy of the forearm flexors enlarges the cubital tunnel.

    False

    Weightlifters and bodybuilders show an increased rather than decreased incidence of ulnar neuropathy at both the cubital tunnel and Guyon's canal. Contributing mechanisms include repetitive elbow flexion under load, traction across the medial epicondyle, hypertrophy of the medial head of triceps or of an anconeus epitrochlearis when present, and grip-related compression at the wrist.

    • Posner MA. Compressive ulnar neuropathies at the elbow: I. Etiology and diagnosis. J Am Acad Orthop Surg. 1998;6(5):282-288. PMID 9753755
    • Lorei MP, Hershman EB. Peripheral nerve injuries in athletes. Treatment and prevention. Sports Med. 1993;16(2):130-147. PMID 8378668

  4. 4. Padded gloves and altered grip position reduce ulnar nerve symptoms in cyclists by redistributing palmar pressure away from Guyon's canal.

    True

    Conservative management of cyclist's palsy combines load relief, gel-padded gloves, neutral wrist positioning, periodic hand repositioning on the bars, and bike-fit modification. These measures resolve symptoms in most non-advanced cases without recourse to surgery.

    • Slane J, Timmerman M, Ploeg HL, Thelen DG. The influence of glove and hand position on pressure over the ulnar nerve during cycling. Clin Biomech (Bristol, Avon). 2011;26(6):642-648. PMID 21458120
    • Patterson JM, Jaggars MM, Boyer MI. Ulnar and median nerve palsy in long-distance cyclists. A prospective study. Am J Sports Med. 2003;31(4):585-589. PMID 12860549

  5. 5. Electrodiagnostic studies (nerve conduction studies and electromyography) are confirmatory rather than first-line investigations for athletic ulnar neuropathy and may be normal in early or dynamic disease.

    True

    Initial assessment of suspected ulnar neuropathy is clinical, including provocative testing — Tinel's sign, the elbow-flexion test, the scratch-collapse test — and motor and sensory examination. Electrodiagnostic studies localise and grade the lesion but can be falsely normal in mild or early compression because the fastest-conducting fibres are preserved.

    • Staples JR, Calfee R. Cubital tunnel syndrome: current concepts. J Am Acad Orthop Surg. 2017;25(10):e215-e224. PMID 28953087
    • Power HA, Sharma K, El-Haj M, Moore AM, Patterson MM, Mackinnon SE. Compound muscle action potential amplitude predicts the severity of cubital tunnel syndrome. J Bone Joint Surg Am. 2019;101(8):730-738. PMID 30994591