Guyon's Tunnel Syndrome, Cyclist's Palsy

Guyon's tunnel syndrome, also known as cyclist's palsy, is a disorder that causes pain, hand weakness, and loss of feeling in the wrist and little finger side (ulnar) of the hand. The condition is caused by the bones of the hand pressing on the ulnar nerve and other blood vessels on the little finger side of the wrist. This condition may greatly decrease athletic performance in sports that require fine hand function or gripping.

SYMPTOMS

  • Tingling, numbness, or burning feeling in part of the hand or fingers. (Especially little finger, and ring finger on the side by the little finger).

  • Pain that wakes you up at night.

  • Sharp pains, that may shoot from the wrist up the arm.

  • Clumsiness and weakness of the hand.

  • Shiny, dry skin on the hand.

  • Reduced performance in sports requiring repeated gripping and fine hand functions (dexterity).

CAUSES

The disorder is caused by pressure on the ulnar nerve. This is most likely the result of external pressures (handlebars on a bike), but may also be internal (tumor, cyst, fracture or aneurysm of the ulnar nerve).

RISK INCREASES WITH:

  • Diabetes mellitus.

  • Underactive thyroid gland (hypothyroidism).

  • Menopause.

  • Raynaud's disease (vascular disorder).

  • Long-distance cycling.

  • Repeated jolting or shaking of the hands or wrist.

  • Gout.

  • Sports that may cause fracture of the hamate bone in the hand (baseball batting, golf, tennis, badminton).

  • Rheumatoid arthritis.

  • Ganglion cyst.

  • Carpal tunnel syndrome.

PREVENTION

  • Use padded handlebars or gloves when cycling.

  • Change the positions of your wrists often, if your activity requires prolonged hyperextension of the wrist (like cycling, weightlifting) or results in repeated jolting or shaking of the hands or wrist.

  • Learn and use proper technique when batting, golfing, or playing tennis, to prevent little finger fractures.

PROGNOSIS

This condition is usually curable, either with non-surgical treatment or going away on its own. Sometimes, surgery is needed, especially if muscle wasting or nerve changes have developed.

RELATED COMPLICATIONS

  • Permanent numbness of the little and ring fingers in the affected hand.

  • Permanent paralysis, weakness, and clumsiness of hand and finger muscles.

TREATMENT

Treatment first consists of stopping activities that aggravate your symptoms. Ice and medicines are then used to reduce pain and inflammation. If possible, activities may be modified so they no longer place as much pressure on the ulnar nerve. This may include wearing padded gloves, a splint or changing your technique. Your caregiver may advise that you visit a physical therapist for further treatment. If inflammation persists, a corticosteroid injection may be given to reduce inflammation.

In the most severe cases, surgery is performed to free the compressed nerve, when non-surgical treatment fails. Surgery, which is performed on an outpatient basis (you go home the same day), provides almost complete relief of all symptoms in 95% of patients. Allow at least 2 weeks for healing.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Stronger pain relievers may be prescribed by your caregiver. Use only as directed and only as much as you need.

  • Injections of corticosteroids may be recommended, to reduce inflammation.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve, despite 2 weeks of treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)