Cycling Upper Limb Problems

This session included presentations on: Risk factors for non-traumatic injuries; Carpal injuries; Traumatic injuries of the clavicle; ACJ dislocations; Nerve entrapment and prevention; and The decision-making process for returning to an elite level.

Non-traumatic injuries in cycling usually involve compression and entrapment neuropathies and can be relatively common. Prevention is best and usually involves having a good bike fit/set-up, frequent changes of position and an anatomic handlebar. Surgical decompression of the ulnar nerve at the Guyon’s canal is only rarely needed.

Traumatic injuries in cycling tend to involve carpal injuries (through falling onto an outstretched hand), clavicle fractures and acromioclavicular joint (ACJ) dislocations (falling onto the shoulder). For carpal injuries, be aware of the possibility of co-existing injury (e.g. hook of hamate). Careful examination and diagnosis (MRI) is needed to avoid missing a fracture, which could result in non-union. Clavicle fractures are usually fixed surgically, particularly distal fractures, where a hook plate/coracoclavicular ligament repair should be considered. Early mobilisation and a quick return to the same level is expected. Treatment of type 3 ACJ dislocations need the careful management otherwise they can fare poorly and scapula dyskinesis can develop. Focused physiotherapy can help but some will need surgery. In surgical treatment remember the role of the deltotrapezoidal fascia and repair it. A case study demonstrated that the decision-making process for successful return to an elite level was a multifactorial process, requiring good communication, clear roles and well-defined rehab goals.