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Preventive strategies, exercises and rehabilitation of hand neuropathy in cyclists: A systematic review

  • Rita Chiaramonte
    Correspondence
    Corresponding author: Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania. Catania, Italy.
    Affiliations
    Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania. Catania, Italy
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  • Piero Pavone
    Affiliations
    Department of General Paediatrics A.O.U., Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
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  • Giuseppe Musumeci
    Affiliations
    Department of Biomedical and Biotechnological Sciences, Anatomy, Histology and Movement Science Section, School of Medicine, University of Catania, Catania, Italy

    Research Center of Motor Activities (CRAM), University of Catania, Catania, Italy

    Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, USA
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  • Michelino Di Rosa
    Affiliations
    Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Catania, Italy
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  • Michele Vecchio
    Correspondence
    Corresponding author: Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania. Residency Program in Physical Medicine and Rehabilitation - University of Catania, via S. Sofia 78, 95123 Catania, Italy. Tel.: +39(0)3782703.
    Affiliations
    Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania. Catania, Italy

    Rehabilitation Unit, "AOU Policlinico G. Rodolico", Catania, Italy
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Published:December 28, 2021DOI:https://doi.org/10.1016/j.jht.2021.11.003

      Highlights

      • Cyclists experience direct and indirect osteoarticular traumas and compression neuropathies from extreme repetitive and sustained compressive force on the volar wrist.
      • Despite the range of treatment available for peripheral neuropathies, a unique and common protocol is lacking on this specific topic
      • The first strategies to avoid peripheral neuropathies or reduce the initial symptoms are preventive strategies, period of rest since the beginning of the symptomatology, rehabilitation training with muscle strengthening, orthoses especially at night.
      • Symptoms refractory to conservative treatment (preventive strategies and rehabilitation) should be treated with pharmacological or surgical approach.

      Abstract

      Background

      Recreation, transportation and sport are the most common uses of bicycles. Unfortunately, repetitive bicycle use can also cause injuries, such as osteoarticular direct and undirect traumatisms and sometimes compression nerve entrapment caused by an extrinsic compressive force.

      Purpose

      The aim of the study is to define diagnostic process, preventive strategies, and treatment of ulnar and median neuropathies in cyclists.

      Study Design

      Systematic review.

      Methods

      A search was conducted on PubMed, EMBASE, the Cochrane Library, and Web of Science. Two reviewers independently reviewed articles and came to a consensus about which ones to include. The authors excluded all duplicates, articles involving individuals with other sport-related injuries than cycling, and articles unrelated to peripheral neuropathies. Articles were included if hand palsy was due to peripheral compression of ulnar or median nerve in cyclists.

      Results

      The search identified 15,371 articles with the keywords “Peripheral Nervous System Diseases” OR “neuropathy” OR “ulnar palsy” OR “median palsy” AND “bicycling” OR “bike” OR “bicycle” OR “cyclist”. The reviewers analyzed 48 full texts. There were 20 publications that met the criteria and were included in the systematic review. These articles were used to describe the main methods used for diagnosis, prevention and treatment of hand neuropathy of cyclists.

      Conclusion

      Despite the range of treatment available for peripheral neuropathies, a unique and common protocol is lacking on this specific topic. For this reason, we delineate a definitive recovery protocol to show the best therapeutic methodologies present in the current literature. Preventive strategies, period of rest since the beginning of the symptomatology, rehabilitation training with muscle strengthening, orthoses at night are the first strategies, but if the symptoms persist, pharmacologic treatment and eventual surgical decompression are sometimes the unique solution.

      Keywords

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      JHT Read for Credit

      Quiz: # 847

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
      • # 1.
        The study design is
        • a.
          RCTs
        • b.
          systematic review
        • c.
          qualitative
        • d.
          prospective cohort
      • # 2.
        All selected articles dealt with
        • a.
          carpal tunnel syndrome
        • b.
          cubital tunnel syndrome
        • c.
          radial tunnel syndrome
        • d.
          compressive peripheral neuropathies involving the hand
      • # 3.
        The literature showed
        • a.
          a consensus as to best practices in treating this class of cases
        • b.
          only one commonality across all studies
        • c.
          no common management protocol
        • d.
          that hand therapy is of little to no therapeutic benefit
      • # 4.
        One important preventive strategy is
        • a.
          carbohydrate loading before cycling
        • b.
          ergonomic positional considerations when cycling
        • c.
          ride fixed gear cycle when training
        • d.
          low dose steroids during training
      • # 5.
        The first line of management at the onset of symptoms is rest from function
        • a.
          true
        • b.
          false
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.