Acute handlebar syndrome: Two extremes of a challenging diagnosis

BACKGROUND: Ulnar nerve mononeuropathy diagnosis can be challenging depending on where neural lesion is present. Repetitive trauma during cycling is a rare cause of ulnar neuropathy. CASE DESCRIPTION: We describe two patients who developed the handlebar syndrome, an ulnar nerve palsy at Guyon’s canal after cycling. The first patient had the syndrome after a short-distance ride and she was treated surgically, while the second patient developed the classical syndrome after a long ride and received conservative treatment. Surgical treatment of the first patient led to functional recovery. CONCLUSION: Handlebar syndrome is a neuropathy caused by extrinsic repetitive compression of ulnar nerve at wrist. Increasing incidence of this disease can be expected after increasing popularity of cycling sports. Avoid of repetitive trauma is the main management goal, with surgical treatment reserved for failure of conservative treatment.