Evaluation for ulnar neuropathy at the elbow in Ironman triathletes: physical examination and electrodiagnostic evidence

Objective: Evaluation of the elbow in Ironman triathletes for ulnar compression neuropathy caused by aerobar use.

Design: Descriptive laboratory study.

Setting: Ironman California 70.3, Ironman Arizona, Ironman New Orleans 70.3, San Antonio, Texas.

Participants: Study 1: (n = 712) Ironman California 70.3/Ironman Arizona participants. Study 2: (n = 54) Ironman New Orleans 70.3 finishers. Study 3: (n = 11) participants training for an Ironman triathlon.

Interventions: Pilot questionnaire (study 1). Pilot questionnaire and prerace and postrace physical examination (study 2). Pilot questionnaire and preride and postride (and postseason) physical examination, and electrodiagnostic testing (study 3).

Main outcome measures: Participants with symptoms, physical examination findings, and electrodiagnostic findings (amplitude or conduction velocity decrease) (P < 0.05).

Results: In study 1, 20.8% reported a history of ulnar symptoms. In study 2, 35.2% reported a history of ulnar symptoms. Preevent physical examination testing of the elbow showed 39.5% with positive Tinel sign and 41.5% with positive flexion/compression test. Postevent testing showed 70.4% with positive Tinel sign and 75.9% with positive flexion/compression test. In study 3, 46% reported ulnar symptoms. Preride physical examination testing showed 4.5% with positive Tinel sign and 9% with positive flexion/compression test. Postride testing showed 95.5% with positive Tinel sign and 91% with positive flexion/compression test. Postseason testing showed 64% with positive Tinel sign and 82% with positive flexion/compression test. Electrodiagnostic testing comparing preride and postride showed that ulnar nerve latency increased in 82%, amplitude decreased in 50%, and conduction velocity slowed in 64%. Electrodiagnostic testing comparing preseason and postseason showed that ulnar nerve latency increased in 73%, amplitude decreased in 64%, and conduction velocity slowed in 82%.

Conclusions: The findings support the hypothesis of an ulnar compression neuropathy at the elbow occurring at high rates in aerobar using Ironman triathletes.