WRIST AND HAND PAIN CYCLING
Steering, braking and shifting gears effectively while cycling requires our hands to be positioned as neutral as possible for leverage, control and comfort while seated, standing and sprinting. Poor positioning, form, technique or footwear can cause a range of issues such as mild discomfort, neuropathy, tendonitis and shoulder/neck soreness. The suggestions below assume well-fitting gloves with appropriate padding.
Contributing factors include but are not limited to:
Handlebar Choice
Road handlebar width should roughly match the width of the shoulder center points, often in a 380-460 mm width. A bar too wide can increase pressure on the Median nerve leading to hand pain or discomfort near the thumb/wrist connection. A bar too narrow can irritate the Median or Ulnar nerve as the hands tend to roll off the outside edge of the brake hoods. Road bars are offered in various shapes with different vertical drop, horizontal reach and ergonomic shape configurations.
Upright mountain/hybrid handlebars run wider for more stability over rough terrain usually in a 700-750 width and between 0 and 40 mm of rise to elevate the hands. These off-road bars also provide a slight inward bend of 3-10 degrees where the grips and controls mount which can produce a more neutral position for the wrists.
Triathlon and Time trial bars are available in a myriad of base bar and aerobar extension combinations. These setups tend to run narrow for aerodynamic advantages. Some of the straight or s-bend extension pipes although aerodynamic, can cause ulnar deviation as the thumb side of the wrist points into the wind leading to hand fatigue and possible ulnar nerve compression. A more functional but slightly less aero approach is a ski-bend aerobar design which keeps the wrist angles closer to neutral with the thumb sides of the wrists pointing up. 
Handlebar Position
Any handle bar positioned too far forward and/or too low can fatigue finger/hand/lower arm muscles from operating the controls and stabilizing the front end.
Handlebar Rotation
A handlebar rotated to far up can cause uncomfortable wrists in drops and brake hood discomfort if the bar is rotated too far down. A good rule of thumb is a bar drop position that maintains a wrist as neutral is possible balanced with a tops position that does the same.
Brake Hood/Lever Position
Road bike brake hood positions should feel natural, accessible and may be set differently from side to side to match a rider’s asymmetry. Tilting the hoods too far up increases pressure on hand webbing and impedes a rider’s ability to access the brake/shift levers when riding in the drops.
Mountain bike brake levers should be adjusted the lever blade is a continuation of the rider’s lower arm angle with as neutral a wrist as possible.
Most newer road and mountain brake levers have lever reach adjustments. Setting up the reach and cable tension appropriately reduces hand fatigue, especially for smaller hands.
Mountain bike levers can slide inboard from the end of the bar so the index and middle fingers wrap across the top of the levers at the first and second knuckles ready for brake activation
 Bar Wrap and Grips       
Road bike handlebar wrap that is too thin transmits more road vibration, increasing discomfort. Wrap that is too thick may reduce vibration but can cause premature hand fatigue as the squishier connection requires more hand/forearm work for stability. The same holds true for minimalist and squishy mountain bike grips. The dirt types may want to experiment with non-round grips. Ergonomic mountain grips offered by Bontrager, Ergon, PRO and Specialized provide a shelfed area toward the bar end, enlarging support and decreasing ulnar nerve/carpal tunnel pressure.
Saddle Position
A saddle set too far back increases handlebar reach which in turn requires more work by the hands and fingers to operate the brakes and shifters. Conversely, a saddle set too far forward causes the pelvis to slide forward increasing pressure on the heels of the hands as the rider unconsciously pushes on the bar to get the pelvis back.
A saddle set too high destabilizes the pelvis which in turn requires more upper body enlistment to control a bicycle. A saddle set too low, although not as problematic as one too high, robs the athlete of leverage which can cause a wrestling action in the front end when applying higher loads.
Shoes/Cleat Position/Foot Correction/Orthoses
Cycling shoe choice/setup can impact the hands and upper body.
  • Loose fitting shoes decrease foot stability in the shoe which can increase pelvic stability leading to unconsciousness upper body enlistment in an attempt to stability the hips
  • Tight fitting shoes cause pain in the toe box. A common strategy with tight shoes is to drop the heel to reduce toe box tension. This unconscious compensation reduces leverage and pushes the rider back on the saddle which may require increased hand and arm enlistment to shift weight forward and control the bar
  • Cleats too far forward, especially on a mountain or cyclocross bike, require more ankle stabilization when pedaling while standing. The feet being further back on the pedals can cause the rider to lean forward to keep the front end settled, putting more pressure on the hands
  • Cleats too far rearward may reduce the snap required for accelerations in short events and riding off road. A common strategy with this scenario is to enlist the hands and arms to grip/pull harder on the bar, leading to quicker fatigue
  • Uncomfortable feet in need of orthoses, shimming or foot correction wedging can destabilize the pelvis similar to poorly fitting shoes causing hand issues
Form/Technique Tip:
Assuming an overall quality position with optimized shoes, form and technique are important variables for hand, arm and upper body comfort. Drummers with a long shelf life understand the relevance of sitting with stable/comfortable form, using enough grip strength to grip a stick while being relaxed enough execute quick and dynamic movements regardless of the music genre. The same holds true for cycling. Use just enough strength to execute the task at hand be it cornering, climbing, sprinting, braking, drifting, shifting, jumping or holding a TT line into the wind. Avoid riding in the same position for prolonged periods. Micro movements when possible maintain blood flow and reduce tension. Avoid holding bar with nerve rich areas like the wrists and carpal tunnels. Function with control and the least hand effort needed, even when yanking on the bar in a sprint. Cycling with smooth form and subtle technique will reduce hand discomfort, reduce heartrate and increase your cycling career by making you a more stable and predictable rider.