By Nita Sharma Das, ND, PhD
Bowler’s Thumb is a rare, neuropathic disease caused by long-term pressure on the ulnar digital nerve of the thumb. It can be relieved through resting the affected hand and taking analgesic medications such as aspirin.
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It is recommended that individuals with Bowler's thumb stop exerting excessive pressure on the ulnar digital nerve and discontinue any physical activity that can incite damage on the affected nerve.
Preventive measures for Bowler's Thumb
Early diagnosis and conservative treatment can provide a better prognosis for Bowler's Thumb. Numbness, pain or any other neurological symptoms on the thumb of bowlers, baseball players, cherry pitters, jewelers, and massage therapists, who have the highest risk of developing Bowler's Thumb, can be an early sign of the condition and therefore should not be neglected.
Besides a thorough analysis of patient's occupational and medical history assessment, there are several diagnostic techniques available to detect the bowler's thumb.
Clinicians usually ask for performing neurectomy, neurolysis, and transposition of the ulnar digital nerve to access the underlying cause of the condition. They may even conduct an MRI to evaluate the cause of the thumb mass. All these diagnostic tests are essential for early diagnosis and determining further therapeutic measures to prevent complications associated with Bowler's Thumb.
Preventing Bowler’s Thumb
There are several steps that can be taken to prevent the development of Bowler’s Thumb:
- Temporarily stopping all sports activities involving the use of the affected hand
- Wearing neoprene sleeves during blowing or other activity that is thought to cause bowler's thumb.
- Changing the thumb-hole position or griping style for professionals who want to continue their career, so that least pressure can generate in the ulnar digital nerve and minimize friction between ball and thumb.
- Usinga light-weight bowling ball and other tools known increase the risk of Bowler’s Thumb
Treatment for Bowler's Thumb
In most cases, Bowler's Thumb can be resolved by treatments such as pressure relief and adequate rest to the affected thumb. However, those who cannot rest should provide support to the ulnar digital nerve and may need surgery.
Neoprene sleeves are strongly suggested as an assistive device to relieve nerve compression. Splint and thumb guards are also recommended to guard the affected thumb against repetitive traumatic injury.
In the case of therapeutic measures failing to provide sufficient relief, surgical intervention becomes the only option to resolve Bowler's Thumb. In most cases, those who opt for surgical intervention can restart sports activities within a two year period. Some of the recommended surgical interventions for treating Bowler's Thumb are listed below:
- Resection of neuroma may or may not assemble with nerve grafting
- Ulnar digital nerve transposition
- Adductor pollicis transposition
Among the variety of surgical interventions, simple neurolysis can provide successful treatment outcomes for most cases. However, neurolysis may not provide permanent relief from Bowler's Thumb, as there is a risk of neuroma recurrence for those who continue to bowl after the injury has healed.
To avoid such recurrence, the clinicians recommend the use of an additional supportive medical device like nerve protector, which act as nerve guard and prevents trauma. A nerve wrap is a safe option other than vein wrap which covers around the compressed nerve to prevent neuronal degeneration, scar formation and also improve the nerve latency.
Ulnar digital nerve transposition is conducted by using 7-0 silk tacking sutures. This process is applied to provide an added guard to the ulnar digital nerve and to prevent direct traumatic vigor at the thumb.
In this process, the ulnar digital nerve is pulled more medially to provide a safeguard from pressure point. The underlying subcutaneous tissue or muscular tissue needs translocation which is made possible by suturing the subcutaneous tissue towards the epineural sheath.
In adductor pollicis transposition, adductor is divided and further repaired by rearranging nerve dorsal towards the muscle. This process is different from Ulnar digital nerve transposition because a bone anchor is used in this process instead of suturing the adductor.
Reviewed by: Antonia Stanojević, BA, MA