Bowler's thumb is a rare traumatic neuropathy that affects the ulnar digital nerve underneath the soft tissue of the thumb.
While practicing, the bowling thumbhole of the ball creates a repetitive frictional irritation in the ulnar soft tissues of the bowlers. In the chronic condition, it causes perineural fibrosis.
The clinical presentation of Bowler's thumb is typically localized pain and tenderness with other nerve-related disorders. Lack of awareness can cause permanent damage to the ulnar digital nerve.
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Bowler's thumb symptoms
Following are the symptoms associated with Bowler's thumb:
- A tingling sensation in the first webspace. This tingling sensation gets worse when an individual is least active, e.g. bedtime.
- Pain and inflammation in the first interphalangeal joints.
- Numbness in the first webspace between thumb and index finger clinically termed as paresthesias. In chronic cases, severe numbness in the affected region can affect individual’s daily activity.
- Gradually the paresthesias condition becomes painful along the medial thumb surface due to the extension of the condition in the distant adjoining parts.
- The space of thumb-index finger becomes sensitive to pain and the complete surrounding area may develop hyperesthesia - a neurological condition which increases stimulus-induced skin sensitivity.
- In a worsening condition, increased sensitivity causes the development of pain even against a non-noxious stimulus. Pain can then occur as a response to pressure, touch, and vibration.
- Pain sensation at the first web space and inner area of thumb. The nature of pain may vary - it can be pressure pain, spontaneous pain or pain felt during movement of the hand rather than the thumb.
- Difficulties performing activities involving thumb, such as pinching or griping, due to weakness.
- While touching the affected area, a palpable tiny mass or tender nodule can be noticed beneath the thumb at the proximal phalanx level. The nature of the mass is mobile and presence of this mass often causes enlargement of the ulnar digital nerve.
- Edema may develop due to local abnormal blood flow.
Bowler's thumb is a chronic condition, so the symptoms are persistent for a longer period. However, an acute condition with similar symptoms may also develop even after practicing or performing in a single match. This happens when acute neuropathy affects the ulnar digital nerve in the thumb muscular tissue.
Although the clinical presentation is similar, acute condition can be differentiated from bowler’s thumb because the symptoms are temporary and get resolved after a period of inactivity. This is due to different underlying causes of the acute and chronic condition.
While neurapraxia or axonotmesis are present in case of an acute condition, in a chronic condition scaring and fibrosis affect the ulnar digital nerve with or without neuroma.
Reviewed by: Antonia Stanojević, BA, MA