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Eplasty. 2015 Oct 24;15:e47. eCollection 2015.

Bowler's Thumb: Case Report and Review of the Literature.

Author information

1
Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark.
2
Department of Veterans Affairs New Jersey Health Care System, East Orange.
3
Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark ; Department of Veterans Affairs New Jersey Health Care System, East Orange.

Abstract

OBJECTIVE:

Traumatic neuropathy of the ulnar digital nerve of the thumb occurs in patients who undergo chronic frictional irritation of the nerve. The condition is aptly termed bowler's thumb, as it commonly afflicts patients who bowl and keep their thumb in the ball for an extended period of time. It is a pathology that rarely appears in the literature and for which standard treatment is unclear.

METHODS:

A 68-year-old man with a history of avid bowling presented with a chief complaint of left thumb numbness and tingling for several months. Physical examination demonstrated a small tender mass along the ulnar surface of the left thumb with a positive Tinel's sign and diminished 2-point discrimination distal to the mass. The patient's symptoms did not improve with conservative measures. Here, we describe his surgical treatment and review the current literature.

RESULTS:

Our patient underwent neurolysis of the ulnar digital nerve of the thumb, with placement of a porcine extracellular matrix nerve wrap. The patient reported improvement of symptoms within 2 weeks and was able to return to his previous level of activity. In the literature, treatment has included from conservative measures such as pressure relief and splinting to surgical intervention including neurolysis, transposition, or neurectomy with nerve grafting.

CONCLUSIONS:

We present neurolysis for treating bowler's thumb as a viable option that may relieve symptoms rapidly while obviating need for adductor transection. Porcine extracellular matrix nerve wrap can be placed in an attempt to prevent recurrence of neuroma, but long-term follow-up is necessary.

KEYWORDS:

bowler’s neuroma; bowler’s thumb; digital neuroma; nerve wrap; thumb neuroma

PMID:
26528379
PMCID:
PMC4623560

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