Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Bowler’s Thumb

SYMPTOMS

There is paraesthesia and decreased sensation in the thumb.

AETIOLOGY

This injury is a compression neuropathy of the ulnar digital nerve of the thumb, for example from using a bowling ball with finger holes that one too small. A neuroma can develop, causing permanent symptoms.

CLINICAL FINDINGS

Positive Tinel’s sign and decreased sensation over the thumb. Compare with the other side.

INVESTIGATIONS

This is a clinical diagnosis. An X-ray would be normal.

TREATMENT

Avoid compression of the thumb temporarily, to see whether symptoms disappear. Adjust technique and size of finger holes to avoid
further damage to the nerve.

REFERRALS

If the symptoms persist, refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon to consider surgical nerve release.

EXERCISE PRESCRIPTION

Normal activities may be continued throughout healing in some sports. In precision sports like bowling, a period of less competing and training may be indicated. Running, cycling and water exercises (when the wound is healed after surgery) are good alternatives to keep up general fitness. Gym training can be maintained.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and a negative Tinel’s sign.

DIFFERENTIAL DIAGNOSES

This is a clinical diagnosis even though MRI might identify a neuroma.

PROGNOSIS

Excellent, if treated appropriately. If it is missed, surgery can be performed at a later stage.

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