Abstract
Bowler’s thumb is a rare traumatic neuropathy of the ulnar digital nerve of the thumb. We present a case of bowler’s thumb in a 21-year-old male recreational bowler who presented with a painful mass on the ulnar side of the right thumb. Magnetic resonance (MR) imaging of the hand was inconclusive. However, subsequent ultrasound (US) showed asymmetric enlargement of the ulnar digital nerve of the thumb with marked epineural thickening corresponding to the palpable mass, confirming the clinical diagnosis of bowler’s thumb. Although this condition is typically diagnosed clinically, imaging can help to clarify clinical findings. In our experience, MR imaging is a clinician’s preferred choice when further evaluating physical findings of digital nerve pathology despite the lack of evidence to support MR as a primary imaging modality for these patients. This case illustrates the role that US can play as an initial imaging modality for the evaluation of small peripheral nerves.
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References
Halsey JN, Therattil PJ, Viviano SL, Fleegler EJ, Lee ES. Bowler’s thumb: case report and review of the literature. Eplasty. 2015;15:e47.
Chen CC, Chien HF, Chen CL. Compression neuropathy of the ulnar digital nerves in the thumbs of a massage therapist. Ann Plast Surg. 2014;72:649–51.
Muramatsu K, Yoshida K, Taguchi T. Two different types of bowler’s thumb. Orthopedics. 2009;32:525.
Swanson S, Macias LH, Smith AA. Treatment of bowler’s neuroma with digital nerve translocation. Hand (N Y). 2009;4:323–6.
Ostrovskiy D, Wilbourn A. Acute bowler’s thumb. Neurology. 2004;63:938.
Suk JI, Walker FO, Cartwright MS. Ultrasonography of peripheral nerves. Curr Neurol Neurosci Rep. 2013;13:328.
Toros T, Karabay N, Ozaksar K, Sugun TS, Kayalar M, Bal E. Evaluation of peripheral nerves of the upper limb with ultrasonography: a comparison of ultrasonographic examination and the intra-operative findings. J Bone Joint Surg Br. 2009;91:762–5.
Koenig RW, Pedro MT, Heinen CP, et al. High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neurosurg Focus. 2009;26:E13.
Chalian M, Behzadi AH, Williams EH, Shores JT, Chhabra A. High-resolution magnetic resonance neurography in upper extremity neuropathy. Neuroimaging Clin N Am. 2014;24:109–25.
Chhabra A, Williams EH, Wang KC, Dellon AL, Carrino JA. MR neurography of neuromas related to nerve injury and entrapment with surgical correlation. AJNR Am J Neuroradiol. 2010;31:1363–8.
Ohana M, Moser T, Moussaouï A, et al. Current and future imaging of the peripheral nervous system. Diagn Interv Imaging. 2014;95:17–26.
Siegel IM. Bowling-thumb neuroma [letter]. JAMA. 1965;192:263.
Belsky MR, Millender LH. Bowler’s thumb in a baseball player: a case report. Orthopedics. 1980;3:122–3.
Thirupathi R, Forman D. The jeweller’s thumb: an occupational neuroma. A case report. Orthopedics. 1983;6:438–40.
De Smet L, Van Ransbeeck H, Fabry G. Bowler’s thumb treated by translocation of the digital nerve. Acta Orthop Belg. 1999;65:367–8.
Lee KS. Musculoskeletal sonography of the tendon. J Ultrasound Med. 2012;31:1879–84.
Chhabra A, Andreisek G, Soldatos T, et al. MR neurography: past, present, and future. AJR Am J Roentgenol. 2011;197:583–91.
Nazarian LN. The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI. AJR Am J Roentgenol. 2008;190:1621–6.
Lee FC, Singh H, Nazarian LN, Ratliff JK. High-resolution ultrasonography in the diagnosis and intraoperative management of peripheral nerve lesions. J Neurosurg. 2011;114:206–11.
Ng ES, Vijayan J, Therimadasamy AK, et al. High resolution ultrasonography in the diagnosis of ulnar nerve lesions with particular reference to post-traumatic lesions and sites outside the elbow. Clin Neurophysiol. 2011;122:188–93.
Padua L, Di Pasquale A, Liotta G, et al. Ultrasound as a useful tool in the diagnosis and management of traumatic nerve lesions. Clin Neurophysiol. 2013;124:1237–43.
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We acknowledge ultrasound technologist Amy Cottrell, RT, for her contributions and Megan Griffiths for editing assistance.
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Wajid, H., LeBlanc, J., Shapiro, D.B. et al. Bowler’s thumb: ultrasound diagnosis of a neuroma of the ulnar digital nerve of the thumb. Skeletal Radiol 45, 1589–1592 (2016). https://doi.org/10.1007/s00256-016-2469-5
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DOI: https://doi.org/10.1007/s00256-016-2469-5