Massage therapy · Kitchener–WaterlooBowler's Thumb

Bowler's thumb happens when a nerve in the thumb is repeatedly squeezed and rubbed, leading to irritation and scar tissue around the nerve (perineural fibrosis) (Showalter, Flemming and Bernard, 2011). It usually develops when the side of the thumb presses against the edge of the bowling ball's thumb hole again and again, and a thumb hole that is the wrong size or position can make this worse (Showalter, Flemming and Bernard, 2011; Halsey et al., 2015). The nerve affected gives feeling to the side of the thumb, so one of the most common symptoms is numbness in the thumb.

Apart from numbness, there may also be pain or tingling on the inner part of the thumb (the side next to the index finger) and the web between the index finger and the thumb. Some people find it harder to grip or pinch things. In some cases, a tender lump can be felt on the thumb (Showalter, Flemming and Bernard, 2011; Halsey et al., 2015).

The name comes from the sport of ten-pin bowling, where the condition is most often seen. Over time, the repeated friction can cause scar tissue to build up around the nerve, which can cause symptoms even when you are not bowling.

Bowler's Thumb Anatomy

How to Treat Bowler's Thumb

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• Try altering your grip, or have the edge of the bowling ball's thumb hole rounded.
• Make sure the thumb hole fits well, so that it does not rub or press on the side of your thumb.
• Use a thumb guard to help protect the thumb when playing the game.

Bowler's thumb comes from the edge of the thumb hole pressing on a small nerve along the inside of your thumb, again and again. Taking that pressure off is the most important part of getting better, so my aim is to help you do that, keep your hand moving and strong, and get you back to bowling comfortably.

I start by assessing your thumb and hand: feeling along the thumb, grip and pinch strength, how your thumb and wrist move, and the muscles of your hand and forearm. I also check further up the arm and neck, because numbness or tingling in the hand can come from higher up, and I ask about your ball, your grip and how often you bowl.

Taking the Pressure Off

• Cutting back bowling while the nerve settles, while keeping the rest of your activities going
• Talking through your ball fit, thumb-hole size and grip, so you know what to check with your coach or pro shop
• Helping you work out what thumb guard or protection might suit you and how to get it

Hands-On Treatment

• Gentle work for the muscles at the base of the thumb, the hand and the forearm, keeping firm pressure off the tender spot on the thumb
• Gentle joint mobilisation for a stiff thumb or wrist
• Nerve glides: gentle movements that help the nerve slide, kept well within comfort

Strength and Return to Bowling

1. Showalter, M.F., Flemming, D.J. and Bernard, S.A. (2011) 'MRI manifestations of bowler's thumb', Radiology Case Reports, 6(1), 458. doi: 10.2484/rcr.v6i1.458
2. Halsey, J.N., Therattil, P.J., Viviano, S.L. et al. (2015) 'Bowler's thumb: case report and review of the literature', ePlasty, 15, e47.