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Neurological hand injuries in bowling

This is an excerpt from Handbook of Neurological Sports Medicine by Anthony Petraglia,Julian Bailes & Arthur Day.

Bowling can be traced back more than 5,000 years ago to Egypt. In the 1930s, a British anthropologist named Sir Flinders Petrie discovered a collection of objects in a child's tomb in Egypt that appeared to have been used for a primitive form of bowling. A crude version of a bowling ball and primitive pins were all sized for a child. A similar game evolved during the Roman Empire that entailed tossing stone objects as close as possible to other stone objects. This game became popular with soldiers and eventually evolved into Italian bocce (considered a form of outdoor bowling). The game has continued to evolve and today is a sport enjoyed by more than 100 million people in more than 90 countries each year and is considered a timeless sport.[ 97]

Although not typically thought of as a sport with a high risk of injury, bowling can be both physically and psychologically demanding. Tremendous force is applied to the body throughout a bowler's stance, approach, pivot step, arm swing, release, and follow-through. Repetitive stress is applied to the entire upper extremity including the fingers, wrist, and elbow. Injuries may vary by age as well. A recent study examined bowling-related injuries presenting to U.S. emergency departments between 1990 and 2008.[ 162] The authors analyzed data from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System and found that children younger than 7 years had a higher proportion of finger injuries and injuries from dropping the ball than individuals older than 7 years. On the other hand, bowlers more than 65 years old sustained a greater proportion of injuries related to falling, slipping, or tripping.

While the annual incidence of injury is extremely low, the sport can cause a spectrum of neurologic hand and upper extremity injuries, either acute or due to overuse. Injuries to the fingers and digital nerves can occur. One report described a bowler with a rare traumatic dislocation of the four long fingers.[197] More commonly, though, the repetitive nature of bowling can lead to injuries to the digital nerve of the thumb, which most bowlers place inside the ball holes; this is referred to as "cherry pitter's thumb"[337] (figure 1.2). Perineural fibrosis of the digital nerve of the thumb[297, 351] and even cases of thumb neuromas have been described.[164, 165] Dobyns and colleagues reported on one of the largest series of these patients.[78] Patients may present with a positive Tinel's sign and skin atrophy or callusing over the neuroma. The nerve may ultimately become atrophied with fibrous tissue proliferation at the site of injury. Not to be forgotten, neck and back pain can also occur in bowling and is often the result of discogenic injury.[ 228]

Bowler's thumb. This patient was taken to surgery because he did not respond to conservative therapy after a clinical diagnosis of bowler's thumb. At surgery, the digital nerve was markedly enlarged secondary to perineural fibrosis. (a) The enlarged ulnar digital nerve (arrows) is surrounded by perineural fibrosis producing an irregular rather than a normal smooth contour. Definitive surgical therapy consisted of neurolysis with careful removal of perineural fibrotic tissue. (b) The nerve is smaller and has a smoother contour following neurolysis. The patient had an uneventful postoperative course and was able to eventually return to bowling.

Reprinted from M.F. Showalter, D.H. Flemming, and S.A. Bernard, 2010, "MRI manifestations of bowler's thumb," Radiology Case Reports 6: 458. By permission of D.H. Flemming.

Read more from Handbook of Neurological Sports Medicine by Anthony L. Petraglia, Julian E. Bailes, and Arthur L. Day.

More Excerpts From Handbook of Neurological Sports Medicine