Common in ten-pin bowlers, and the bowling hand takes the strainEmerging evidence
A ten-pin ball weighs up to 16 pounds (about 7.3 kg), and adult bowlers mostly use 10 to 15 pounds. It is "gripped using only the thumb, middle and ring fingers", swung and released, and to make it hook "this requires releasing the ball exclusively via a wrist action", as the authors of the one study of elite bowlers' wrists put it. In that study, of all 39 bowlers in Malaysia's national and back-up squads (average age 24, 21 women, bowling about 5 sessions a week of over 2 hours), 66.7% had had symptoms at the wrist of the bowling hand, 43.6% in the ring finger, 30.8% in the middle finger and 20.5% in the thumb; wrist pain was 59.0% in the bowling hand against 2.6% in the other.
On examination, 53.8% had de Quervain's, 5.1% carpal tunnel syndrome, 7.7% tennis elbow and 5.1% golfer's elbow, and a trigger ring finger was found in 12.8% by the study's table (5 bowlers), though its text says 3. It is a cross-sectional study of a small elite squad: it shows how common the problems were, not what caused them, and the examiners didn't test the little-finger side of the wrist.
In 101 elite US college bowlers (a survey with a 40.6% response), 87% reported an injury and "Upper-extremity injuries were the most common". A 1988 review put it this way (we read its abstract): "Bowling is not a physically taxing sport. But poor technique, the cumulative stress of pushing a heavy bowling ball thousands of times, or the wear and tear of poorly fitting equipment may produce or aggravate certain chronic conditions."
Sources 7, 1, 12, 21
Most injuries that reach hospital are falls and dropped ballsEmerging evidence
Injuries that need an emergency department are different from the aches of bowling. Of an estimated 375,468 bowling injuries in US emergency departments from 1990 to 2008, the finger was the commonest site (19.0%) and 42.7% were sprains or strains; children under 7 had more finger injuries (49.2%) and more injuries from dropping the ball (42.8%), and in bowlers aged 65 or over most injuries came from falls, slips or trips. From 2014 to 2023, falls were the leading cause (27.5%), the finger was 12.6% of injuries, 95% of people were treated and sent home, and adults had more overuse injuries than children or older adults. In bowlers aged 18 or under, the wrist was 8.6% of injuries, more often in teenagers and girls. Most aches after bowling never reach a clinic, so these figures are the tip of the pile.
Sources 5, 6, 13
Where it hurts: the thumb side, the little-finger side, the thumb and the fingersEmerging evidence
On the thumb side of the wrist, de Quervain's (irritated tendons at the base of the thumb) was the commonest finding in the elite bowlers. On the little-finger side, the usual causes in sport are the tendon along that edge (extensor carpi ulnaris) and the cartilage cushion beside it (the TFCC); a review describes the tendon as most strained with the palm turned up and the wrist bent and tipped towards the little finger, and an NHS hand clinic lists pain on that side and difficulty turning the forearm for the TFCC. That these are the little-finger-side causes in bowlers is our reading of general reviews: no bowling study has counted them, and the one study of bowlers' wrists found the thumb side commonest.
Bowler's thumb is a small nerve on the inner side of the thumb (the side facing the index finger), squeezed where the thumb presses the edge of the thumb hole: it causes tingling or numbness along the thumb and sometimes a tender lump. How often it happens is unknown. The middle and ring fingers carry the ball in the finger holes, and their joints and skin take the strain.
Sources 1, 2, 3, 17, 4, 14
When a scan helps, and when it misleadsEmerging evidence
Most wrist pain from bowling needs no scan; the exact spot of tenderness and the pattern sort it, as the NHS wrist pain page does by symptoms. An X-ray is needed after a fall on the hand, especially with pain at the base of the thumb (the scaphoid), and after a finger injury that may be broken. Scans of the little-finger side can mislead: an NHS hand clinic says "It is quite normal for these changes to occur, and most of the time the changes seen do not produce any symptoms or instability of the wrist".
A magnetic resonance imaging (MRI) scan matters when it would change the plan: an unstable joint, a tendon that snaps out of place, or pain that hasn't settled with good care. A deep ache in the heel of the hand can need a computed tomography (CT) or MRI scan for a hook of hamate fracture, as in the professional bowler's case. Bowler's thumb is diagnosed by examination: in one man the MRI showed nothing at the lump, while an ultrasound scan showed the nerve swelling in a 21-year-old recreational bowler, and nerve tests may be normal.
Sources 9, 17, 19, 4, 15
How it usually goesEmerging evidence
Aches settle in days. In the elite squad, wrist pain had lasted 1 to 6 months in 10 of 39 bowlers and more than 12 months in 1, and ring finger pain more than 12 months in 6; the authors noted that "a good number of these athletes bowled on, despite the awareness of their symptoms".
For bowler's thumb, "about half of affected patients appeared to show improvement of their symptoms with conservative management", those who stopped bowling improved more, and "all those who returned to bowling required some change in grip or thumb-hole placement"; a short-lived form after a single night of bowling is thought to settle on its own within months. For the TFCC, an NHS hand clinic says "The healing process takes around 3 months with this type of injury", and normal use often takes 6 to 12 months. No study has followed recreational bowlers with wrist pain over time, and no one can promise a date.
Sources 1, 4, 17
When it isn't bowling: the causes the warning signs cover
Some wrist and hand pain has causes bowling didn't create, and the warning signs follow the pages behind them. The NHS broken arm or wrist and broken finger or thumb pages give the signs of a break after a fall or a dropped ball, NHS inform's hand page adds the signs of an infection, and the NHS mallet finger page covers a fingertip that won't straighten. A sudden hot, swollen joint can be an infection, which the NHS septic arthritis page says needs urgent treatment, and the NHS compartment syndrome, stroke and heart attack pages give their 999 signs. Tingling in the thumb and fingers can be carpal tunnel syndrome, as the NHS page describes, and a catching thumb can be trigger thumb, as the NHS trigger finger page describes.
UK hand surgeons' standards and the national scaphoid pathway ask for a CT scan of a scaphoid fracture that wasn't kept still for more than 4 weeks, and say a wrist sprain that doesn't get better may be a more significant injury; a review and an orthopaedic surgeons' page cover a torn ligament between the wrist bones (the scapholunate ligament), which the review says is best repaired within four to six weeks. The wrist rule's limits come from an NHS wrist fracture booklet, an NHS hand-therapy leaflet on nerve glides, a review of TFCC tears and an NHS hand therapy leaflet on still holds.
Sources 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41
