LETTERS
patient's occupation. Clinical and ultrasound examination, including examination of the tendon extensor mechanism, showed no functional impairment. The exostosis was located much more radially than dorsally, and therefore, directly underlying the area of pressure uptake. However, the small photographs in our clinical image report may not serve to illustrate the dynamic nature of the vibrations which resulted in motions toward the radial side of the finger. We now provide a picture that indicates more precisely the close relationship in this case (Figure 1).
Based on the history, clinical, and radiologic findings taken together, we firmly believe that continued vibration traumata are very likely to have caused this exostosis, leading to "drummer's finger" as stated previously. It is widely accepted that an initial stimulus, often related to trauma, is common in lesions like this. In this case, repeated microtraumata may well be the initial stimulus for the proliferative process observed, especially since a sharp trauma or any other traumatic event would not have gone unnoticed by a professional drummer. Although direct evidence is difficult to provide, we strongly prefer this interpretation rather than to think that the occurrence of exostosis in a drummer was purely coincidental in this case.