Boxer's Knuckle

Boxer's knuckle involves pain and weakness over the knuckle of an injured hand. The pain is due to injury of the tendon that straightens the finger (extensor tendon). Normally, a layer of tissue lies over the tendon to keep it in place. Damage to this tissue may allow the extensor tendon to move out of proper position (sublux). This causes the symptoms of boxer's knuckle. Boxer's knuckle often occurs at the first knuckle of the middle finger.

SYMPTOMS

  • Pain and tenderness over the injured knuckle.

  • Difficulty straightening the finger, without assistance.

  • Full passive motion of the finger (can be moved with assistance).

  • Swelling and warmth of the injured finger, over the knuckle.

CAUSES

Direct or repeated injury (trauma) to the knuckle, such as with boxing or martial arts, that causes damage to the extensor tendon or the tissue that holds it in place.

RISK INCREASES WITH:

  • Hitting or fighting sports (boxing, martial arts).

  • Contact sports (football, rugby).

  • Poor strength and flexibility.

  • Previous or concurrent injury to the knuckle.

PREVENTION

  • Maintain appropriate conditioning:

  • Hand and finger flexibility.

  • Muscle strength and endurance.

  • Wear protective equipment (padded gloves).

PROGNOSIS

This condition usually heals with splinting or surgery.

RELATED COMPLICATIONS

  • Permanent loss of full range of motion.

  • Stiffness of finger.

  • Weakness of the hand and finger.

  • Tendon rupture (tearing).

  • Arthritis of the joint.

  • Frequently recurring symptoms and repeated injury. Fixing the problem the first time may decrease the chances of recurrence and optimize healing time.

  • Longer healing time, if not treated properly.

  • Injury to other structures (bone, cartilage, tendon), and ongoing (chronic) unstableness.

  • Prolonged impairment (sometimes).

  • Risks of surgery: infection, injury to nerves (numbness, weakness), bleeding, or problem recurring after surgery.

TREATMENT

Treatment first involves restraining the joint, icing, and elevation of the finger, at or above heart level, to reduce inflammation. Medicines may be given for pain. Often, surgery is advised to repair the injured tissues. After surgery, restraint of the joint is achieved with a cast, brace, or splint. This may allow the tissues to heal. After restraint (with or without surgery), stretching and strengthening exercises are needed to regain complete use of the knuckle. Exercises may be completed at home or with the assistance of a therapist or athletic trainer. Return to sports is allowed after full range of motion and normal strength are achieved, usually after 4 months.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are usually prescribed only after surgery. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • Pain increases, despite treatment.

  • Any of the following occur after surgery:

  • Pain, numbness, or coldness in the finger.

  • Blue, gray, or dark color appears in the fingernails.

  • Signs of infection: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)