The Buttered Knuckles of the Martial Arts World – A Comprehensive Review on Boxer’s Knuckle

Karolina Szala-Czerwonka; Adrian Rejmer; Natalia Woś; Katarzyna Rojek; Lucjan Bednarz; Karolina Wijas; Kinga Bialic; Rafał Bakalarczyk; Artur Bialic; Paweł Majewski

doi:10.12775/JEHS.2023.29.01.007

Authors

Karolina Szala-Czerwonka Uniwersytecki Szpital Kliniczny im. Fryderyka Chopina w Rzeszowie, 35-055 Rzeszów ul. Szopena 2 https://orcid.org/0009-0001-8545-9237
Adrian Rejmer Samodzielny Publiczny Zespół Zakładów Opieki Zdrowotnej w Kozienicach, Al. Gen. Wł. Sikorskiego 10 26-900 Kozienice, Poland https://orcid.org/0000-0002-1248-4941
Natalia Woś Uniwersytecki Szpital Kliniczny im. Fryderyka Chopina w Rzeszowie, ul. Szopena 2, 35-055 Rzeszów, Poland https://orcid.org/0009-0002-9212-2664
Katarzyna Rojek Samodzielny Publiczny Szpital Kliniczny Nr 4 w Lublinie, ul. Doktora Kazimierza Jaczewskiego 8, 20-954 Lublin, Poland https://orcid.org/0009-0004-3691-3669
Lucjan Bednarz Uniwersytecki Szpital Kliniczny im. Fryderyka Chopina w Rzeszowie https://orcid.org/0009-0001-3213-3508
Karolina Wijas Samodzielny Publiczny Zakład Opieki Zdrowotnej w Świdniku https://orcid.org/0009-0000-7776-8446
Kinga Bialic Kliniczny Szpital Wojewódzki Nr 2 im. Św. Jadwigi Królowej w Rzeszowie https://orcid.org/0009-0009-4029-5919
Rafał Bakalarczyk Wojewódzki Szpital Specjalistyczny im. Stefana Kardynała Wyszyńskiego Samodzielny Publiczny Zakład Opieki Zdrowotnej w Lublinie, Al. Kraśnicka 100, 20-718 Lublin, Poland https://orcid.org/0009-0008-8788-8503
Artur Bialic Kliniczny Szpital Wojewódzki Nr 2 im. Św. Jadwigi Królowej w Rzeszowie, ul. Lwowska 60, 35-301 Rzeszów, Poland https://orcid.org/0009-0008-9148-8801
Paweł Majewski Wojewódzki Szpital Specjalistyczny im. Stefana Kardynała Wyszyńskiego Samodzielny Publiczny Zakład Opieki Zdrowotnej w Lublinie, Al. Kraśnicka 100, 20-718 Lublin, Poland https://orcid.org/0009-0000-4624-3129

DOI:

https://doi.org/10.12775/JEHS.2023.29.01.007

Keywords

boxer's knuckle, mcp, metacarpophalangeal, joint, capsule, punching

Abstract

Introduction:

Boxer's knuckle is a common injury that occurs due to repetitive trauma to the hand, often seen in those who engage in boxing or other similar combat sports. It is a painful condition that can cause swelling, tenderness, and limited movement in the affected area. In some cases, boxer's knuckle can be severe enough to require medical attention and even surgery. This injury can have a significant impact on an athlete's training and overall performance, and it is important to take preventative measures to avoid its occurrence. Understanding the causes, symptoms, and treatment options for boxer's knuckle is essential for any athlete who regularly engages in combat sports or any activity that involves repeated hand trauma.

Objective of the study:
The objective of this review study is to analyze and summarize the literature related to boxer's knuckle, including its epidemiology, pathophysiology, clinical features, diagnosis, and management. The study aims to provide a comprehensive understanding of the condition, its causes, risk factors, and treatments, and to identify the gaps and limitations in the existing literature. Furthermore, this review intends to provide evidence-based recommendations and guidelines for the prevention, assessment, and treatment of boxer's knuckle in athletes and other individuals who are at risk of developing the condition. Ultimately, the study seeks to contribute to the development of a more precise and effective approach to managing this common hand injury.

Material and methods:

Review of PubMed articles using the following keywords: “mcp joint rupture boxing”, “boxer's knuckle”, “metacarpophalangeal joint boxing”, “extensor hood injuries”. Additionally, related articles proposed by the PubMed website were checked. Single citations that were not in the PubMed database but, in the opinion of the authors, contained valuable knowledge worthy of inclusion in the article were also reviewed.

References

Arai K, Toh S, Nakahara K, Nishikawa S, Harata S. Treatment of soft tissue injuries to the dorsum of the metacarpophalangeal joint (Boxer's knuckle). J Hand Surg Br. 2002 Feb;27(1):90-5. doi: 10.1054/jhsb.2001.0656. PMID: 11895354.

Nagaoka M, Satoh T, Nagao S, Matsuzaki H. Extensor retinaculum graft for chronic boxer's knuckle. J Hand Surg Am. 2006 Jul-Aug;31(6):947-51. doi: 10.1016/j.jhsa.2006.02.027. PMID: 16843154.

Posner MA, Ambrose L. Boxer's knuckle--dorsal capsular rupture of the metacarpophalangeal joint of a finger. J Hand Surg Am. 1989 Mar;14(2 Pt 1):229-36. doi: 10.1016/0363-5023(89)90011-7. PMID: 2703667.

Kanerva L. Knuckle pads from boxing. Eur J Dermatol. 1998 Jul-Aug;8(5):359-61. PMID: 9683870.

Melone CP Jr, Polatsch DB, Beldner S. Disabling hand injuries in boxing: boxer's knuckle and traumatic carpal boss. Clin Sports Med. 2009 Oct;28(4):609-21,vii. doi: 10.1016/j.csm.2009.06.004. PMID: 19819405.

GLADDEN JR. Boxer's knuckle; a preliminary report. Am J Surg. 1957 Mar;93(3):388-97. doi: 10.1016/0002-9610(57)90828-0. PMID: 13403057.

Drury BT, Lehman TP, Rayan G. Hand and Wrist Injuries in Boxing and the Martial Arts. Hand Clin. 2017 Feb;33(1):97-106. doi: 10.1016/j.hcl.2016.08.004. PMID: 27886844.

Javed M, Hemington-Gorse S, Shokrollahi K. A new recreational mechanism for the boxer's knuckle: cause for concern? Ann R Coll Surg Engl. 2011 Jul;93(5):e55-6. doi: 10.1308/147870811X583250. PMID: 21943451; PMCID: PMC5827219.

Matharu GS, Gatt IT, Delaney R, Loosemore M, Hayton MJ. Extensor hood injuries in elite boxers: injury characteristics, surgical technique and outcomes. J Hand Surg Eur Vol. 2022 Dec;47(11):1162-1167. doi: 10.1177/17531934221123139. Epub 2022 Sep 15. PMID: 36112963; PMCID: PMC9727113.

Watté N, Walschot L, Vanhoenacker F. Boxer's Knuckle. J Belg Soc Radiol. 2021 Nov 22;105(1):79. doi: 10.5334/jbsr.2620. PMID: 34901740; PMCID: PMC8622069.

Loosemore M, Lightfoot J, Gatt I, Hayton M, Beardsley C. Hand and Wrist Injuries in Elite Boxing: A Longitudinal Prospective Study (2005-2012) of the Great Britain Olympic Boxing Squad. Hand (N Y). 2017 Mar;12(2):181-187. doi: 10.1177/1558944716642756. Epub 2016 Jul 8. PMID: 28344531; PMCID: PMC5349401.

Stracher M, Posner MA. Boxer's Knuckle. Tech Hand Up Extrem Surg. 2002 Dec;6(4):196-9. doi: 10.1097/00130911-200212000-00007. PMID: 16520601.

Leon Lam W, Bruyere A, Leclerc:1105-1106. doi: 10.1177/1753193420934072. Epub 2020 Jun 26. PMID: 32588711.

Bents RT, Metz JP, Topper SM. Traumatic extensor tendon dislocation in a boxer: a case study. Med Sci Sports Exerc. 2003 Oct;35(10):1645-7. doi: 10.1249/01.MSS.0000089340.89660.EB. PMID: 14523299.

Tomori Y, Ohashi R, Naito Z, Nanno M, Takai S. Florid reactive periostitis in the fifth phalange of a professional boxer: A case report. Medicine (Baltimore). 2016 Dec;95(51):e5697. doi: 10.1097/MD.0000000000005697. PMID: 28002343; PMCID: PMC5181827.

Ghazi M. Rayan, David Murray,Classification and treatment of closed sagittal band injuries, The Journal of Hand Surgery, Volume 19, Issue 4, 1994, Pages 590-594, ISSN 0363-5023, https://doi.org/10.1016/0363-5023(94)90261-5.

Hussain MH, Ghaffar A, Choudry Q, Iqbal Z, Khan MN. Management of Fifth Metacarpal Neck Fracture (Boxer's Fracture): A Literature Review. Cureus. 2020 Jul 28;12(7):e9442. doi: 10.7759/cureus.9442. PMID: 32864266; PMCID: PMC7451089.

Kichouh M, De Maeseneer M, Jager T, Marcelis S, Van Hedent E, Van Roy P, De Mey J. Ultrasound findings in injuries of dorsal extensor hood: correlation with MR and follow-up findings. Eur J Radiol. 2011 Feb;77(2):249-53. doi: 10.1016/j.ejrad.2010.05.015. Epub 2010 Jun 20. PMID: 20566255.

Ferlemann K, Zilch H. Geschlossene Streckhaubenverletzungen am Grundgelenk der Langfinger [Closed injuries of the extensor hood of the metacarpophalangeal joint]. Unfallchirurgie. 1997 Dec;23(6):262-6. German. doi: 10.1007/BF02628923. PMID: 9483789.

Lin JD, Strauch RJ. Closed soft tissue extensor mechanism injuries (mallet, boutonniere, and sagittal band). J Hand Surg Am. 2014 May;39(5):1005-11. doi: 10.1016/j.jhsa.2013.11.018. PMID: 24766832.

Loosemore MJ, Ansdell ML, Charalambous CP, Harrison JW, Hayton MJ. Traumatic extensor hood rupture. Hand (N Y). 2009 Jun;4(2):177-9. doi: 10.1007/s11552-008-9154-7. Epub 2008 Dec 19. PMID: 19096895; PMCID: PMC2686793.

Scalcione LR, Pathria MN, Chung CB. The athlete's hand: ligament and tendon injury. Semin Musculoskelet Radiol. 2012 Sep;16(4):338-49. doi: 10.1055/s-0032-1327007. Epub 2012 Oct 9. PMID: 23047281.

Newport ML, Shukla A. Electrophysiologic basis of dynamic extensor splinting. J Hand Surg Am. 1992 Mar;17(2):272-7. doi: 10.1016/0363-5023(92)90404-d. PMID: 1564273.q C. An unusual presentation of Boxer's knuckle in the little finger: a case report. J Hand Surg Eur Vol. 2020 Dec;45(10):1105-1106. doi: 10.1177/1753193420934072. Epub 2020 Jun 26. PMID: 32588711.