By Dr. Charles P. Melone, Jr., M.D.
Hand injuries constitute a sports-specific epidemic in boxing and comprise a diverse spectrum of problems. Foremost among these is the “boxer’s knuckle”, an injury to the prominent metacarpophalangeal joints of the hand, traditionally termed the knuckles. Constantly used and often bused in the closed fist punching mechanism, the knuckles are highly vulnerable to injury that requires prompt detection and treatment.
The injury involves disruption of the extensor tendons and the supporting structures traversing the top of the knuckle and severely compromises the fighter’s ability to perform.
Diagnosis is readily established by examination, which demonstrates a painfully swollen knuckle with marked tenderness, a damaged extensor tendon and limited joint motion. A partial or incomplete tendon rupture is effectively treated by non-surgical methods including splinting, anti-inflammatory medication, ice, heat, physical therapy and occasionally local injections.
In contrast, the complete tendon rupture is optimally treated by surgical repair. In all cases, before the fighter resumes punching, the hand must be thoroughly healed and rehabilitated – a process that may encompass as long as three months.
As with all sports injuries, optimal management of the boxer’s hand must focus on innovative concepts of prevention. Improved training techniques, rotational hand taping and wrapping, anatomically designed protective devices for training, and enhanced safety features of gloves for bouts are necessary to lessen the incidence of potentially disabling hand injuries.
Dr. Charles P. Melone, Jr. resides and practices in New York, New York. He graduated from Georgetown University Medical School. He is Chief of Hand Surgery at Beth Israel Medical Center and Clinical Professor of Orthopedic Surgery at Albert Einstein College of Medicine. He began treating and operating on boxers some 25 years ago and is now a consultant to the Nevada State Athletic Commission, New York State Athletic Commission, as well as consultant in hand injuries to the New York Knicks, New York Yankees, New Jersey Devils, and the New Jersey Nets.