Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Sharma R, Alhusseiny K, et al. Boxer knuckle. Reference article, Radiopaedia.org (Accessed on 24 Apr 2024) https://doi.org/10.53347/rID-10773
Boxer knuckle (not to be confused with a boxer fracture) refers to an appearance when there is a disruption to the sagittal bands of the extensor hood, particularly over the metacarpophalangeal (MCP) joint.
It is most common in the middle finger, and radial sided sagittal band injuries are more common than ulnar sided band injuries 4.
It often results after a clenched fist strikes an object in a traumatic situation. Less often, it can result in the absence of trauma, such as in an inflammatory arthritis (e.g. rheumatoid arthritis).
The ulnar and radial sagittal bands exert tensile forces in opposite directions during flexion, which keeps the extensor tendon in apposition with the metacarpal bone.
Ultrasound
May show radial or ulnar subluxation/dislocation of the extensor tendons from their usual position 3. This can be better elicited on dynamic sonography.
Treatment and prognosis
Acute injuries can be managed in an extension splint for 6 weeks. Operative techniques include either direct repair, reconstruction procedures or joint fusion 5.
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1. Hame SL, Melone CP. Boxer's knuckle. Traumatic disruption of the extensor hood. Hand Clin. 2000;16 (3): 375-80, viii. - Pubmed citation
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2. Khoury V, Cardinal E, Bureau NJ. Musculoskeletal sonography: a dynamic tool for usual and unusual disorders. AJR Am J Roentgenol. 2007;188 (1): W63-73. doi:10.2214/AJR.06.0579 - Pubmed citation
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3. Lopez-ben R, Lee DH, Nicolodi DJ. Boxer knuckle (injury of the extensor hood with extensor tendon subluxation): diagnosis with dynamic US--report of three cases. Radiology. 2003;228 (3): 642-6. doi:10.1148/radiol.2283020833 - Pubmed citation
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4. Wu K, Masschelein G, Suh N. Treatment of Sagittal Band Injuries and Extensor Tendon Subluxation: A Systematic Review. Hand (N Y). 2021;16(6):854-60. doi:10.1177/1558944719895622 - Pubmed
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5.Grandizio L & Klena J. Sagittal Band, Boutonniere, and Pulley Injuries in the Athlete. Curr Rev Musculoskelet Med. 2017;10(1):17-22. doi:10.1007/s12178-017-9379-6 - Pubmed
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