Injury prevention should aim to protect the hands and wrists of elite amateur boxers.

The purpose of this investigation was to explore prospectively the nature and duration of hand and wrist injuries in training and competition in the Great Britain (GB) amateur boxing squad between 2005 and 2012. Longitudinal prospective injury surveillance of the GB boxing squad was performed from 2005 to 2012. The location, region affected, description, and the duration of each injury were recorded by the team doctor and team physiotherapist. We recorded whether the injury occurred during competition or training and also whether it was a new or a recurrent injury. The injury rate during competition was calculated as the number of injuries per 1000 hours. Finger carpometacarpal instability and finger metacarpophalangeal joint extensor hood and capsule sprain also known as "boxer's knuckle" injuries were significantly more common than other injury diagnoses. The number of injuries during training or competition was similar, which is remarkable given the far greater number of training hours than competition hours performed. Injury rate for hand and wrist injuries in competition was 347 injuries per 1000 hours, while the estimated injury rate in training was <0.5 injuries per 1000 hours. Carpometacarpal instability and boxer's knuckle were more common than any other kind of hand and wrist injury in this cohort of elite amateur boxers. The rate of hand and wrist injuries was higher in competition than in training. Our study highlights the importance of hand and wrist injury prevention in the competition environment.

Objectives: The hand is commonly injured in boxing but it is not clear why some athletes sustain hand injuries while others do not. It is possible that there are differences in the distribution of impact forces at the knuckle during punching between athletes and that certain distribution patterns may be predictive of increased injury risk. We developed a method of analysing the distribution of impact forces at the knuckle during punching using pressure film. Pressure film allows a calculation of the distribution and magnitude of pressure and force between any two surfaces that come into contact. Methods: Pressure film was inserted into the gloves of three male subjects prior to punching a stationary target. After each punch, the pressure film was removed and analysed to determine the distribution of the impact force during each punch across each of the four knuckles. Punches were repeated multiple times for each subject. The proportional distribution of the impact force during punches was compared between knuckles and within subjects. Results: The proportional distribution of the impact force exerted during punches was significantly different between knuckles and within subjects (p < 0.05). Knuckle 2 displayed the largest proportion of impact forces while knuckle 3 displayed the smallest proportion of impact forces. Conclusions: Pressure film inserted into boxing gloves can be used to analyse the distribution of impact forces across the knuckles during punching. Further work is needed to confirm the reliability and validity of the technique and establish whether there is an association between the impact forces at the individual knuckles and hand injury risk during boxing.

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