Extensor hood injuries in elite boxers: injury characteristics, surgical technique and outcomes

Abstract

We describe our experience of managing extensor hood injuries in boxers (57 fingers). The diagnosis was mostly clinical, with imaging only if the diagnosis was equivocal. The middle (61%) and index (26%) digits were most frequently injured. On exploration, 26% had no hood tear, however all required tenolysis from the adherent capsule. Of 42 hood tears, 15 were central splits between adjacent extensor tendons in the index or little fingers,15 tears were on the ulna side of the extensor tendon and 12 tears were on the radial side. A pseudobursa was encountered in 35%, capsular tears in 28% and chondral injury in one patient. Longitudinal curved metacarpophalangeal joint incisions were used, with hood repair performed in flexion using a locked running suture. Mean postoperative metacarpophalangeal joint flexion was 90°. Ninety-eight per cent returned to the same level of boxing at a mean of 8 months (range 1–24) from surgery. One finger was revised for re-rupture 6 months later. A reproducible technique for treating these injuries is described, with patients able to return to boxing with little risk of complications. Level of evidence: IV

Wrist & Hand

“…Authors from Wrightington (UK) described their single-surgeon experience in managing these injuries in a cohort of elite boxers undergoing surgery for clinically suspected extensor hood injuries. 6 They collated their series over a…”

“…Authors from Wrightington (UK) described their single-surgeon experience in managing these injuries in a cohort of elite boxers undergoing surgery for clinically suspected extensor hood injuries. 6 They collated their series over a 13-year period. Patients presented with pain over the affected metacarpophalangeal joint after a single punch or repeated impacts.…”

Boxer's knuckle: Sonographic anatomy and assessment of sagittal band tears of the dorsal hood

“…[1][2][3] Injuries to the dorsal hood account for 16% of all hand and wrist injuries in boxers. 1,3 'Boxer's knuckle' describes a closed injury to the metacarpophalangeal joint (MCPJ) of the hand and is used synonymously to describe tears of the sagittal bands of the dorsal hood and associated extensor tendon instability. 4,5 It can result from a direct blow to the flexed MCPJ, commonly from boxing or punching, or from relatively low-energy repetitive injuries.…”

“…Hand injuries are common in amateur and professional boxers and result in time lost from training and competition 1–3 . Injuries to the dorsal hood account for 16% of all hand and wrist injuries in boxers 1,3 .…”

“…Hand injuries are common in amateur and professional boxers and result in time lost from training and competition 1–3 . Injuries to the dorsal hood account for 16% of all hand and wrist injuries in boxers 1,3 . ‘Boxer's knuckle’ describes a closed injury to the metacarpophalangeal joint (MCPJ) of the hand and is used synonymously to describe tears of the sagittal bands of the dorsal hood and associated extensor tendon instability 4,5 .…”