Knuckle health

What is a martial art? One answer is that it is a sport in which we can test our fighting skills while keeping the injury rate reasonably low. To achieve this, we have rules, officials and protective equipment. The protective equipment in kickboxing is boxing gloves, mouthguard and box. This determines what type of injuries we see in kickboxing.

Because we use gloves, we see very few finger injuries, which is really good. In karate and kung fu, we see lots of finger and thumb injuries. Unfortunately, because we have some protection, boxing and kickboxing have developed to involve a lot of repetitive and powerful blows to the head. This explains the nature of the three types of hand injury that I commonly treat in kickboxers and boxers.

KNUCKLES

The most common injury I see is pain around the knuckles. This is usually not bruising of the bone of the dome of the knuckle but a tendonitis of the extensor tendons as they divide around the knuckle and sit on either side of the knuckle in a little gully. There are two ways in which the tendon can become injured. Firstly, it can be due to direct trauma from repetitive pounding. More commonly it is probably due to hyperflexion of the knuckle. This happens if you make contact with the back of the fingers rather than the knuckle causing the fingers to be suddenly forced downwards which stretches the extensor tendons causing minor tearing.

Mild forms of this injury are very common and will often settle down with rest and ice. It can be helpful to apply ice after every training session if you cannot rest. If that does not work I prescribe an anti-inflammatory tablet such as Anaprox. Some people may get benefit from rubbing on an anti-inflammatory cream such as Voltaren.

The next stage of treatment is a cortisone injection. This usually works but you should rest for at least a few days after the injection. If the fighter has pain of the knuckles before a fight it is easy to inject a bit of long acting local anaesthetic such as Naropin. This gives about four hours of pain relief.

A new treatment option that I have used with very good results is PRP. This is platelet rich plasma, which we get from taking some blood from your arm and then putting the blood in a centrifuge. This separates the red blood cells from the plasma. We throw out the red blood cells and inject the plasma, which contains platelets, growth factors and a few stem cells. It has a really good healing effect and is not expensive. PRP is also good for many other injuries such as arthritis of the knee.

If the knuckle is resistant to treatment the next stage is to take a look at it with an ultrasound. Sometimes the fibrous slips that hold the tendon in place have been torn and require surgical repair. This is rare.
Knuckle injuries can be prevented by using a ‘metacarpal bar’, which can be made out of some sort of polyurethane or rolled up strapping tape. This fits inside the palm of the hand to stop the fingers from over flexing. Many of my sparring partners are now using the new handwraps from Everlast, which include a shock absorbing pad that fits over the knuckle surface to reduce impact.

THUMB STRAIN

This injury usually occurs when you hit someone’s elbow with your thumb. The thumb is strained in the direction away from the index finger. This will often tear the ligament, which holds the thumb in place at the base of the thumb near the skin web between the index finger and the thumb. This can be a really nasty injury. If the injury is severe and not treated you can end up with a loose joint, which can cause arthritis later in life. In severe cases the bone can also be fractured. This must be repaired to prevent arthritis. Because the consequence of missing this fracture is so serious if you think there is a chance of a fracture it is best to get an x-ray. The fracture of the base of the thumb is called a ‘Bennett’s Fracture’ — it is very painful because it involves the joint. Resting it is not enough. It requires surgery. Please have private health insurance!

Thumb strains used to be really common but now we see a lot less of them since modern gloves have been modified to provide thumb protection. This usually involves having a strong strap connecting the thumb to the rest of the glove. Some gloves have the thumb built in to the rest of the glove to protect the thumb.

Thumb strains have to be assessed to see if there is laxity of the joint. If there is, a splint is required. Simple strains can be treated with rest and anti-inflammatories, with more severe cases sometimes getting a cortisone injection.

FRACTURES OF BASE OF 2nd or 3rd METACARPALS

This is an injury that I only see in fighters who are punching really hard. Some of our best knockout artists have suffered from it. The important thing is to diagnose it early and try to heal the fracture. To do this you have to immobilise the fracture in a cast for about three–four weeks. If you take the cast off too soon then the fracture does not heal. This creates a lot of work for people like me because we have to inject local anaesthetic into the fracture area before fights.

These fractures are easily missed because doctors who do not treat fighters may not know what they are looking for. The fracture usually does not show up on a plain x-ray. A special fine cut CT scan is required. I now usually do not waste time and money on a plain x-ray. I just order the CT scan if I suspect a fracture.

I believe that this type of fracture can be prevented by strapping the wrist up very firmly with ankle strapping tape to prevent wrist movement. IK

Read more training articles or check out our Australian gym guide. Don't forget to like us on Facebook!

Photo credit: Lee McCormick