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Wrist Injuries
mvpboxing |  May 04, 2017, 12:05PM
Boxer's fracture
  1. Definition and Occurrence
    1. The second and third fingers are the most stable of the entire hand and are intended to distribute the majority of the force during jab (boxing). These fingers are anchored to the strongest and most ergonomically aligned wrist bones. The fourth and fifth fingers are less stable and can easily become injured when a boxer strikes a prominent boney area of the head or arm.
    2. Boxers may injure their knuckles either as a single traumatic event (acute) or from repetitive blows (chronic).
    3. The aptly named boxer’s fracture is a fracture of the neck of the fifth metacarpal. The neck represents the part of the finger just before the knuckle, which is the joint between the metacarpal and the phalanges.
  2. Signs and Symptoms
    1. Pain
    2. Swelling
    3. Decreased fifth finger range of motion
  3. Treatment
    1. X-Ray to determine if fracture needs to be reduced with or without surgery
    2. If the break in the finger bone is angle too far towards the palm, fixation of the fractured segments will be achieved with surgical pins
    3. If surgery is not required, the fracture will be reduced by a physician
      1. Wrist and fingers in a splint for 3 weeks
    4. After either treatment, immediate range of motion and stretching is of the immobilized fingers is important to avoid adhesions and scarring. Immobilized hands tend to become stiff quickly.
    5. Once full range of motion is achieved after immobilization, finger and wrist strengthening exercises are initiated.
  4. Prehab (Prevention)
    1. Practicing correct striking mechanics
    2. Wear protective boxing gloves with correct weight and size when sparring and when striking punching bag.
    3. Application of appropriate gauze bandage to protect hands and knuckles.
    4. Finger and wrist taping to increase stability.
Wrist and Finger Ligament sprains and strains
  1. Definition and Occurrence
    1. There are many different ligaments that provide stability to the wrist joint. Ligaments are necessary at where the arm bones meet the wrist and also at the connection between the two rows of wrist bones.
    2. These ligaments can often become strained or sprained from a traumatic incident where they are stretched or loaded beyond capacity. A common occurrence is during a fall on an outstretched arm. This can often cause torque and overstretching of the wrist ligaments.
  2. Signs and Symptoms
    1. Pain and swelling at the site of injury
    2. Pain with passive movement that stretches the ligament
    3. Pain with active movement that stretches the ligament
  3. Treatment
    1. Rest, Ice, and compression in the initial stages
    2. Wrist bracing if instability present
    3. Once pain diminishes and pain free movement increases, begin strengthening exercises
      1. Putty squeezes for grip strength
      2. Wrist strengthening in all motions
      3. Wrist stability training
  4. Prehab
    1. Wrist stability training
    2. Wrist strengthening
    3. Proper striking mechanics
    4. Bracing/taping if wrist is unstable from previous injury
Trigger finger (Stenosing-tenosynovitis)
  1. Definition and Occurrence
    1. The muscle tendons that flex the fingers to make a fist are held down by sheaths. These sheaths allow the muscle tendons to function properly by holding them close the finger and by giving them the proper leverage to move the finger.
    2. Sometimes, these sheaths can become thickened and thus more narrow, which does not afford the muscle tendon enough room to slide smoothly. Without ample room for the tendon to slide and function, the finger cannot function properly.
    3. Most common in thumb, middle and ring fingers
    4. More common with rheumatoid arthritis, diabetes, and people with lateral epicondylitis.
  2. Signs and Symptoms
    1. Popping, locking, or snapping when the finger is moved into flexion or extension. This is most evident when making a full fist and then trying to open the fist.
    2. A visible and palpable thickening over the finger flexor muscle tendon. The nodule will usually be around where the palm meets the finger and will move with the finger.
  3. Treatment
    1. Usually, immobilization is not recommended, keep the finger moving, whether actively or passively, to avoid prolonged stiffening
    2. Consult with physician about possible corticosteroid injection
      1. One injection can be used to relieve symptoms in 66% of people (Wilk and Brotzman, 2003)
    3. If injections are unsuccessful, surgery to release the tendon thickening may be indicated

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