Traumatic Extensor Tendon Dislocation in a Boxer: A Case Study

THURSTON BENTS, ROBERT1; PATRICK METZ, JOHN2; MARK TOPPER, STEVEN3

Medicine & Science in Sports & Exercise:
CLINICAL SCIENCES: Clinical Case Studies
Abstract

BENTS, R. T., J. P. METZ, and S. M. TOPPER. Traumatic Extensor Tendon Dislocation in a Boxer: A Case Study. Med. Sci. Sports Exerc., Vol. 35, No. 10, pp. 1645–1647, 2003. An elite collegiate boxer developed extensor tendon subluxation in the small finger of his dominant right hand. He was thought to have a radial sagittal band disruption and was allowed to complete his season with custom padding. Surgical exploration revealed intact sagittal bands with divergent dislocation of the two extensor tendons to the small finger with underlying capsular rupture. These lesions were repaired and he successfully returned to boxing. Soft tissue injuries to the dorsal MCP joint may involve the collateral ligaments, the sagittal bands, the extensor tendons, or the joint capsule. Symptoms usually involve persistent pain, swelling, and tendon subluxation or dislocation. Accurate recognition and treatment is crucial as nonoperative treatment is generally unsuccessful and surgical reconstruction is required for optimal return to function.

Traumatic soft tissue injuries to the metacarpophalangeal (MCP) joint may result from repetitive or isolated forceful blows with the clenched fist. The most commonly described injury is disruption of the sagittal fibers of the extensor tendon mechanism. This may be isolated or combined with a more serious and disabling extensor hood disruption with dorsal capsular rupture. This pattern of injury has been termed “boxer’s knuckle” (1–3). We describe an unusual variation of boxer’s knuckle in which the sagittal bands remained intact but the extensor tendons were divergently dislocated with an underlying capsular tear. Written informed consent was obtained from the subject to be included in this report.

Author Information

1U.S. Air Force Academy, Colorado Springs, CO;

2JFK Hospital, Edison, NJ; and

3Rampart Hand Clinic, Colorado Springs, CO

Address for correspondence: Lt. Col. Robert T. Bents, M.D., USAF, Chief, Orthopedic Clinic, 4102 Pinion Drive, Suite 100, USAF Academy, CO 80840; E-mail: Robert.Bents@usafa.af.mil.

Submitted for publication February 2003.

Accepted for publication June 2003.

©2003The American College of Sports Medicine