Boxer’s Fracture

Boxer’s Fracture

What is a boxer’s fracture?

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It gets its name because the injury is common in inexperienced boxers.

The metacarpal bones are the intermediate bones of the hand found inside the flat of the hand. They connect the bones of the fingers (the phalanges) to the bones of the wrist (the carpals). The fifth metacarpal is the metacarpal of the fifth (pinky) finger. The neck of the metacarpal bone is where the main shaft of the bone starts to widen outwards towards the knuckle.

Boxers are not the only people who can get a boxer’s fracture, but usually the injury results from direct injury to a clenched fist. The force fractures the neck of the metacarpal bone below the pinky.

Your doctor will need to distinguish boxer’s fractures from other metacarpal fractures, which break the shaft of the metacarpal, or fractures of the base of the small finger. These injuries may need different treatments.

Metacarpal bones, in general, are some of the most commonly fractured bones in the hands. A large percentage of these qualify as “boxer’s fractures.”

What causes a boxer’s fracture?

Usually, a boxer’s fracture happens when you punch a wall or another solid object at a high speed. You also might get a boxer’s fracture if you fall hard on your closed fist. The neck of the metacarpal bone is its weakest point, so it tends to fracture here.

What are the symptoms of a boxer’s fracture?

Symptoms of a boxer’s fracture can include:

  • Painful bruising and swelling of the back and front of the hand
  • Tenderness of the back of the hand in the region of the fractured fifth metacarpal
  • Bent, “claw-like” pinky finger that appears out of alignment
  • Limited range of motion of the hand and of the fourth and fifth fingers

Your knuckle may also not have its normal bumpy shape. Your symptoms may vary in severity depending on the complexity of your fracture. You might have only mild pain, or the pain might be more severe.

How is a boxer’s fracture diagnosed?

Your doctor will ask you about your symptoms, how you injured the hand, and your past medical problems. Your doctor will also examine your hand carefully, checking for tenderness, strength, misalignment, range of motion, breaks in the skin, and other features.

An X-ray of the hand can clearly confirm a boxer’s fracture.

How is a boxer’s fracture treated?

Your treatment depends on how severe the fracture is. Initial treatment might include:

  • Washing any cuts that are present in the skin
  • Getting a tetanus shot if you have a cut and haven’t had a shot for several years
  • Resting your hand for a few days
  • Keeping your hand above the level of your heart for a few days
  • Icing your injury several times a day
  • Taking pain medicine (prescription or over-the-counter)
  • Wearing a splint for several weeks

Before your doctor puts your hand into a splint, he or she may need to put your bones back into alignment. Usually, you’ll receive a local anesthetic to keep you from feeling any pain, and your doctor will physically manipulate the bones back into place. In some cases, your doctor might have to open up your hand surgically to get the bones back into alignment.

You also may need to work with a physical therapist for a while as your fracture heals. You’ll learn exercises to strengthen the muscles of your hand and keep them from getting stiff.

If you have an unusually severe boxer’s fracture, you may need immediate and more complicated surgery. For example, if your bone has broken through the skin, or if it has broken in several places, you will probably need surgery. You might also need surgery if you have a job or significant hobby that requires a lot of fine-motor movement of the hand, like playing the piano.

Even if you don’t need surgery right away, you might need it at some point. If your hand doesn’t heal as well as expected, surgery might be an option.

What are the complications of a boxer’s fracture?

An untreated boxer’s fracture can lead to a decrease in your ability to grip, limited range of motion of the finger, and an abnormal looking finger. With proper treatment, these complications are usually minor, if present at all.

What can I do to prevent a boxer’s fracture?

Avoid fistfights and punching solid objects to prevent many cases of boxer’s fracture. If you box, make sure you use the correct technique and the proper equipment.

How to manage a boxer’s fracture

Your doctor may give you some instructions about how to manage your boxer’s fracture, such as:

  • Keep your bones strong by eating a healthy diet with enough vitamin D, calcium, and protein
  • Stopping smoking, to help your fracture heal more quickly
  • Keeping your splint from getting wet

Your hand will be very easy to reinjure for 4 to 6 weeks after your splint is gone. You may need to use a hand brace if you return to contact sports during this time. Talk with your doctor about what makes sense for you.

When should I call my healthcare provider?

Call your doctor if:

  • You have numbness or tingling in your fingers
  • You fingers look blue
  • You have severe pain or worsening swelling
  • Your splint gets damaged and you need a new one

Key Points

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It usually happens when you punch an object at a high speed.

  • Symptoms of a boxer’s fracture include pain and swelling of the hand, limited range of motion of the pinky finger, and misalignment of the finger.
  • Your doctor can diagnose your boxer’s fracture with a medical history, physical exam, and X-ray.
  • You might need treatment with simple rest, ice, pain medicine, and splinting.
  • You might need surgery for your injury if it is severe.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Can Smartphone Use Bring on Carpal Tunnel Syndrome?

Can Smartphone Use Bring on Carpal Tunnel Syndrome?

FRIDAY, June 23, 2017 (HealthDay News) — People who spend lots of time on their smartphones may be scrolling, tapping and swiping their way to carpal tunnel syndrome, a painful wrist and hand disorder.

A small study found a link between extended use of smartphones and other hand-held electronic devices and a greater likelihood for experiencing the telltale wrist and hand pain of the syndrome.

But the researchers did not prove that heavy smartphone use caused carpal tunnel syndrome, and one hand surgeon said very few people in the real world use their smartphones as much as the heavy users in the study did.

Study author Peter White said the findings suggest “caution may be warranted when using hand-held electronic devices, in order to minimize the chance of developing carpal tunnel syndrome.”

White is an assistant professor in the department of health technology and informatics at Hong Kong Polytechnic University.

The carpal tunnel is a narrow and hard pathway of bone and ligament found at the base of the hand, according to the U.S. National Institute of Neurological Disorders and Stroke. It contains tendons, which enable finger-bending, as well as the so-called “median nerve,” which runs from the forearm to the palm and provides feeling to some fingers.

Carpal tunnel syndrome can gradually develop following repeated pressure to the point where the median nerve passes into the hand and meets the wrist.

A common cause, said White, are work conditions that call for “repetitive, forceful or awkward hand movements, for example, when typing.” And the result is often pain (sometimes extending up the arm), numbness, finger tingling and weakened grip strength.

To explore whether smartphone use might up the carpal tunnel syndrome risk, White and his associates followed up on their prior investigation involving 500 Hong Kong University students.

Those students fell into two camps: intensive users of hand-held electronic devices (meaning five or more hours of use per day) and non-intensive users (less than five hours per day). Hand-held devices included mobile phones, tablet computers and game consoles.

More than half (54 percent) of the intensive group reported musculoskeletal pain and/or discomfort, compared with 12 percent among the less intensive group.

The new study looked at 48 students from the first study. Half were intensive users who spent (on average) more than nine hours a day using their devices. Those in the other group spent just under three hours a day on their devices.

The participants answered questionnaires on electronic device habits and any pain or discomfort in their neck, shoulder, back, elbow or wrist/hand region.

Ultrasounds and physical exams on the wrist region were also done.

Muscle pain was found to be more common among intensive users.

The researchers also found that intensive electronics users had “significantly” more discomfort, and more severe discomfort, in their wrist and hand.

The more time a person spent using a hand-held electronic device, the more intense and long-lasting their wrist and hand pain was.

To explain why, the researchers pointed to device design, which requires the repeated use of fingers to click, swipe, scroll, tap and press. The result is an enlargement and flattening of the median nerve, alongside bulging of a key ligament.

To minimize risk, White advises keeping the wrist as straight as possible when using devices.

He added, “One should try to minimize repetitive movements of one’s fingers and thumb when using hand-held electronic devices, especially for single-hand use. It is also important to take regular rest periods, so as to avoid continuous intensive use, so as to allow recovery time and to prevent prolonged stress.”

But hand surgeon Dr. Dori Cage questioned how much of a risk smartphone use really poses.

“The strong correlation of carpal tunnel syndrome with smartphone use is surprising, as I have not seen that in my practice,” said Cage, an American Academy of Orthopaedic Surgeons spokesperson.

Cage, who’s with San Diego Hand Specialists, also suggested that “it is unlikely that the general population would have [the] degree of phone use” seen among the intensive users in the study.

“This is likely an issue affecting only a small percentage of cellphone users,” she said.

The study was published June 21 in the journal Muscle and Nerve.

More information

There’s more information on carpal tunnel syndrome at U.S. National Institute of Neurological Disorders and Stroke.

Overview of Hand Surgery

What is hand surgery?

Hand surgery is a broad term that covers many different types of procedures. Plastic surgeons who perform hand surgery seek to restore hand and finger function. But they also try to make the hand look as normal as possible, as well. Hand surgery may be done for many reasons, including:

  • Hand injuries
  • Rheumatic diseases, such as osteoarthritis and rheumatoid arthritis, that change and damage the structures in the hand
  • Degenerative changes to the structures in the hand
  • Problems or defects that are present at birth, or congenital
  • Infections

What are the different types of hand surgery?

Many different types of surgeries can be performed on the hand. It depends on the underlying cause of the problem. These procedures include:

Skin grafts

Skin grafts involve replacing or attaching skin to a part of the hand that has missing skin. This surgery is most often done for fingertip amputations or injuries. Skin grafts are done by taking a piece of healthy skin from another area of the body, called the donor site, and attaching it to the injured area.

Skin flaps

Like a skin graft, a skin flap involves taking skin from another part of the body. But this procedure uses skin that has its own blood supply. That’s because the section of skin that is used includes the underlying blood vessels, fat, and muscles. Flaps may be used when an area that is missing skin does not have a good blood supply. This may be because of the location, damage to the vessels, or extensive tissue damage.

Closed reduction and fixation

This may be used when there is a bone fracture, or broken bone, in part of the hand, including the fingers. This type of surgery realigns the broken bone and then holds it in place, or immobilizes it, while it heals. Immobilization can be done with internal fixtures, such as with wires, rods, splints, and casts.

Tendon repair

Tendons are the fibers that join muscle to bone. Tendon repair is a difficult surgery because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or sudden rupture. There are 3 types of tendon repair: primary, delayed primary, or secondary.

  • Primary repair of an acute or sudden injury is often done within 24 hours of the injury.  This is usually a direct surgery to fix the injury.
  • Delayed primary repair is usually done a few days after the injury, but while there is still an opening in the skin from the wound.
  • Secondary repairs may occur 2 to 5 weeks or longer after the injury. They may include tendon grafts. This is when tendons from other areas of the body are inserted in place of the damaged tendon. Or other more complex procedures may be used.

Nerve repairs

An injury can damage the nerves in the hand. This can cause a loss of hand function and a loss of feeling in the hand. Some nerve injuries may heal on their own. Others may require surgery. Generally, surgery is done about 3 to 6 weeks after the injury. This is the best time for nerve repairs that are linked with other more complicated injuries.

In cases where nerve damage is not linked to more complicated injuries, surgery to check the damaged nerve is usually done soon after the injury. This increases the chance of a full recovery. If the nerve is cut or severed, it may be fixed by reattaching it to the other end of the nerve. Or a nerve graft may be done. This involves replacing the damaged nerve with nerves taken from other areas of the body.

Fasciotomy

This procedure is done to help treat compartment syndrome. This painful condition occurs when there is swelling and increased pressure in a small space, or compartment, in the body. Often this is caused by an injury. This pressure can interfere with blood flow to the body tissues and destroy function. In the hand, a compartment syndrome may cause severe and increasing pain and muscle weakness. Over time, it can cause a change in color of the fingers or nailbeds.

For a fasciotomy, your doctor will make a cut or incision in your hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.

Surgical drainage or debridement

Hand infections are very common. Treatment for hand infections may include rest, using heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.

Joint replacement

This type of surgery, also called arthroplasty, is used in cases of severe hand arthritis. It involves replacing a joint that has been destroyed by arthritis with an artificial joint look at here now. This artificial joint may be made of metal, plastic, silicone rubber, or your own body tissue, such as a tendon.

Replantation

This type of surgery reattaches a body part, such as a finger, hand, or toe, which has been completely cut or severed from the body. The goal is to restore as much function as possible. Replantation uses microsurgery. This is a complex type of surgery that uses tiny tools and is done under magnification using a microscope. In some severe cases, more than 1 surgery may be needed.

What are the risks of hand surgery?

Most surgery carries the risks of anesthesia and bleeding. Additional risks associated with surgery depend greatly on the type of surgery being performed and may include:

  • Infection
  • Incomplete healing
  • Loss of feeling or movement of the hand or fingers
  • Blood clots may form

Hand Pain and Problems

Anatomy of the hand

The hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are 3 major types of bones in the hand itself, including:

Anatomy of the hand
Click Image to Enlarge
  • Phalanges. The 14 bones that are found in the fingers of each hand and also in the toes of each foot. Each finger has 3 phalanges (the distal, middle, and proximal); the thumb only has 2.
  • Metacarpal bones. The 5 bones that compose the middle part of the hand.
  • Carpal bones. The 8 bones that create the wrist. The carpal bones are connected to 2 bones of the arm, the ulnar bone and the radius bone.

Numerous muscles, ligaments, and sheaths can be found within the hand. The muscles are the structures that can contract, allowing movement of the bones in the hand. The ligaments are fibrous tissues that help bind together the joints in the hand. The sheaths are tubular structures that surround part of the fingers.

What are some common hand problems?

There are many common hand problems that can interfere with activities of daily living (ADLs), including the following:

Arthritis

Arthritis is joint inflammation and can occur in multiple areas of the hand and wrist. Arthritis of the hand can be very painful.

Osteoarthritis

Osteoarthritis is one of the most common forms of arthritis in the hands and may be caused by normal use of the hand or it may develop after an injury. Osteoarthritis usually develops in one of 3 places: the base of the thumb, at the end joint closest to the finger tip, or at the middle joint of a finger.

Signs and symptoms of osteoarthritis include:

  • Stiffness
  • Swelling and pain
  • Bony nodules at the middle or end joints of the finger
  • Pain and possibly swelling at the base of the thumb
  • Loss of strength in the fingers and the grip of the hand

Treatment for osteoarthritis includes:

  • Nonsteroidal anti-inflammatory drugs
  • Resting  the affected hand
  • Wearing splints at night
  • Using heat to soothe the pain
  • Using ice to reduce swelling
  • Possible cortisone injections
  • Possible surgery when no other treatments work

Carpal tunnel syndrome

Carpal tunnel syndrome is a condition in which the median nerve is compressed as it passes through the carpal tunnel in the wrist, a narrow confined space. Since the median nerve provides sensory and motor functions to the thumb and 3 middle fingers, many symptoms may result.
The following are the most common symptoms for carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include:

  • Trouble gripping objects with the hand(s)
  • Pain or numbness in the hand(s)
  • “Pins and needles” feeling in the fingers
  • Swollen feeling in the fingers
  • Burning or tingling in the fingers, especially the thumb and the index and middle fingers

The symptoms of carpal tunnel syndrome may look like other conditions such as tendonitis, bursitis, or rheumatoid arthritis. Always see your healthcare provider for a diagnosis.

Treatment may include:

  • Splinting of the hand (to help prevent wrist movement and decrease the compression of the nerves inside the tunnel)
  • Oral or injected (into the carpal tunnel space) anti-inflammatory medicines (to reduce the swelling)
  • Surgery (to relieve compression on the nerves in the carpal tunnel)
  • Changing position of a computer keyboard, or other ergonomic changes

Ganglion cysts

Soft, fluid-filled cysts can develop on the front or back of the hand for no apparent reason. These are called ganglion cysts the most common, benign (noncancerous), soft-tissue tumor of the hand and wrist.

The following are the most common symptoms for ganglion cysts include:

  • Wrist pain that is aggravated with repeated use or irritation
  • A slow growing, localized swelling, with mild aching and weakness in the wrist
  • An apparent cyst that is smooth, firm, rounded, or tender

The symptoms of ganglion cysts may look like other medical conditions or problems. Always see your healthcare provider for a diagnosis.

Initially, when the cyst is small and painless, treatment is usually not needed. Only when the cyst begins to grow and interferes with the functionality of the hand is treatment usually necessary. Treatment may include:

  • Rest
  • Splinting
  • Nonsteroidal anti-inflammatory medicines
  • Aspiration
  • Cortisone injections
  • Surgery

Tendon problems

Two major problems associated with tendons include tendonitis and tenosynovitis. Tendonitis, inflammation of a tendon (the tough cords of tissue that connect muscles to bones) can affect any tendon, but is most commonly seen in the wrist and fingers. When the tendons become irritated, swelling, pain, and discomfort will occur.

Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. The tendon sheath is usually the site which becomes inflamed, but both the sheath and the tendon can become inflamed simultaneously. The cause of tenosynovitis is often unknown, but usually strain, overuse, injury, or excessive exercise may be implicated. Tendonitis may also be related to disease (such as, diabetes or rheumatoid arthritis).

Common tendon disorders include the following:

  • Lateral epicondylitis (commonly known as tennis elbow). A condition characterized by pain in the back side of the elbow and forearm, along the thumb side when the arm is alongside the body with the thumb turned away. The pain is caused by damage to the tendons that bend the wrist backward away from the palm.
  • Medial epicondylitis (commonly known as golfer’s or baseball elbow). A condition characterized by pain from the elbow to the wrist on the palm side of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm.
  • Rotator cuff tendonitis. A shoulder disorder characterized by the inflammation of the shoulder capsule and related tendons.
  • DeQuervain’s tenosynovitis. The most common type of tenosynovitis disorder characterized by the tendon sheath swelling in the tendons of the thumb.
  • Trigger finger/trigger thumb. A tenosynovitis condition in which the tendon sheath becomes inflamed and thickened, thus preventing the smooth extension or flexion of the finger/thumb. The finger/thumb may lock or “trigger” suddenly.

Treatment for most tendon problems may include:

  • Activity modification
  • Ice
  • Splinting or immobilization
  • Steroid injections
  • Nonsteroidal anti-inflammatory medicines
  • Surgery

Anatomy of the Hand

The hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity here are the findings. There are 3 major types of bones in the hand itself, including:

  • Phalanges. The 14 bones that are found in the fingers of each hand and also in the toes of each foot. Each finger has 3 phalanges (the distal, middle, and proximal); the thumb only has 2.
  • Metacarpal bones. The 5 bones that compose the middle part of the hand.
  • Carpal bones. The 8 bones that create the wrist. The 2 rows of carpal bones are connected to 2 bones of the arm–the ulna bone and the radius bone.

Numerous muscles, ligaments, and sheaths can be found within the hand. The muscles are the structures that can contract, allowing movement of the bones in the hand. The ligaments are fibrous tissues that help bind together the joints in the hand. The sheaths are tubular structures that surround part of the fingers.

In addition, there are arteries, veins and nerves within the hand that provide blood flow and sensation to the hand and fingers.