Boxer’s knuckle is an injury to the structures that stabilise the extensor tendon over the knuckle, known as the sagittal band. This structure keeps the tendon centred as the finger straightens.
When the sagittal band is damaged or ruptured, the tendon can move out of position, leading to pain, snapping or difficulty controlling finger movement.
The injury often occurs following a direct blow to the knuckle or forceful impact, although it can also develop through repetitive strain. It most commonly affects the middle finger.
Without appropriate treatment, the tendon may remain unstable, affecting normal finger function.
Symptoms usually occur following injury and may include:
Symptoms are often more noticeable during active finger movement.
Symptoms usually occur following injury and may include:
Symptoms are often more noticeable during active finger movement.
Diagnosis is based on clinical assessment, including examination of tendon position and finger movement.
The tendon may be seen or felt moving out of place during movement of the finger.
Imaging such as ultrasound or MRI may be used in selected cases to confirm the diagnosis.
Treatment depends on the severity of the injury and whether the tendon remains stable.
Non-surgical treatment may include:
If the tendon is unstable or the injury does not improve, surgical repair of the sagittal band may be recommended.
When non-surgical treatment is not effective, surgical repair may be recommended.
The procedure involves repairing or reconstructing the sagittal band to stabilise the extensor tendon over the knuckle.
Surgery is typically performed as a day-case procedure under local or regional anaesthetic.
Following treatment, the finger is usually supported in a splint to protect the repair.
Recovery typically involves:
Recovery timelines vary, but most patients regain good function with appropriate rehabilitation.
As with any surgical procedure, there are potential risks, although these are uncommon.
Possible complications include:
Your surgeon will discuss the expected outcomes and risks before proceeding with treatment.
You should seek medical advice if you experience pain, swelling or a snapping sensation over the knuckle, particularly following an injury.
Early assessment is important, as timely treatment can help restore normal tendon function and prevent ongoing instability.
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