An unusual presentation of Boxer’s knuckle in the little finger: a case report

Lam, Wee Leon; Bruyere, Alexandra; Leclercq, Caroline

doi:10.1177/1753193420934072

Cited by 1 publication

(2 citation statements)

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“…Boxer's knuckle injury of the little finger is invariably described as a divergent dislocation of the extensor digiti minimi (EDM) and extensor digitorum communis (EDC) tendons. However, illustrations and observations found in clinical reports do not correlate well with the descriptions appearing in anatomical works [3][4][5][6][7][8][9][10][11]. When observing the intraoperative photographs appearing in several of these articles [3,4,7,9], we believe that the two tendinous slips of the EDM were incorrectly identified as the EDM and EDC.…”

Section: Introductionmentioning

confidence: 81%

“…However, illustrations and observations found in clinical reports do not correlate well with the descriptions appearing in anatomical works [3][4][5][6][7][8][9][10][11]. When observing the intraoperative photographs appearing in several of these articles [3,4,7,9], we believe that the two tendinous slips of the EDM were incorrectly identified as the EDM and EDC. Similarly, reports related to the radiological literature mention the same confusion [12].…”

Section: Introductionmentioning

confidence: 81%

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New Insights into Boxer’s Knuckle Injury of the Little Finger

Durand,

Christen,

Ledoux

et al. 2023

JCM

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Background: The original description of boxer’s knuckle injury of the fifth ray mentions that the injury occurs between the extensor digitorum communis (EDC) and the extensor digiti minimi (EDM). Subsequent reports claim similar findings. Anatomical studies show that the EDC of the fifth ray is absent in most patients, while the EDM is generally composed of two slips. We present a modification of the current description of boxer’s knuckle injury of the little finger based on the correlation between advanced preoperative 3D imaging and intraoperative findings. Methods: Five patients were investigated preoperatively using high-resolution ultrasound and 3D tendon reconstruction-based MR arthrography. Surgical exploration identified the lesion site relative to the EDM and EDC. Results: All patients had two slips of the EDM and no EDC to the fifth ray. The injury appeared as a longitudinal tear of the EDM between its two slips. The mean gap was 7.8 mm (range 4.5–10 mm) on the pathological side vs. 1.3 mm (range 1–2 mm) on the healthy contralateral side. Conclusions: We believe that previous descriptions of boxer’s knuckle of the fifth ray are inaccurate. High-resolution ultrasound and 3D reconstructions based on MR arthrography are reliable diagnostic tools allowing to locate the injury with precision.

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