How Hand Doctors Treat a “Boxer’s Fracture” (Broken Knuckle)
A “boxer’s fracture” is the common term for a “broken knuckle”. The medical term for this injury is a “metacarpal fracture.” Not only is a broken knuckle painful, it is a serious medical condition that can lead to long term loss of mobility in the hand if it is not treated promptly.
Hand Doctor Dr. Rehman previously explained the causes and symptoms of boxer’s knuckle. In this article she explains how hand doctors diagnose and treat boxer’s fractures.
What to Do if You Suspect a Broken Knuckle
If you suspect a metacarpal fracture (broken knuckle), completely immobilize the hand, as soon as possible. A “boxer’s fracture” needs rapid medical attention to prevent long term complications, such as a permanent loss of mobility or movement in the affected knuckle.
For this reason, diagnosis and treatment of a broken knuckle should preferably be performed by an experienced hand doctor whenever possible – because they are specifically trained and highly experienced in injuries of the hand.
However, if you suspect a metacarpal fracture and a hand doctor cannot be reached, the injured individual should go to the emergency room.
How Hand Doctors Diagnose a Broken Knuckle
Diagnosing a boxer’s fracture typically involves a physical examination by the hand doctor, as well as imaging tests.
The hand doctor will need to know how the injury happened, as this will give valuable clues as to the possible injuries quickly … especially when the hand is too swollen to tell if or where there is a break in a bone.
The hand doctor may put slight pressure on each bone to determine where the break is, and/or gently push each finger towards the knuckle to see if it causes pain in order to determine where the injury is.
The patient may also be asked to make a closed fist, by the hand doctor. If a knuckle is broken, the affected finger or fingers may look misaligned, and/ or may rotate towards the thumb more than normal.
Typically an X-ray image is then taken, to confirm the hand doctor’s diagnosis.
How Hand Doctors Treat a Broken Knuckle
The hand doctor’s recommended course of treatment for a boxer’s fracture will vary depending on the severity of the injury. Do to the complexity of the hand, broken knuckle treatment is not as straightforward as many other bone fractures.
Immobilization is the primary goal for treatment of a boxer’s fracture. This allows the broken bones to heal properly. The hand doctors may put a splint in place, while in other cases a cast may be necessary. The splint or cast will completely immobilize the joints both above and below the site of the break.
Home care may involve ice packs to limit swelling and reduce pain. Typically over the counter anti-inflammatory pain medications such as Tylenol or ibuprofen are sufficient to manage the discomfort.
In more severe boxer’s fractures, your hand doctor may decide you require surgery. This is generally required when the broken bones show signs of “angulation” – meaning that a part of the metacarpal bone has moved out of its proper alignment.
Recovery from a Broken Knuckle
The recovery time from a broken knuckle will vary based on how severe the injury is. Simple bone fractures may heal in several weeks – while more severe breaks can take months to heal completely.
Physical therapy may also be needed to help the hand recover from a metacarpal fracture, and to completely restore motor skills.
During the recovery period, it is important to regularly check in with a specialized hand doctor like Dr. Uzma Rehman in the Bloomfield Hills area, who can monitor your progress, track the healing process, and ensure you are getting the hand therapy you need to preserve and restore full usage of the fingers and hand.
Physical Therapy for a Broken Knuckle
Physical and occupational therapy plays a crucial role in recovery from metacarpal (knuckle) fractures. After initial healing and immobilization, typically 4-6 weeks post-injury, Dr. Rehman works closely with hand therapy specialists to implement a carefully phased rehabilitation program. The initial focus centers on controlling swelling and maintaining mobility in unaffected digits while protecting the healing fracture site.
Early therapy interventions include gentle active and passive range of motion exercises for uninvolved joints, including the wrist and unaffected fingers, to prevent stiffness and maintain circulation. Therapists employ specialized edema management techniques such as retrograde massage, compression, and elevation to minimize swelling that can lead to long-term stiffness.
As healing progresses, typically around 6-8 weeks post-injury, therapy advances to include controlled active motion of the affected joint. This phase incorporates specific exercises designed to restore metacarpophalangeal (MCP) joint mobility while carefully monitoring for any signs of fracture displacement. Therapists utilize techniques such as joint mobilization, selective soft tissue mobilization, and progressive resistive exercises tailored to the patient’s healing stage.
Strengthening exercises begin gradually, often incorporating therapy or hand exercise putty of increasing resistance levels. These exercises focus on intrinsic hand muscle strength, particularly the interossei and lumbricals, which are crucial for proper finger alignment and fine motor control. Specific attention is paid to maintaining the transverse metacarpal arch, which can become flattened during immobilization.
Occupational therapy components address functional activities essential for daily living and work tasks. This includes retraining proper grip patterns, maintaining appropriate joint protection during activities, and gradually returning to normal hand use. Therapists may provide adaptive equipment or temporary splinting to facilitate safe return to activities while protecting the healing knuckle.
The final phase of rehabilitation focuses on advanced strengthening, endurance training, and activity-specific conditioning. This might include exercises using specialized equipment like finger extension bands, grip strengtheners, or computer-assisted devices that provide biofeedback. Throughout recovery, careful monitoring ensures that increased activity doesn’t compromise fracture healing or cause excessive inflammation.
Top Bloomfield Hills Hand Doctor
A broken knuckle or “boxer’s fracture” that is rapidly diagnosed and treated by a skilled hand doctor will usually heal with no long term complications. But if treatment is delayed or the break is left untreated, a boxer’s fracture can result in crooked finger, decreased range of motion in the hand and even the inability to grasp objects.
Proper medical diagnosis, treatment and follow up care by an experienced hand doctor is critical for good healing from a broken knuckle.
If you suspect you may have a boxer’s fracture (broken knuckle) – or any hand injury – call boar certified Bloomfield Hills hand surgeon Doctor Rehman as soon as possible. She and her expert team of hand therapists will diagnose and treat your injury – as well as put in place a long-term therapy and rehabilitation plan to ensure that you heal as rapidly and fully as possible.