A common joint injury observed in boxing is a tear of the ulnar collateral ligament (ULC) of the 1st ray metacarpophalangeal joint, the ligament that lies on the inside of the thumb (1). This ligament is often damaged when the thumb is caught and bent back during punching or defending. This is commonly referred to as a “skiers thumb” (when occurring acutely), or a “gatekeepers thumb” (when occurring chronically).
Athletes will often report localised pain around the thumb, particularly with bending the thumb back, and will typically have difficulty gripping.
Less severe cases of this injury can be managed with 4-6 weeks of immobilisation in a splint, followed by a graded strengthening program, particularly focusing on grip strength. Joint mobilisation may also be useful for less severe UCL injuries, with mobilisation of the thumb in the opposite direction to the direction of the injury often effective in reducing pain and improving function.
The risk with this type of injury is the development of a stener lesion, where the aponeurosis (a sheet of connective tissue that acts as an anchor) of the adductor pollicis (thumb muscle) becomes caught between the two ends of the ligament, and prevents healing of the ligament (2). This will often result in a lump on the inside portion of the thumb. In these cases, immobilisation of the joint will not allow for full recovery and surgery is required.
1. Noble C. Hand injuries in boxing. Am J Sports Med. 1987;15(4):342–346.
2. Ritting AW, Baldwin PC, Rodner CM. Ulnar collateral ligament injury of the thumb metacarpophalangeal joint. Clin J Sport Med. 2010;20(2):106–112.

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