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Medical Author:

Manuel Hernandez, MD

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Physical examination in conjunction with X-rays is essential to properly diagnose a boxer's fracture. Findings that suggest the need for X-rays include activities that increase the risk of fracture, deformity of the hand, localized tenderness, swelling of the hand, discoloration, decreased ability to move the hand, wrist or fingers, numbness, unequal temperatures between the injured and uninjured hands, or a cut caused by teeth when punching someone in the mouth (resulting in a human bite injury).

The doctor will determine if X-rays are warranted based on the circumstances surrounding the injury. After the doctor obtains detailed information about how the hand was injured, a physical examination is the next step in the evaluation.

• Swelling and discoloration commonly are seen with fractures and are associated with damage caused by direct trauma to the bone and surrounding muscles, ligaments, tendons, nerves, and blood vessels.
• Decreased ability to move the hand in the usual directions and manner may result from the swelling or pain associated with the fracture. The doctor will ask the patient to make a fist. This helps to determine the extent of the injury, as well as the type of treatment that may be needed. This also may indicate if a ligament has been torn. Torn ligaments will not show up on standard X-rays, but they sometimes occur with fractures.

X-rays of the hand are performed to look at the hand from three different directions. Evaluating the hand from different viewpoints reduces the risk of not seeing a fracture on the X-ray. After evaluating the bones on the X-ray, the doctor can determine what type of fracture is present. In certain cases, the doctor may order more X-rays, with special views to look for hard-to-find fractures. These studies are ordered when the standard X-rays do not show a fracture and the information regarding the patient's injury or physical examination suggests the presence of a hard-to-find fracture.

On physical examination the doctor will look for the presence of foreign bodies in the hand. Activities that could cause a foreign body to become lodged in the hand include:

punching another person in the mouth

• an animal bite
• being cut with a sharp object
• a penetrating injury
• abrasions or splinters from an object

Foreign bodies that may show up on X-rays are glass, bone, metal, and stones. However, organic or living materials such as wood or plants will not show up on standard X-rays and will require further studies if their presence is suspected.

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