Hand Carpometacarpal Joint Instability in Elite Boxers: Injury Characteristics, Surgical Technique, and Outcomes.

PURPOSE: We describe a single-surgeon's experience of managing hand carpometacarpal joint (CMCJ) instability in elite boxers, focusing on injury characteristics, surgical technique, and outcomes. METHODS: This retrospective cohort included consecutive elite boxers undergoing surgery for hand CMCJ instability from 2009 to 2021. CMC joint instability is usually clear on clinical examination using a 'seesaw' test. All cases had a plain radiograph and in equivocal cases for instability advanced imaging such as MRI or ultrasound scan. CMCJs were accessed via longitudinal incisions between index/middle rays, and additionally ring/little. Often marked deficiency in the CMCJ ligamentous capsule was seen. The articular surfaces were decorticated to cancellous bone and autogenous bone graft impacted. The CMCJs were fixed in extension using various methods, latterly memory staples. Outcomes included radiographic fusion, return to boxing, and complications. RESULTS: Forty hands had surgery in 38 boxers. In total, 101 CMCJs were fused, with an average of 2.5 joints per patient. Patients were mainly young (mean age 24.1 years), male (37/38) with the trailing hand more commonly affected (trailing hand 87.5%, leading hand 12.5%). The most frequently fused CMCJ was the index (97.5%, n = 39), then middle (95%, n = 38), ring (45%, n = 18), and little (15%, n = 6). There were 82% (31/38) of patients who returned to the same level of boxing at a median of 8 months from surgery (range 3-27 months). Three patients had revision surgery for non-union, a median of 10.3 months after initial surgery (range 9.4-133.1 months): 2 for index/middle and one for the little CMCJ. All 3 revisions fused and the patients returned to boxing at the same level, although the little CMCJ required a second bone graft and fixation. CONCLUSIONS: Patients can achieve full recovery after treatment of CMCJ instability, and most can return to boxing at the same level with little risk of complications. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Goal adjustment capacities in uncontrollable life circumstances: Benefits for psychological well-being during COVID-19.

Goal adjustment capacities (i.e., goal disengagement and goal reengagement) are core self-regulatory resources theorized to buffer psychological well-being during intractable life circumstances. However, research has yet to examine whether these capacities protect well-being for individuals who encounter uncontrollable losses in their ability to pursue important life goals due to the COVID-19 pandemic. Using a nationally-representative sample of U.S. adults aged 18-80 (n = 292), the present longitudinal study examined the extent to which goal disengagement and reengagement predicted levels and change in psychological well-being for individuals who differed in perceived control over their goals early in the pandemic. Results from multilevel growth models showed that goal reengagement, but not goal disengagement, capacities predicted higher levels of well-being during the pandemic (lower perceived stress, depressive symptoms; higher life satisfaction, meaning in life). Moderation models showed the benefits of goal reengagement for well-being were pronounced among individuals who perceived pandemic-induced declines in control over their goals. Findings inform theories of motivation and self-regulation and point to the adaptive value of goal reengagement capacities during uncontrollable life circumstances.

Extensor hood injuries in elite boxers: injury characteristics, surgical technique and outcomes.

We describe our experience of managing extensor hood injuries in boxers (57 fingers). The diagnosis was mostly clinical, with imaging only if the diagnosis was equivocal. The middle (61%) and index (26%) digits were most frequently injured. On exploration, 26% had no hood tear, however all required tenolysis from the adherent capsule. Of 42 hood tears, 15 were central splits between adjacent extensor tendons in the index or little fingers,15 tears were on the ulna side of the extensor tendon and 12 tears were on the radial side. A pseudobursa was encountered in 35%, capsular tears in 28% and chondral injury in one patient. Longitudinal curved metacarpophalangeal joint incisions were used, with hood repair performed in flexion using a locked running suture. Mean postoperative metacarpophalangeal joint flexion was 90°. Ninety-eight per cent returned to the same level of boxing at a mean of 8 months (range 1-24) from surgery. One finger was revised for re-rupture 6 months later. A reproducible technique for treating these injuries is described, with patients able to return to boxing with little risk of complications.Level of evidence: IV.