Ask the Doc: Dr. Benjamin on cauliflower ear, hand injuries and knee strikes


Dr. Johnny BenjaminAfter a hugely successful debut column, MMAjunkie.com medical consultant and columnist Dr. Johnny Benjamin is back with his latest “Ask the Doc” feature.

Dr. Benjamin, a veteran combat-sports specialist and a member of the Association of Boxing Commission’s medical advisory team, this week takes a look at some MMA-related injuries and how to prevent them.

What exactly is cauliflower ear? Why is Fedor Emelianenko susceptible to hand injuries? And what’s the doc’s opinion on knees to the head of a down opponent?

Dr. Benjamin discusses all those topics in his latest column.

Q. What exactly does “cauliflower ear” entail? How is it treated? Is it serious?

A. First, a basic anatomy lesson. The ear is composed of cartilage covered by perichondrium covered by skin and little else. The cartilage has no blood supply; it merely supplies shape. The adherent overlying perichondrium is the lifeline for the cartilage by supplying blood that carries oxygen and nutrition to the cartilage. Bored you to death yet? Simply put, without the perichondrium nursing the cartilage, the ear may die or become disfigured. When combatants take blows to their ears or get their ears repeatedly ground into the mat, the friction can shear (tear away) the perichondrium from the cartilage. This “new” space is quickly filled with blood (hematoma) — just like the “mouse” under someone’s eye when they catch an “eye jammie.”

This early/fresh (acute) — let’s call it an ear “mouse” — should be drained ASAP before the blood begins to thicken (coagulate). Old thickened blood is much harder (read: more painful) to drain than fresh blood. After the collection of blood is properly drained, a compressive dressing should be applied so that the blood won’t re-accumulate. Although I am aware that the medical oracle YouTube is replete with how-to videos on draining cauliflower ears and there is an ol’ sage lurking in every self-respecting dojo that will be more than happy to “drain it for ya for free,” remember that it is free for a reason. Make certain that you ask Dr. Priced Right if he or she also takes care of the rip-roaring infection that may end up costing you part of your ear. Also, hearing damage is often associated with cauliflower ears. So I hope for your sake that your dojo doctors are also ENT specialists in their spare time.

If you are a teenager and subscribe to the “chicks dig it” school of thought and feel that is sufficient rationale to alter your body or make any other lifelong decision, rest easy there is hope: it’s called maturity and plastic surgery. Both of which can be difficult, painful and expensive.

If you are an adult and choose to leave your cauliflower ear untreated, I say good for you. That is one of the many privileges of being grown. You’re not hurting anyone. (Who made The New York Times the boss of you?)

Q. I saw Bas Rutten on “Inside MMA” discussing Fedor Emelianenko’s recurring hand issues. Why does he seem to be prone to hand injuries? What’s your take?

A. I can’t speak about Fedor specifically because I’ve never examined him, but I’ll tell you what I do know. Improper technique, misplaced strikes, devastating power, limited padding in grappling gloves and small hands are common factors involved in combat-sport hand injuries.

A properly executed punch should make contact with the second and third knuckles (index and long finger) with a tightly clinched fist and the wrist locked and straight. Combatants throwing wide looping strikes with a partially closed fist are at risk. Also, striking the top of the head where the skull is the thickest is a very common source or hand injuries.

A simple, old-school training technique may be worth revisiting: knuckle push-ups. Knuckle push-ups performed on the first two knuckles help to reinforce proper alignment of the wrist for striking. Loading during this special type of push-up also helps to strengthen the bones and ligaments of the hand. It also encourages you to keep a tightly clinched fist.

Q. Since you are one of the doctors on the ABC rules committee, what do you think of knees to the head of a grounded opponent?

A. Once again, blood, cuts and to some extent broken bones are not particularly dangerous, usually cause no long-term dysfunction, and frankly, we are pretty good at handling them. But concussions, more serious closed head injuries and broken necks are another animal all together. This is a sport and should never become a matter of life, death or loss of livelihood.

The quads and glutes are the strongest muscles in the body. When an elite athlete applies these combined forces correctly through the longest, strongest bone in the body — the thigh bone (femur) — devastation is lurking. A grounded opponent is uniquely vulnerable because in certain situations his or her head can be pinned by a knee to the floor or cage with potentially life-altering consequences. Legalizing this “perfect storm” is bad for the sport and even worse for the athletes and their families.

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