A volar plate injury most commonly occurs when a finger is suddenly bent backwards or hyperextended. The volar plate is a thick ligament on the palm side of the finger that prevents hyperextension of the joint. A backwards force applied can overstretch or tear the volar plate away from its attachment and can sometimes also pull away from a small piece of bone.
Definition
A volar plate injury occurs when the finger is bent backward too far (hyperextended). It often happens to athletes. The middle joint of the finger is affected and can involve a strain, tear or avulsion fracture.
Causes
Volar plate injury can occur when a ball strikes the finger bending it back past a straight position at the middle joint. Commonly seen in sports such as cricket, netball and basketball. It may also occur when the finger makes contact with the ground or another player, for example when tackling in football.
Signs & Symptoms
When a volar plate injury occurs, there is usually immediate pain in the joint. Other symptoms include:
- loss of motion in the joint/not able to fully straighten or bend the finger
- Swelling
- Bruising on the palm side of the joint.
In severe cases, the joint may be dislocated.
Treatment
An x-ray is useful to determine if there has been an avulsion fracture or whether the damage involves purely a strain or tear of the soft tissue. If a fracture is present (that involves 40% of the articular joint surface) it may be unstable and require surgical fixation and repair.
A hand therapist can assess the extent of the injury, stability of the finger and the appropriate treatment.
For injuries involving an avulsion fracture, a custom made orthosis is made to protect the volar plate and allow it to heal.
- Strains can often be managed with buddy strapping.
- When an orthosis is required it is worn full time for 4-6 weeks.
- During this time a hand therapist will guide you through safe movement exercises at the right time, not too early nor too late in the healing process.
Left untreated, over time the PIPJ may become stiff and be restricted in movement to bend and straighten.
Melbourne Hand Therapy Can Help You
The volar plate and joint need to be supported in the correct position to ensure the future stability of the finger joint and prevent contracture or loss of motion.
Our experienced hand therapists are experts at assessing volar plate injuries and recommending the correct treatment which may include the fabrication of custom made orthoses. We will guide you through safe exercises to prevent stiffness whilst the healing process is occurring.
In more serious cases where surgery may be required, we can immediately action a referral to one of our hand surgeon colleagues. We will then see you post-operatively for rehabilitation of the injury.
After the initial healing period we will determine when you can safely return to sport, which may be early with a well-fitted orthosis, or sports taping. Hand therapy will also include strengthening to help regain full function of the affected hand and finger.
