QUESTION: A 16 year old girl was playing basketball at school and injured her finger when trying to catch the ball. Her finger was pushed back into hyperextension. The middle knuckle is now swollen and she cannot bend her finger into a fist. What is the problem?
What Is Volar Plate Injury?
A volar plate injury can occur when the finger is forced into hyperextension. It is very common in ball sports. The volar plate is a ligament which sits at the front of the proximal interphalangeal joint. It prevents the finger from hyperextending.
The volar plate is supported by a ligament on either side of the joint called the collateral ligaments, which prevent deviation of the joint from side to side. The ligaments can partially or fully tear and can avulse with a small fracture fragment when the finger is forced backwards into hyperextension. This can cause swan neck deformity of the finger.
Xray showing avulsion fracture of volar plate
Your hand therapist can assess the finger for stability, swelling and movement. An X-Ray or Ultrasound may be needed, your therapist will advise whether this is required.
Treatment of Volar Plate Injury
Your hand therapist will fabricate a thermoplastic finger splint to help protect the ligament whilst it heals. This is sometimes needed for 3-6 weeks. You will also be provided with:
- Education regarding joint protection, activity modification and techniques to reduce swelling.
- Active range of movement exercises will be commenced early. You will be encouraged to bend forward to the palm, and then straighten within the limits of the splint.
- It is important to attend for regular review to allow remoulding the splint and so prevent flexion contractors. You might also be provided with a small Figure of 8 style splint once your swelling has subsided. This will allow increased flexibility while still providing protection to the injured structures.
- Specific strengthening exercises can be commenced from 6 weeks.
- Splinting and buddy taping techniques may be required when returning to sports or heavy activities, once instructed by your hand therapist.
Dorsal splint for volar plate injury
Active flexion within limit of the splint
Figure of 8 extension block splint
Active flexion in the Figure of 8 splint
A referral to a hand surgeon may be required for large avulsion fractures or where the joint is unstable. Your therapist can assess your finger and in discussion with you GP arrange a referral if necessary.
If you have any questions regarding volar plate injury, please feel free to give us a call.