A volar plate injury is common in ball sports, such as netball or cricket when a ball hits the end of the finger, forcing it into hyperextension.
What Is a Volar Plate Injury?
The volar plate is a ligament that is on the palm side of the finger. It stabilises the proximal and middle phalanx and prevents hyperextension at the proximal phalangeal joint. With sudden force the ligament can be stretched to its capacity and then it fails, pulling a small piece of bone off with it. It results in a painful, bruised, and swollen finger that can be hard to move.
These are best treated early, but often patients present late as they do not realise the severity of the injury. Many people ‘jar’ their finger but do not do any serious damage and movement/pain returns to normal within a few days. Significant bruising and swelling is an indicator that a fracture or ligament damage may be present, and it is encouraged that you seek medical advice.
Treating Injuries to the Volar Plate
Often patients require some sort of splinting for protection whilst the ligament heals. This could be in the form of a static digit splint, a figure of 8 splint, or buddy strapping, such as the below.
Flexion exercises are encouraged because when the finger is flexed the ligaments essentially relax and are not under tension. This means that flexion is a safe exercise and is essential as these injuries are prone to developing stiffness.
Extension may be blocked in the splint to allow the avulsion fracture/ligament to heal without being under tension. Your therapist will be able to guide you on what is the most appropriate management.
Reducing swelling is important in regaining motion and settling pain. A complication of this injury is developed a fixed flexion deformity. This is where the ligaments on either side of the joint (collateral ligaments) and the volar plate scar in a shortened position not allowing full extension of the proximal interphalangeal joint. Specific exercises and splints may be required to slowly stretch the structures out again.