There are five fingers (also known as digits) attached to the human hand. The four fingers can be folded over the palm which allows the grasping of items. Each finger, beginning with the nearest to the thumb, has a name to distinguish it from the rest, which are the index finger, middle finger, ring finger, and little finger.
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 that sits at the front of the proximal interphalangeal joint. It prevents the finger from hyperextending. In addition, the volar plate includes a few unique anatomical features, including:
- Distally – dense fibrocartilaginous structure.
- Centrally – thin and confluent with volar periosteum of the middle phalanx.
- Proximally – lateral aspects of the volar plate form a pair of checkrein ligaments.
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 backward into hyperextension. This can cause swan neck deformity of the finger.
Causes & Symptoms
Volar plate injuries can occur when the proximal interphalangeal (PIP) joint of a finger is hyperextended causing a ligamentous injury. Many of these injuries are frequently seen in athletes, especially ball-handling sports. The collateral ligament injury typically heals without difficulty, although scar tissue formation can occur in the healing of this ligament. The scar formation from the healing collateral ligament often results in enlargement on one side of the PIP joint leading to the appearance of a permanent bulge.
Volar plate injuries can also be caused by diseases and other types of trauma. Diseases such as rheumatoid arthritis can weaken and loosen the volar plate, leaving it susceptible to injury. Trauma to the finger, such as breaking a fall with an outstretched hand, can hyperextend or dislocate a finger and tear or even rupture its volar plate and one or both of the collateral ligaments. In some cases, the bone at the attachment of the volar plate may fracture and be pulled away partially or completely.
Throughout the symptoms linked to volar plate injuries, careful assessment should be performed in determining the severity of the injury. Certain symptoms of volar plate injuries involve either stretching of ligaments, or much more serious, an avulsion fracture. An avulsion fracture is where a small piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Generally, ligaments hold your bones, joints, and organs in place while tendons connect muscles and bones. In an avulsion fracture, your bone moves one way and your tendon or ligament moves in the opposite direction with a broken chunk of bone in two.
Other symptoms associated with volar plate injuries include:
- Significant swelling or deformity at the joint.
- Pain when the finger is resting.
- Inability to move the joint fully.
- Severe pain with range of motion of the finger.
- Weaker bone structure and disfigurement due to insufficient healing.
Who gets a Volar Plate Injury?
Patients who have weakened bones, such as older adults or those with a calcium deficiency, have a higher risk of experiencing a volar plate injury. Additionally, people who work with their hands, such as athletes and manual laborers, have an increased chance of getting their volar plate injured. Certain sports that can increase the risk of this type of injury include the following below:
How Does it Affect You? How Serious is it?
Overall, volar plate injuries are led by fractures in any of the fingers of the patient. Therefore, this can lead to several other injuries alongside this particular injury (such as spiral fractures, stable fractures, and boxer’s fractures).
If you fracture or even break a finger, there are a few levels of severity that will determine what approach your doctor chooses to take. If you have a stable, non-displaced fracture, this means you may have a crack in the bone, but the bones are still in the right place. A stable fracture is the simplest type of fracture to fix and typically requires stabilization and immobilization.
A spiral fracture or shatter can be much more complicated and problematic when it comes to fractures in general. A spiral fracture occurs when the bone breaks with a twisting motion. It often separates into two parts, with the edges no longer aligned. Other more complicated fractures include a crack at the knuckle and damage to the ligament around the bone.
Another frequent finger injury is the pinkie break, sometimes called a boxer’s fracture. The boxer’s fracture is actually an injury to the metacarpal bone of the hand, just below the bottom joint of the pinkie finger. Another complication that is associated with finger fractures is arthritis. There are three different types of finger arthritis that can take place after a finger fracture, including the following:
- Osteoarthritis – also called ‘wear-and-tear’ arthritis, is the most common type of finger arthritis. Osteoarthritis causes normal cartilage to wear away. This exposes bare bones at the joints. The most frequently affected joints in the hand are the knuckles of the mid-finger and fingertip (PIP and DIP joints) and the joint at the base of the thumb.
- Rheumatoid arthritis – This condition causes a different type of joint impact. Rheumatoid arthritis is an autoimmune condition that affects the entire body. It causes the immune system to attack the soft tissues surrounding the joints. The most commonly affected joints in the hand are the knuckles at the base of the fingers (MCP joints).
- Gout – is a condition that happens when crystals develop within the joints. These crystals can form in one or more joints when there is too much of a substance called uric acid in the body. While the big toe is the most commonly affected part of the body, gout can also develop in finger joints.
Recommended Treatment & Rehabilitation
If you have symptoms of a volar plate injury, your doctor will most likely obtain an X-ray to help determine if there is an additional fracture to the injury. Not all fractures appear accurately on a single X-ray, so it may be required to obtain multiple X-rays in different angles if the diagnosis isn’t clear. Examinations of the injured finger are very helpful to guide treatment. An examination can help determine if there is an outstretched, shortening, or rotation of the digit as a result of the injury. An examination can also be helpful to ensure there is no ligament damage or other injury that could alter the treatment recommendations.
It is very important to know if the fracture due to the volar plate injury is stable or unstable. To determine the stability of a fracture, your doctor will look at the pattern of the break on an X-ray to predict if the fracture will tend to slip out of position over time or stay in a stable position. Secondly, your doctor will begin to search for deformities of the finger such as shortening, outstretching, or rotation. Your fingers on the injured hand should line up the same way as the fingers on your uninjured hand. This means if you straighten out all your fingers on both hands, they should come to the same comparable length.
The first critical treatment step for a volar plate injury is immobilization…you need to keep the finger in place to allow it to recover. Your doctor may recommend a cast or splint depending on where and how severe the injury is. If a stable fracture was presented, a simple splint may help immobilize the fractured finger. Buddy taping of the fingers after the initial few days of immobilization is also a necessary treatment for finger support. At first, buddy taping will be necessary all the time, gradually progressing to buddy taping only with expertise or sporting activities with the affected hand.
Many patients may require physiotherapy for range of motion exercises. Stiffness and swelling are of great concern and may be long-term reminders of the injury.
Here are some examples of typical rehabilitation exercises for volar plate injuries:
First, place your hand flat on a table, palm down. Then, lift and lower your affected finger off the table. Repeat this exercise 8-12 times a day.
Place your good hand on a table, palm up. Next, put your hand with the affected finger on top of your good hand with your fingers wrapped around the thumb of your good hand like you are making a fist. Slowly uncurl the joints of your hand with the affected finger where your fingers connect to your hand so that only the top two joints of your fingers are bent. Afterward, move back to your starting position with your fingers wrapped around your good thumb. Repeat this method 8-12 times a day.
With your unaffected hand, grasp your affected finger. Your thumb will be on the top side of your finger just below the joint that is closest to your fingernail. Slowly bend your affected finger only at the joint closest to your fingernail. Hold this position for 6 seconds before repeating 8-12 times a day.
Place your good hand on a table, palm up. Then, put your hand with the affected finger on top of your good hand. Use the thumb and fingers of your good hand to grasp below the middle joint of your affected finger. Finally, bend and then straighten the last two joints of your affected finger. Repeat this exercise 8-12 times a day.
Imaginary ball squeeze
Pretend that you’re holding an imaginary ball. Slowly bend your fingers around the imaginary ball and squeeze the ball for 6 seconds. Then, slowly straighten your fingers back to the starting position as if you are releasing the imaginary ball. Repeat this method 8-12 times a day.
Place a small towel roll on a table. With your palm facing down, grab the towel and squeeze it for about 6 seconds. Finally, slowly straighten your fingers to release the towel. Repeat this exercise 8-10 times a day.
Begin by folding a small towel in half and laying it flat on a table. Next, put your hand flat on the towel, palm down. Grab the towel and scrunch it toward you until your hand is in a fist. Slowly straighten your fingers to push the towel back so it is flat on the table. Repeat this exercise 8-12 times a day.
Alternative & Homeopathic Treatment
Once a splint has been applied to your injured finger, you will likely still feel pain for at least a few days. Usually, over-the-counter (OTC) pain relievers are enough to cure pain, including non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. Here are other homeopathic treatments to help reduce a volar plate injury:
- Elevation – Keep your hand elevated above the level of your heart as much as possible. Elevation helps reduce swelling, therefore, the more your finger is swollen, the more time it will take to heal once it is elevated.
- Ice application – If you have a splint that allows you to feel ice, consider applying an ice pack to your fingers a few times a day for 20 minutes at a time for the first few days after the fracture. This will help reduce further swelling.
- Rest – Letting the injured finger rest for a few days can help lessen the recovery time before performing any regular activity.