Volar plate ligament injury of the finger hand therapyBy Nigel Chua
“Working with a knowledgeable hand therapist can make the difference between success and failure in complex hand surgical cases. The therapist extends the continuum of our care, as well as functioning as coach and trainer for our patients.”
- Marybeth Ezaki, MD, Past President, American Society for Surgery of the Hand.
Volar plate ligament (red) with an avulsion fracture
The volar plate is a ligament on the palm side of the finger, made of tough tissue connecting the finger bones together for stability.
The most common joint of the finger to have a volar plate injury is the one closest to the knuckle called the proximal interphalangeal joint, or PIP.
The volar plate tightens as the PIP joint is straightened and keeps the joint from being bent backward or hyperextended. Because of that, our volar plate can be sprained, ruptured or avulsed.
A sprain occurs when the ligament is stretched or some fibers are torn. A rupture is when the ligament is completely torn. An avulsion is when the ligament is torn away from the bone, causing a fracture.
WHAT ARE THE SYMPTOMS OF A VOLAR PLATE INJURY?
Initially, the finger may be
around the PIP joint.
Finger motion may be decreased due to pain and swelling. If the PIP joint has been dislocated, it may look out of place.
WHAT ARE THE CAUSES OF A VOLAR PLATE INJURY?
The most common causes of volar plate injuries are sports or falls when the finger is bent back forcefully. The volar plate can also be injured if the PIP joint is dislocated.
Catching a ball in sports is a common cause of volar plate injury
WHAT IS THE TREATMENT FOR A VOLAR PLATE INJURY?
Th good news is that most volar plate injuries can be treated without surgery.
A physical examination and x-rays may be taken to rule out the possibility of finger fractures.
Treatment may consist of a short period of protection by wearing an orthosis and early exercise. That being said, if the volar plate injury is not stable, surgery might be required.
WHAT CAN A HAND THERAPIST DO FOR ME?
It is important to see our senior hand therapists after having a volar plate injury.
We will likely make a custom volar plate splint to protect the finger as it heals. We will teach you hand therapy exercises to
- prevent stiffness
- reduce swelling
- improve strength and function of the hand.
Example of a finger-protection orthosis for a volar plate injury
Patients may also receive the following hand therapy treatment modalities:
- cold therapy
- heat therapy
- moist heat paraffin wax therapy
- manual therapy
- joint mobilization
- ultrasound therapy
- stretching exercises
- strengthening exercises
- scar management.