Volar Plate Injury
An injury to the ligament on the palm side of a finger joint
Quick Facts
- Type: Hand / finger ligament injury
- Usual cause: Finger bent backward (hyperextension)
- Joint affected: Most often the middle finger joint (PIP)
- Common in: Ball sports and falls onto the hand
Overview
A volar plate injury is a sprain or tear of the volar plate, a thick, strong ligament on the palm side of a finger joint. The volar plate helps keep the joint stable and prevents the finger from bending too far backward. Injuries most often affect the proximal interphalangeal (PIP) joint, the middle knuckle of the finger, and typically happen when the finger is forced backward into hyperextension.
This is a common hand injury in ball sports, such as basketball and volleyball, and in falls onto an outstretched hand. Most volar plate injuries are mild sprains that heal well with simple treatment, but some involve a small fracture or significant instability and need closer attention. Early treatment and appropriate movement help prevent long-term stiffness, which is a frequent problem after finger injuries.
Symptoms
Symptoms appear soon after the finger is injured and center on the affected joint.
- Pain at the front (palm side) of the finger joint, especially the middle knuckle
- Swelling and tenderness around the joint
- Bruising
- Difficulty bending or straightening the finger fully
- Pain when the finger is bent backward
- A feeling of stiffness, which can persist for some time
In more severe injuries, the joint may feel unstable or be partly dislocated, and there may be a small chip of bone pulled off where the ligament attaches.
Causes
A volar plate injury is caused by a force that bends the finger joint backward beyond its normal range.
- Hyperextension: the finger is jammed or forced backward, stretching or tearing the volar plate; this is the most common mechanism.
- Ball sports: a ball striking the end of an outstretched finger, common in basketball, volleyball, and similar activities.
- Falls: landing on an outstretched hand can force the fingers backward.
- Dislocation: the volar plate is often injured when a finger joint dislocates.
Risk Factors
- Playing ball sports, especially basketball, volleyball, and football
- Activities with a high risk of falling onto the hands
- Previous finger injuries
- Not protecting or taping vulnerable fingers during sport
Diagnosis
A volar plate injury is diagnosed from the history and examination, with X-rays to check for fracture or dislocation.
- History and examination: a finger jammed or bent backward, with pain and tenderness on the palm side of the joint, suggests the injury; the doctor checks movement and stability.
- X-rays: taken to look for a small avulsion fracture where the ligament attaches, and to confirm the joint is properly aligned.
- Assessment of stability: gently testing the joint to see whether it is stable or tends to slip backward.
Treatment
Most volar plate injuries are treated without surgery, and early, controlled movement helps prevent long-term stiffness.
- Buddy taping: taping the injured finger to the one next to it provides support while allowing gentle movement.
- Splinting: a short period in a splint may be used, often keeping the joint slightly bent rather than fully straight, depending on the injury.
- Ice and elevation: to reduce pain and swelling in the early days.
- Early motion and hand therapy: gentle exercises, sometimes guided by a hand therapist, to restore movement and reduce stiffness.
- Pain relief: over-the-counter pain medication as needed.
- Surgery: reserved for injuries with a large fracture fragment, significant instability, or a joint that keeps dislocating.
Some swelling and stiffness can linger for weeks to months even after a relatively minor injury, which is normal during recovery.
Prevention
- Tape or protect fingers that are prone to injury during ball sports
- Learn and use proper catching and falling techniques
- Warm up and stretch the hands before sport
- Strengthen the hands and fingers as part of training
- Treat finger injuries promptly and complete rehabilitation before returning to play
When to See a Doctor
See a doctor for a finger injury with significant pain, swelling, or difficulty moving the joint, or if the finger looks crooked or feels unstable. Seek prompt care if you have:
- An obvious deformity or a finger that appears dislocated
- Inability to bend or straighten the finger
- Numbness, severe swelling, or a finger that looks pale or feels cold
- An open wound over the joint
- Pain and stiffness that do not improve over several weeks
Frequently Asked Questions
What is a volar plate injury?
It is a sprain or tear of the volar plate, the strong ligament on the palm side of a finger joint that stops the finger bending too far backward. It usually affects the middle knuckle and happens when the finger is forced backward (hyperextended).
How does a volar plate injury happen?
It typically occurs when a finger is jammed or bent backward, often from a ball hitting the end of an outstretched finger in sports like basketball or volleyball, or from a fall onto the hand. It is also common when a finger joint dislocates.
How is a volar plate injury treated?
Most are treated without surgery using buddy taping or a splint, ice, elevation, pain relief, and early gentle movement, sometimes with hand therapy. Surgery is reserved for injuries with a large fracture fragment, marked instability, or a joint that keeps dislocating.
How long does it take to recover from a volar plate injury?
Many heal over several weeks, but some swelling and stiffness can persist for weeks to months even after a minor injury. Early controlled movement and hand exercises help restore motion and reduce lasting stiffness.
When should I see a doctor for a finger injury?
See a doctor if a finger is very painful or swollen, hard to move, looks crooked, or feels unstable. Seek prompt care for an obvious deformity, a dislocated finger, numbness, a pale or cold finger, or an open wound over the joint.
References
- American Academy of Orthopaedic Surgeons. Hand and Finger Injuries.
- MedlinePlus, U.S. National Library of Medicine. Finger injuries and disorders.
- American Society for Surgery of the Hand. Finger Sprains and Dislocations.
- Mayo Clinic. Broken finger — Symptoms and causes.