Volar plate is a thick ligament which protects occurrence of hyperextension. Volar plate separates the joint gap of the flexor tendons and the proximal interphalangeal joint i.e. the first knuckle on the finger. Volar plate(1) passes from the proximal phalanx i.e. the bone of the finger nearest to the hand to the middle phalanx. Volar plate injury is caused due to rupturing of volar plate at the insertion of it on middle phalanx of finger resulting from disruption caused by higher force of hyperextension. This may also pull off small pieces of bone from middle phalanx due to hyperextension of ligaments. Volar plate injury often occurs in combination with collateral ligament tears, the ligaments which prevent excessive sideways motion of finger joints.
Volar plate injuries are also frequently referred to as a jammed finger.
Causes of Volar Plate Injury or Jammed Finger
- Volar Plate Injury or Jammed Finger most frequently occurs when a ball forcibly pulls the finger backwards while taking a catch such as in baseball.
- Volar plate avulsion injuries frequently occur in ball sports like netball or basketball as a result of hyperextension force, which leads to bending of fingers in the backward direction or due to force applied from sideways.
- Volar plate avulsion injuries may be caused as a result of hyperextension of the proximal interphalangeal joint of a finger which often leads to ligamentous injury.(2)
- Volar Plate Injury or Jammed Finger may affect either the ligament or can be avulsion fracture in which the ligament pulls off little pieces of bone at its attachment damaging the collateral ligament resulting in sprained finger.
- Sudden onset of pain in the finger at the time of injury.
- Pain is felt in the joint of the middle finger.
- Immediate development of swelling after the injury.
- Appearance of deformity in the injured finger.
- Pain is also experienced during the movements of the injured joint.
- Bruising on the palmar side of the joint of middle finger.
Treatment for Volar Plate Injury or Jammed Finger
Generally, conservative route suffices for treating Volar Plate Injury or Jammed Finger where there is no involvement of avulsion fracture. Conservative care for Jammed Finger involves immobilization with a splint for up to a week followed by gentle exercises for range of motion. Immobilization for Jammed Finger may be done using splints or buddy straps.
- RICE protocol for Jammed Finger is followed.
- Anti-inflammatory medications may be used to reduce the pain, swelling and inflammation.
- If the Volar Plate Injury or Jammed Finger involves fracture, then surgery may be required to fix the fracture before immobilization.
- Metal implants such as pins and wires are used to fix the broken fragments of bone depending upon the nature and type of the fracture.
- Risks of the procedure are infection, bleeding, injury to neurovascular structures etc.
Physical Therapy For Volar Plate Injury or Jammed Finger: PT is essential for faster healing of the Jammed Finger and get the wrist and hand back to normal. Physical therapy treatment for Jammed Finger includes:
- Joint mobilizations.
- Soft tissue massages.
- Improving flexibility with the help of exercises.
- Activity adjustment.
- Slow return to activities of daily living (ADLs).
Exercises for Volar Plate Injury or Jammed Finger
Listed below are some common exercises done for improvement of strength and endurance after complete healing of Jammed Finger.
- Wrist Bend Exercise For Jammed Finger: This is done by placing forearm on a flat surface with wrist and fingers on the edge. The wrist is now bent in the forward and backward direction slowly until painless stretch is sensed. This is done 10 times without increase of pain.
- Hand Open and Close Exercise For Jammed Finger: This involves making a fist first and then straightening fingers slowly as much as possible till a painless stretch is sensed. This is also done for about 10 times without increase of pain.
- Finger Adduction to Abduction Exercise(3) For Volar Plate Injury or Jammed Finger: To do this exercise, straighten fingers and join them together. Now, the fingers are moved away from each other as far as possible. This is done at least 10.
- Tennis Ball Squeeze Exercise For Volar Plate Injury: Hold a spongy object and squeeze it as hard as it can be squeezed without aggravating pain for about 15 seconds.
Volar Plate Injury or Jammed Finger Recovery Period
Since Jammed fingers are associated with ligament injury or tear of the ligament, so healing time is not going to be very quick as finger ligaments tend to have poor blood supply. For minor injury or tear from jammed finger, healing time could be 2-6 weeks. For major injury from Jammed Finger, healing time could be 4-8 weeks and for a very severe injury, healing time could be 2-3 months.
Investigations for Volar Plate Injury or Jammed Finger
A detailed examination is required for its diagnosis including a neurovascular examination to look for damage to nerves or vessels. The first and important step in establishing a diagnosis of volar plate injury or jammed finger is x-ray, which goes a great length in determining the severity of injury. Other tests include CT scan and MRI in rare instances.