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Date: June 2023

Review date: June 2025 

Ref: C-459/FC/Occupational Therapy/Volar Plate injury v4

PDF:   Volar Plate injury final June 2023 v4.pdf[pdf] 283KB

Volar Plate injury

What is the volar plate?

The volar plate is a fibrous cartilage structure on the palm/front of the middle

(PIP) joint of your finger/thumb. The volar plate prevents the middle joint from overstretching. The collateral ligaments on each side of the joint prevents the joint from bending sideways. The volar plate and collateral ligaments help maintain stability of the joint and prevent it from dislocation.

What is a volar plate injury?

Volar plate injury occurs when the middle joint of your finger is forced to overstretch backwards. It can be caused by a ball hitting the finger, or a fall or the finger is caught and forced backwards.

The volar plate can be strained, partially torn, or fully torn when it has been forced into overstretching. Sometimes it can pull off a small piece of bone at the middle joint of your finger

Symptoms of a volar plate injury

• Painful

• Swollen

• Bruised around the middle joint of the finger

• Difficulty in moving the finger

PIP joint dislocation

The PIP joint is the middle joint in your finger, and it is a very complicated joint with lots of soft tissue structures supporting it.            

When this joint is dislocated, the soft tissue structures are often over stretched on one side and compressed on the other side.

This can cause reduced movement, pain, swelling and laxity (looseness) around the joint.

What can you do to reduce swelling in your finger?

It is normal to have swelling after an injury. Swelling can make your hand uncomfortable and stiff. Most of the swelling should settle down in about 4 to 6 weeks but occasionally it will take a lot longer than expected.

You can keep the swelling down by elevating your hand above your heart as often as possible. You can rest your hand on a couple of pillows at night to keep it slightly elevated.

Your clinician may advise you to use a compression wrap to reduce the swelling.

You can also try wrapping an ice pack or bag of frozen peas in a damp tea towel and putting this on your hand in the first few days of your injury. Leave for 10 minutes or less and repeat 3 times a day. If you suffer from circulation problems, it is not appropriate for you to use a cold compress.

How long it will take PIP injury to heal?

A PIP injury usually takes between 4 to 6 weeks to heal. It can take up to 12 weeks to fully heal. You may find you still have some discomfort in the middle joint of the finger for up to 6 months following the injury.

Treatment of a PIP injury

Treated with either Buddy/Bedford strapping (see below) or dorsal blocking splint (see page 11).

Buddy/Bedford strapping

In cases where the injury is only minor and the joint and soft tissue structures are stable, the injured finger can be supported by strapping it with the adjacent finger. This helps to protect the injured finger and allow the injury to heal while you can move the finger freely. The strapping should be worn all the time for 4 weeks.

The fingers can be buddy strapped with sticky tapes or a Bedford Splint (double finger elasticated stockinette)

Exercises

The following exercises prevent stiffness in your finger. It is normal that you find moving your injured finger initially uncomfortable, this will improve over time.

For the first 4 weeks post-injury do not force the middle joint of your finger straight.

Maintain shoulder, elbow, wrist and any joints that are not included in the splint to prevent them from stiffening.

The following exercises are to be performed:…………times a day.

Each movement is to be performed for:…….….repetitions.

Holding each position for:…………..seconds.

Your clinician will advise to exercise in or out of buddy or Bedford strap

If you would like to access the exercise videos, please visit www.hep.video and type in the specific access code related to the exercise.

Passive Flexion Exercises

Use other hand to push fingers into palm of hand.  Access code:VVGS979QR

Active Tendon Gliding Exercises

Access code: VV6H7CMGT

At 4 weeks post injury if you are struggling to fully straighten your finger. Commence Passive extension exercises:

Access code:VVGS979QR

Use other hand to push fingers straight/push fingers straight on a flat surface. X…….daily, X………reps. Hold for:…………seconds.

Splinting (dorsal block splint)

You may be given a thermoplastic splint to wear.

Dorsal block splint

Splinting schedule

• Please wear your splint 24 hours a day including when you are in the bath/shower for a total of 4 weeks post-injury or otherwise advised by your hand therapist.

How should I remove and put the splint back on?

Look after your hand separately. Remove your splint once or twice a day to gently wash your hand.

• Undo the Velcro straps on the splint and remove the splint from your finger.

• Keep all your fingers slightly bent.

• Wash your hand with soap under a running tap.

• Dry your hand thoroughly.

• Put your splint back on your finger.

• Wash the splint in lukewarm soapy water.

Exercises while you are wearing your splint

While your finger is healing, the soft tissue in your joint could become stuck and make your finger stiff to move.

The following exercises can help prevent stiffness in your finger. It is normal that you find moving your injured finger initially uncomfortable. You should not overstretch the middle joint of your finger when you exercise your finger as this may cause more damage to the joint.

Please do the following exercises ____________times a day.

Each time do _____________repetitions of each movement.

1. Passive flexion 

    Undo the top strap/s and use other hand to push finger into palm of hand. Hold for _______ seconds

2. Isolated movement in end joint

    Undo the top strap/s on your splint.

    Use other hand to support your finger just below the end joint of your finger.

    Bend and straighten the end joint of your finger within the splint as far as you can.

3. Isolated movement of the middle joint

   Undo the top 2 straps on your splint.

   Keep other fingers straight.

   Bend and straighten the middle joint of your finger as far as you can within the splint.

4. Flexion of whole finger

   Undo the top two straps on your splint.

   Gently bend all the fingers down and curl them into the palm.

   Straighten your finger to as far as the splint.

Exercises at 4 weeks post-injury out of splint

Commence passive flexion, active tendon gliding exercises and passive extension as described on pages 7-10

Start to use your hand for light activities gradually increasing. Avoid contact sport until 10-12 weeks post-trauma.

When can you return to driving?

You should not drive while you are in a splint. You should not return to driving if you have significant pain or if you have reduced grip function that affects your ability to drive safely and perform an emergency stop manoeuvre.

We cannot give you permission to drive. It is your decision.  It is your responsibility to ensure that you are safe to drive, and you are in control of the vehicle.  Please refer to the DVLA website regarding fitness to drive.

What outcome can you expect after a PIP injury?

Most PIP injuries heal in about 6 weeks. However, the swelling, pain or discomfort may take several months to settle completely. The soft tissue structures can take up to 3 months to heal fully. Most simple injuries will return to normal function after 3 months.

Your finger may become stiff due to lack of movement. It is important that you exercise your finger as you are advised by your Hand Therapist. It may take 2 months or sometimes longer to regain full movement in your finger.

You may find your hand weaker when you start to use it. It may take a few months to get your strength back.

Complications

• Lasting swelling in finger

• Stiffness in finger

• Pain

• Inability to fully straighten the middle joint of the finger

• The middle joint can be larger than before the injury

• Deformity

• Very occasionally some instability in the joint

If you have any concerns, please contact: