Introduction
A volar plate injury — often called a “jammed” or “sprained” finger — affects the middle joint (PIP joint) of your finger. It happens when the joint bends too far backward, injuring a strong ligament on the palm side called the volar plate. These injuries are common in sports and everyday accidents but usually heal well with proper care and movement.
Anatomy & What Goes Wrong
- The volar plate is a tough, flexible ligament on the palm side of your middle finger joint (PIPJ).
- It connects the base of the middle bone to the base of the proximal bone and helps stop hyperextension and sideways forces.
- Two elastic checkrein ligaments attach it proximally; distally, it merges with collateral ligaments and the middle phalanx base.
- When forced backward by impact—such as catching a ball or falling—the plate can stretch or tear. In some cases, it may pull off a small piece of bone (an avulsion fracture).
How It Happens & Who’s at Risk
- Finger tip gets hit or bent backward, such as by a ball, fall, or catching your finger.
- Most often affects the index, middle, ring, or little finger PIP joint.
- Ranges from a mild sprain to a complete rupture; may involve dislocation or bone fragment.
Signs & Diagnosis
- Symptoms: Immediate sharp pain, swelling, bruising on the palm side, stiffness, reduced bending or straightening, possible crooked look.
- Physical exam: Doctor checks swelling, tenderness, deformity, and tests stability using gentle pressure. Pain with passive extension suggests injury.
- X-ray: Used to rule out dislocation and identify avulsion fractures. Oblique and lateral views help detect small bone fragments often missed on front views.
Classifying Injury Severity
- Eaton system: Ranges from minor avulsion (Type 1) to unstable fractures involving over 40% of joint surface (Type 3b).
- Keifhaber–Stern system: Labels injuries as stable (<30% bone involvement), tenuous (30–50%), or unstable (>50% or needs >30° flexion to stay aligned).
How It’s Treated
Conservative Care (most cases)
- Rest, elevation, ice, pain relief (e.g., ibuprofen or paracetamol).
- Buddy taping: Tape injured finger to its neighbour to protect but still allow safe movement. Wear this continuously for 2–4 weeks. Add a dressing between fingers to absorb sweat.
- Splints: Used for larger fractures or instability—typically an angled block splint that gradually straightens over several weeks.
- Gentle exercise: Start within days—bend and straighten the finger gently to avoid stiffness. Add exercises such as making a fist, tendon‑gliding movements, and light resistance as swelling and pain decrease.
- Hand therapy: Guidance from a specialist if symptoms persist or after delays in starting care.
Surgery (less common)
- Recommended if there’s joint instability or large displaced fracture (>40–50%).
- Procedures may include fixation of bone fragment, repair of ligaments, or reconstruction of the volar plate.
- Better outcomes are seen when surgery happens within 4 weeks of injury.
Recovery Timeline & Expectations
- Healing time: Light injuries often heal in about 6 weeks.
- Swelling & mild discomfort: Can persist for months, sometimes up to 1–2 years.
- Stiffness: May become persistent without early movement; seek help if motion reduces after six weeks.
- Returning to activities:
- Daily tasks like writing or dressing can resume after ~2 weeks with support.
- Office work as comfort allows; manual or gripping tasks may need 6 weeks.
- Driving is safe only when you can operate controls and an emergency stop without pain.
- Sports may resume after ~6 weeks; contact sports or heavy gripping should wait ~12 weeks.
Potential Long-Term Issues
- Persistent swelling, pain, and sensitivity.
- Stiff finger or inability to fully straighten (extension lag).
- Swan‑neck deformity (crooked joint) from instability.
- Chronic joint stiffness or arthritis.
- Surgical scars or even need for joint fusion/replacement in rare chronic cases.
Quiz Section (brief patient-level questions)
- What is the volar plate, and where is it located?
- How does a typical jammed finger injury occur?
- Name three immediate symptoms of a volar plate injury.
- Why is an X‑ray often done even if no fracture seems obvious?
- What is buddy taping, and why is it used?
- How do exercise recommendations evolve as your finger heals?
- When might surgery be considered instead of splinting or taping?
- What’s a key difference between Eaton and Keifhaber‑Stern systems?
- Name two long‑term complications from a mismanaged injury.
- How long might swelling or lingering mild pain last even after healing?
Key Take‑Away Points
- Volar plate injuries are common, typically caused by forced hyperextension.
- Most heal well with early gentle movement, buddy taping, and supervised rehabilitation.
- Recovery often takes several weeks, with swelling sometimes lasting up to two years.
- Surgical management is reserved for unstable or severe injuries.
- Long‑term issues are less common with prompt and appropriate care.
Clinical Pearls / Important Reminders
- Don’t immobilise too long—early, controlled movement prevents stiffness.
- Monitor swelling and flexibility; seek expert advice if improvement stalls after six weeks.
- Even if injured several weeks ago, hand therapy can still lead to a good outcome.
When to Seek Help
- Pain, stiffness, or limited motion worsening or lasting longer than expected.
- Symptoms of instability or persistent deformity.
- Delay before starting rehabilitation—late presentation benefits from professional guidance.
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025