When it comes to injuries hands can be complex in nature due to the fine skills needed using fingers in day-to-day activities which highlights the importance that physiotherapy or hand therapy plays in its rehabilitation. A common injury to the fingers is a Volar Plate injury. The mechanism to cause this is when a finger experiences a forced or sudden hyperextension which results in injury to the finger. This can include damage to the bone (avulsion fracture) or a ligament tear.

The Volar plate can be located on the palm side of the hand underneath the middle knuckle called the Proximal Interphalangeal Joint (PIPJ). This is a synovial hinge joint which allows the finger to flex and extend. The volar plate provides stability to the joint in addition to the collateral ligaments and helps to prevent hyperextension. When forces exceed the volar plates strength/ integrity, this is when an injury can occur.

This type of injury is common in younger patients particularly those involved in contact or hand-based sports such as basketball or cricket. Common signs and symptoms that you may have sustained an injury to the volar plate are: bruising and swelling in the area and if you have pain either right away or with slight movement.

An assessment of the finger by a hand therapist in conjunction with an Xray can help to determine the treatment pathway required. This depends on if the type of injury (avulsion fracture or ligament injury), severity of the injury and how much of the articular surface is affected. Early on the focus would be to reduce swelling and to protect the area from further harm. A thermoplastic splint can be used to protect and stabilise the injury to allow for better healing. Weaning from the splint will usually occur around week 3-4 depending on severity and will happen over a two week period. After restoring both passive and active range to the finger, it is important to rebuild the strength in the finger as the muscles and ligaments in the area will have lost strength and be more vulnerable.  This will be dependent on the goal of the individual as to the task specific training needed to be done. Full contact sport should be avoiding for 6-7 weeks and would be assessed on an individual basis to make sure that certain criteria are met and that it would be safe to return.