Finger injuries / dislocations
Volar plate injuries
Recognising the Symptoms and Solutions
Ali Phillips | Hand & Wrist Specialist
Painful, swollen finger?
Hello, I'm Ali Phillips. If you've "jammed" your finger playing sports or had a fall, you might have a Volar Plate Injury. It's one of the most common finger injuries I see. Although it can be painful and worrying, with the right care you can expect an excellent recovery. My goal here is to give you clear, compassionate information to help you understand your injury and the journey back to a healthy hand.
Book a ConsultationWhat Exactly is a Volar Plate Injury?
Think of the Volar Plate as a very thick, strong ligament at the base of the middle joint of your finger – the one we call the Proximal Interphalangeal (PIP) joint. Its primary job is to stop the finger from bending backwards, thereby providing crucial stability.
A Volar Plate Injury typically happens when the finger is forcefully hyperextended, or bent back the wrong way. Consequently, this causes a dorsal dislocation, where the middle bone of the finger (middle phalanx) is pushed backwards over the top of the first bone (proximal phalanx), tearing the Volar Plate in the process. For this reason, it's much more than just a "sprain".
What are the Symptoms of a Volar Plate Injury?
Pain and Tenderness
You'll feel significant pain, especially on the palm side of the middle finger joint. It will also be very tender to the touch.
Significant Swelling
The joint will swell up quickly and look quite bruised. In addition, this swelling can make the finger look "sausage-shaped".
Difficulty Bending
Pain and swelling will make it very difficult to bend the finger. Furthermore, you may also feel that the joint is unstable or "wobbly".
Why an Expert Diagnosis is Crucial
Not all finger dislocations are the same, and getting the diagnosis right from the start is absolutely critical. For this reason, an X-ray is essential and non-negotiable.
Dorsal vs. Volar Dislocation: A Critical Difference
This Injury: Dorsal Dislocation
This is the common "jammed finger" where the joint bends back too far. As a result, the Volar Plate at the front is torn. Fortunately, this injury will almost always heal well without surgery, but it needs the correct therapy to prevent stiffness.
A Different Injury: Volar Dislocation
This is a much more serious, but rarer, injury where the finger dislocates towards the palm. This tears the Central Slip, the vital tendon on the back of the finger that straightens the joint. A Central Slip injury, however, will not heal on its own and often needs surgery or highly specialised splinting. Mistaking one for the other leads to poor outcomes.
Checking for Joint Stability on X-ray
After confirming the diagnosis on X-ray, the next critical step is to assess the joint's stability. I look to see if the joint surfaces are congruent, meaning they are perfectly parallel and aligned, like two parts of a hinge. If they are, the joint is stable. If the joint is 'hinging' open at the back, it is unstable. In cases where you are in too much pain to move, a local anaesthetic injection can numb the finger, allowing us to safely check its movement. Ultimately, this single step determines your treatment path.
Don't Guess With Your Finger Injury
An accurate diagnosis from a specialist is the most important step towards a full recovery. If there is any doubt, a referral should be made immediately.
Get an Expert OpinionHow Can We Get You Better?
Treatment is entirely guided by the stability of the joint. The goal is always to get the finger moving as soon as it is safe to do so to prevent stiffness.
For Stable Joints: Buddy Taping If the joint is congruent and stable, the treatment is immediate mobilisation. We "buddy tape" the injured finger to its neighbour, which acts as a moving splint, allowing you to bend and straighten the finger safely.
For Unstable Joints: Dorsal Blocking Splint If the joint is not congruent and wants to slip out of place, it needs to be protected. A specialist hand therapist will make a custom thermoplastic splint that holds the finger slightly bent, preventing it from dislocating. This is called a dorsal blocking splint. You will still perform exercises within the safe range of the splint.
Expert Hand Therapy Regardless of the treatment, working with a hand therapist is vital. They are the experts in managing swelling, guiding your exercises, and ensuring you regain motion and strength for the best possible outcome.
Surgery is almost never indicated for a dorsal dislocation that injures the volar plate. The ligament has an excellent capacity to heal. However, surgery is often required for the other type of injury—a volar dislocation that tears the central slip.
Your Questions Answered
A "jammed finger" is a colloquial term. A Volar Plate Injury is the specific medical diagnosis for the most common type of jammed finger, where the PIP joint has been hyperextended (bent backwards), causing a dorsal dislocation and tearing the ligament on the palm side.
You can ask your GP for a referral to a consultant hand surgeon, or you can search for a specialist through your private medical insurer or online directories. Look for a surgeon who is a member of the British Society for Surgery of the Hand (BSSH).
The ligament takes about 6 weeks to heal, but the main goal is restoring motion. You will likely buddy tape for 3-6 weeks. The joint can remain swollen and slightly stiff for 6-12 months, which is a normal part of the healing process.
A dorsal blocking splint is used when a PIP joint is unstable after being relocated. It holds the finger in a slightly bent position to prevent it from dislocating again, while still allowing for safe bending exercises. It protects the healing ligament in a stable position.
You must always seek urgent medical attention and get an X-ray. It is impossible to know the extent of the injury, whether there is a fracture, or which direction the joint dislocated without an X-ray. Attempting to treat it at home can lead to long-term pain, stiffness, and instability.
Any injury to a joint can increase the long-term risk of post-traumatic arthritis. However, for a volar plate injury where the joint is relocated perfectly and heals in a stable, congruent position, the risk is low. The best way to minimise the risk is to follow the hand therapy plan to restore full movement.
A congruent joint means the surfaces of the two bones that form the joint are perfectly parallel and aligned throughout their range of motion. It looks like a perfect hinge. If the joint is incongruent, it means the surfaces are not aligned, and the joint may be unstable or 'hinging' open, which requires different treatment.
You should see a hand therapist as soon as possible after your diagnosis. Early intervention is key to managing swelling and starting the correct, safe exercises to prevent stiffness. They will be a crucial part of your recovery team from day one.
Yes, generally it is. The central slip is a tendon that will not heal on its own and if the injury is missed, it can lead to a permanent deformity of the finger (a boutonnière deformity). A volar plate tear is a ligament injury that almost always heals without surgery. This is why an expert diagnosis is so important.
Swelling is the most persistent symptom. While the worst of it goes down in the first few weeks, it is completely normal for the joint to look and feel 'thicker' or more swollen than your other fingers for six months, and sometimes up to a year. This is part of the body's healing and remodelling process.
Your Recovery Milestones
The key to a great recovery is not to stress, but to start moving early and gently. Swelling after this injury can set like concrete if the joint is kept still for too long. Here are some gentle goals to aim for.
Day 1
Start Moving Immediately
As soon as you are in your buddy strapping, begin gently flexing (bending) and extending (straightening) your finger. The goal is to reduce swelling. Think of it as gently pumping the fluid out of the joint.
Week 1
Aim for Full Straightness (Extension)
As the initial pain subsides after a few days, your priority should be to get the finger fully straight. Regaining this last bit of extension is often the hardest part, so concentrating on it early is key. Everything should be gentle. If it's too painful to straighten, it may mean the joint is unstable and you should seek advice, as you may need a splint.
Week 3
Aim for a Full Fist (Flexion)
By the end of the third week, you should be aiming to get the finger fully bent into a complete fist. The overall goal is full extension and full flexion by this point. Don't let the joint heal in a bent position.
The most important thing is to be reassured. As long as the X-ray shows the joint is located and congruent, it will heal beautifully. Your job is to keep it moving to prevent stiffness.
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