What is a volar plate avulsion injury?
Volar plate injuries are often termed as a "jammed finger". Our volar plate is a very thick ligament that helps to prevent the joint from hyperextending and preventing hyperextension injuries.
But, if there's significant and enough force in a hyperextension manner, it may cause enough disruption to rupture the volar plate at its insertion point at the middle of the phalanx of a finger. This often causes a small piece of the bone fragment from the middle phalanx being pulled off (avulsion), by the ligament as it hyperextends.
The same injury may also cause or involve a collateral ligament tear. Our collateral ligament of our fingers functions like a car's suspensions - providing stability from excessive side-to-side motion at the finger joints.
What causes a volar plate avulsion injury?
Volar plate avulsion injury can happen when one's proximal interphalangeal joint (PIPJ) is hyperextended to a point where is causes a ligamentous injury.
Many of such injuries are commonly seen in athletes and sports people, especially those who are actively engaged in sports that has balls and trajectories...but it's not limited to sports people. Very often, it often happens to . Injuries to the collateral ligaments often heals well without much problems, but the biggest problem is scar tissue.
Scar tissue forms in the healing of collateral ligaments, causing stiffness, tightness and decreased range of motion and strength. The scar formation often results in the enlargement on one side of the proximal interphalangeal joint leading to it looking like there's a permanent bulge on the side of the finger.
What are the signs and symptoms of volar plate injury?
The doctor and hand therapist should perform careful assessment to accurately determine the severity of the volar plate injury. Usually, volar plate injuries are described and tested by either stretching the ligaments, or if it's more serious, an avulsion fracture (where the ligament had pulled off a bony fragment from the joint surface of the middle phalanx).
Common signs and symptoms include:
X-rays can determine avulsion fractures and avulsion injuries, but MRIs can accurate demonstrate the extent of the soft tissue injury.
What are the hand therapy interventions required?
Medical intervention and early hand therapy is important, crucial even, to regain optimal mobility and function. Early treatment will require immobilization using custom made splint to suit one's finger exactly, managing pain and swelling management.
After a few days of splinting and immobilization, we will start with gentle warmth therapy using paraffin wax bath and intermittent hotpack heat therapy, coupled with gentle range of motion exercises and stretching to prevent and treat stiffness. Once we had received the green light from the referring physician that the bone had stabilized and is ready for more strenuous therapy, we can start more exercises such as stretches, passive range of motion and even strengthening. Focus of therapy is to maximize range of motion, decrease stiffness and progressive strengthening.
Often, buddy taping will be prescribed to tape the injured finger to a non-injured finger to help with the range of motion.
If you find that you have an avulsion fracture injury, please see a doctor as soon as possible. We also have a list of orthopedic doctors and sports physicians whom we work with here, but you can also make an appointment to see us first to determine the severity.
Sometimes, you may not need medical intervention, especially if it's a very mild avulsion injury. In such cases, early diagnosis and intervention will accelerate range of motion recovery and potential outcome.
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