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Injuries and Medical Advice

Volar Plate Strain

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I was bouldering, reaching high, thumb down, in an offset crack with the thumb pushing against one side and the fingers pushing against the other. I did the problem and felt fine. Later, my middle finger was stiff and sore around the side when I put pressure on it. Simulating crimping didn’t hurt. A hand surgeon said it was a mild strain of the volar plate. He advised six weeks rest and easing back into climbing (he also recommended finger-buddy taping). Three months later the finger feels better, but tasks that put a bit of pressure to the side can still hurt. MRI needed? Can I ease back into climbing?

— Scott, USA, via e-mail


The volar plate reinforces and stabilizes the palm side of the finger joints and thumb. The structure of the plate and how it interplays with the surrounding pulleys has a little variation that is relevant for climbers, namely that a rupture to the A3 pulley (middle knuckle) can adversely affect how that volar plate articulates in finger flexion.

Damage to the volar plate is typically by way of hyperextension, made more likely with some added axial load; picture a basketball ramming into the end of your finger. This action will result in the plate tearing at its distal insertion point or, alternatively, an avulsion fracture where that insertion pulls off a piece of bone.

The diagnosis of a volar-plate injury is tenuous given the mechanics of an injury, which is far more likely to elicit an A3 pulley strain. In the flexed position that you describe, the pulley is under inordinately more load than the volar plate. Add that you mention pain when pressure is placed more to the side of the finger, where the A3 inserts, and I tend to think the latter injury is more likely.

Ultimately, however, the advice you have been given is good—conservative management rather than surgical. If the pain is only apparent when you put pressure on the area, you should proceed with care. Consider it a warning shot across your bow, and understand that anything potentially aggravating may result in a direct strike. Climbing at a reduced intensity and removing any high-stress training is generally enough to allow the injury to settle down. If the site becomes painful when you pull on the finger, then you have over stepped; back it up, pumpkin! Otherwise, some pain to the type of pressure you describe is categorically normal. I wouldn’t recommend an MRI unless the finger continually aggravates.

Feature image by Dave Parry

This article appeared in Rock and Ice 232