PIP joint sprain (jammed finger), including volar plate injury

What it is

The PIP joint is the middle knuckle of a finger. It is held together by a ligament on each side (the collateral ligaments) and a thick fibrous pad on the palm side (the volar plate) that stops the finger bending backwards. A jam stretches or tears one or more of these. The same impact can also crack the bone at the joint surface or pull a fragment of bone off with the volar plate, which looks and feels almost identical in the first few days.

How volleyball causes it

Blocking is the main source. A hard-driven ball arriving at 60 to 80 mph meets a hand that is not fully spread or not yet firm, and the ball catches one finger end-on. If it drives the finger straight backwards, the volar plate on the palm side takes it. If it catches the finger off-centre, one of the side ligaments takes it. Digging a hard-driven ball off the fingertips does the same thing with less force, and setting a ball that arrives faster than expected can hyperextend a finger before the hand is loaded. Fingers also get jammed on the net cable, on an opponent's hand over the net, and on the floor during a pancake or a dive where the fingertips land before the flat of the hand.

BlockingDefenseSettingPassing

What it feels like

• Swelling around the middle knuckle within an hour, often leaving the finger sausage shaped for weeks
• Pain when you try to make a full fist, and the fingertip will not reach the palm
• Tenderness when you press along the sides of the joint or on the palm side crease
• Pain and a stretched feeling when the finger is bent backwards, which points at the volar plate
• The joint stays visibly thicker than the same knuckle on the other hand long after the pain fades
• Stiffness that is worst first thing in the morning and after a session

Stop and get it seen if

• The finger crosses over or under its neighbour when you make a fist, or the nail is rotated compared to the other hand. Rotation means a fracture until proven otherwise and it needs imaging.
• The joint opens up or feels like it slides when gently stressed sideways, or the finger looks bent at rest in a way you cannot straighten passively.
• Point tenderness on the bone above or below the joint rather than on the joint line itself, which suggests a fracture rather than a sprain.
• The finger is numb, cold, white or dusky, or the tip does not refill with colour when you press and release the pad.
• Broken skin over the knuckle, especially from contact with teeth or the net cable, or a knuckle that becomes hot, red and increasingly painful after day two. That pattern is infection, not swelling.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Working out what it actually is

   0 to 10 days

   Separate a straightforward sprain from a fracture, a volar plate avulsion or an unstable joint, and control the initial swelling

   • Swelling and heat are at their peak and the joint is hard to assess accurately
   • An x-ray has been taken, or a clinician has explained why one is not needed
   • The finger can be moved passively through some range without a sensation of the joint giving way

2. 2. Protected movement

   1 to 4 weeks

   Get the joint moving early enough to avoid permanent stiffness, while the injured tissue is still shielded from sideways and backwards force

   • Buddy taping to a neighbouring finger, or a splint fitted by a clinician, is being used for anything with ball or floor contact
   • Active bending improves week on week rather than plateauing
   • Swelling settles overnight instead of staying constant
   • The joint is no longer painful at rest

3. 3. Return to ball contact

   2 to 8 weeks from injury

Ready to play again when

• Can make a full fist and fully straighten the finger, with any gap symmetrical enough not to interfere with grip
• Blocking or digging a hard-driven ball produces no sharp pain and no instinctive hand withdrawal
• No sideways looseness when the joint is stressed, and no pain point on the bone either side of the joint
• Swelling does not rebound in the 24 hours after a full session
• Confidence to play without taping, or a conscious decision to keep taping for the season

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Buddy tape at-risk pairs before blocking sessions. Index to middle and ring to little, taped above and below the middle knuckle, with the joint left free to bend. This limits sideways force without stopping you playing.
• Train block hand shape until it is automatic. Wall presses with hands spread wide, fingers straight and stiff, thumbs up, holding the shape for several seconds so the hand meets the ball as one plane rather than with a single finger leading.
• Rubber band finger extension. Loop a band around all five fingertips and spread the fingers apart against it. This builds the intrinsic hand muscles that hold the fingers spread and firm at the moment of contact.
• Grip and putty work. Squeezing therapy putty or a grip trainer, plus finger flexor holds on a bar or plate pinch, so the whole hand can stiffen against impact.
• Rehearse the pancake and the dive so the flat of the hand contacts the floor first. Fingertip-first landings are how a lot of jams and mallet fingers happen.
• Trim nails short and take rings off before you play. Both turn a routine jam into a skin or nailbed injury.