The volar plate of the finger MCP joint is a fibrocartilaginous structure on the palmar surface of each metacarpophalangeal joint, connecting the metacarpal neck to the base of the proximal phalanx. Its proximal attachment is thin and membranous, without the checkrein ligaments of the PIP joint, which allows some MCP hyperextension. Its sides receive the deep transverse metacarpal ligaments and the sagittal bands, and its palmar surface forms the floor of the A1 pulley.
| Origin | Palmar neck of the metacarpal (loose membranous attachment) |
|---|---|
| Insertion | Palmar base of the proximal phalanx |
Prevents MCP joint hyperextension, provides a smooth articular surface for the flexor tendons as they enter the fibro-osseous sheath, and anchors the proximal pulleys and collateral ligaments.
MCP volar plate injury produces dorsal MCP dislocation, most commonly at the index finger and next at the little finger. Complex (irreducible) MCP dislocations occur when the volar plate becomes interposed between the metacarpal head and the proximal phalanx, with the metacarpal head buttonholed between the lumbrical and the flexor tendons. Simple dislocations are reduced by flexing the wrist and pushing the proximal phalanx base over the metacarpal head; longitudinal traction or hyperextension should be avoided, as it can convert a simple dislocation into a complex one. Complex dislocations require open reduction to extract the interposed volar plate. In rheumatoid arthritis, MCP volar plate attenuation combined with collateral ligament weakness contributes to ulnar drift and palmar subluxation.
Dorsal MCP dislocation where the volar plate folds into the joint becomes irreducible by closed manipulation because traction widens the joint space allowing further volar plate interposition; open reduction through a volar incision extracts the plate from the joint and is followed by splinting in slight flexion.
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