What would cause a volar plate tear not to heal?

I tore the volar plate half off my PIP joint 2 years ago. It wasn't treated until a year after the accident. Cortisone injections, physical therapy, splinting of all kinds and prescription anti-inflammatories just made the pain worse. A small lump on top on the outside of the joint appeared last December. I was never told what that was. The pain is still getting worse and the joint still swells. The doctor won't do surgery because I have 15 degrees flexion and I did get a second opinion on that. If this kind of injury is supposed to heal in 4 months without treatment what are some possible causes for it not healing in 2 years with tons of treatment? What can I do at home to help with pain/healing besides put heat on it?

[S. Kaul, MD]

Hi there!

Conservative managemnet after an year of volar plate injury is unlikely to yeild best results. Best results are obtained when management is initiated early. Interventional or surgical measures are only considred in cases of severe injury or where the deformity or functional impairment is severe. Also without a physical examination it would be difficult to determine the cause of the lump. Possibilities include inflammations, cysts, degeneration, growths/ masses etc. You could try some warm compresses and/ or OTC NASIDS for pain relief at home. Physiotherapy may also be helpful. If the discomfort continues, it is best advised to consult your orthopedician for a possible review in the management plan.
Hope this is useful.

Take care!