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Volkmann ischemic contracture

Ischemic contracture - Volkmann; Compartment syndrome - Volkmann ischemic contracture

 

Volkmann ischemic contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm.

Causes

 

Volkmann contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This occurs when there is increased pressure due to swelling, a condition called compartment syndrome.

Injury to the arm, including a crush injury or fracture, can lead to swelling that presses on blood vessels and decreases blood flow to the arm. A prolonged decrease in blood flow injures the nerves and muscles, causing them to become stiff (scarred) and shortened.

When the muscle shortens, it pulls on the joint at the end of the muscle just as it would if it were normally contracted. But because it is stiff, the joint remains bent and stuck. This condition is called a contracture.

In Volkmann contracture, the muscles of the forearm are severely injured. This leads to contracture deformities of the fingers, hand, and wrist.

There are three levels of severity in Volkmann contracture:

  • Mild -- contracture of 2 or 3 fingers only, with no or limited loss of feeling
  • Moderate -- all fingers are bent (flexed) and the thumb is stuck in the palm; the wrist may be bent stuck, and there is usually loss of some feeling in the hand
  • Severe -- all muscles in the forearm that both flex and extend the wrist and fingers are involved; this is a severely disabling condition

Conditions that can cause increased pressure in the forearm include:

  • Animal bites
  • A forearm fracture
  • Bleeding disorders
  • Burns
  • Excessive exercise
  • Injection of certain medicines into the forearm

 

Symptoms

 

Symptoms of Volkmann contracture affect the forearm, wrist, and hand. Symptoms may include:

  • Decreased sensation
  • Paleness of the skin
  • Muscle weakness and loss (atrophy)
  • Deformity of the wrist, hand, and fingers that causes the hand to have a claw-like appearance

 

Exams and Tests

 

The health care provider will perform a physical exam, focusing on the affected arm. If the provider suspects Volkmann contracture, detailed questions will be asked about past injury or conditions that affected the arm.

Tests that may done include:

  • X-ray of the arm
  • Tests of the muscles and nerves to check their function

 

Treatment

 

The goal of treatment is to help people with Volksmann ischemic contracture (VIC) regain some or full use of the arm and hand. Treatment depends on the severity of the contracture:

  • For mild contracture, muscle stretching exercises and splinting the affected fingers may be done. Surgery may be needed to make the tendons longer.
  • For moderate contracture, surgery is done to repair the muscles, tendons, and nerves. If needed, the arm bones are shortened.
  • For severe contracture, surgery is done to remove muscles, tendons, or nerves that are thickened, scarred, or dead. These are replaced by muscles, tendons, or nerves transferred from other body areas. Tendons that are still working may need to be made longer.

 

Outlook (Prognosis)

 

How well a person does depends on the severity and stage of disease at the time treatment is started.

Outcome is usually good for people with mild contracture. They may regain normal function of their arm and hand. People with moderate or severe contracture who need major surgery may not regain full function.

 

Possible Complications

 

Untreated, Volkmann contracture results in partial or complete loss of function of the arm and hand.

 

When to Contact a Medical Professional

 

Contact your provider right away if you have had an injury to your elbow or forearm and have developed swelling, numbness, and pain keeps getting worse.

 

 

References

Jobe MT. Compartment syndrome and Volkmann contracture. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 74.

Netscher D, Murphy KD, Fiore NA. Hand surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 69.

Stevanovic MV, Sharpe F. Compartment syndrome and Volkmann ischemic contracture. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS, eds. Green's Operative Hand Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 51.

 

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            Review Date: 9/22/2016

            Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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