Volkmann's contracture is a permanent

flexion Motion, the process of movement, is described using specific anatomical terminology, anatomical terms. Motion includes movement of Organ (anatomy), organs, joints, Limb (anatomy), limbs, and specific sections of the body. The terminology used de ...

contracture In pathology, a contracture is a shortening of muscles, tendons, skin, and nearby soft tissues that causes the joints to shorten and become very stiff, preventing normal movement. A contracture is usually permanent, but less commonly can be temp ...

of the

hand A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the Koala#Characteristics, koala (which has two thumb#O ...

at the

wrist In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known as the carpal ...

, resulting in a claw-like deformity of the hand and fingers. Passive extension of fingers is restricted and painful.

Signs and symptoms

The most important signs and symptoms of

compartment syndrome Compartment syndrome is a serious medical condition in which increased pressure within a Fascial compartment, body compartment compromises blood flow and tissue function, potentially leading to permanent damage if not promptly treated. There are ...

are observable before actual contracture. What is known as the five Ps of compartment syndrome include:

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

, generally the initial symptom, accompanied by pulselessness,

pallor Pallor is a pale color of the skin that can be caused by illness, emotional shock or stress, stimulant use, or anemia, and is the result of a reduced amount of oxyhaemoglobin and may also be visible as pallor of the conjunctivae of the eye ...

paralysis Paralysis (: paralyses; also known as plegia) is a loss of Motor skill, motor function in one or more Skeletal muscle, muscles. Paralysis can also be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory d ...

, and paraesthesias. Pain will likely also increase upon extension of the affected limbs hands and fingers, which is one of the earliest signs of compartment syndrome and should urgently be followed up by an exam to look for potential development of Volkmann contracture itself. Palpating for tissue firmness in the forearm, and the pulse volume and character of the

radial artery In human anatomy, the radial artery is the main artery of the lateral aspect of the forearm. Structure The radial artery arises from the bifurcation of the brachial artery in the antecubital fossa. It runs distally on the anterior part of the ...

, also reflects the degree of compartment syndrome.

Causes

Any fracture in the elbow region or upper arm may lead to Volkmann's ischemic contracture, but it is especially associated with supracondylar fracture of the

humerus The humerus (; : humeri) is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius (bone), radius and ulna, and consists of three sections. The humeral upper extrem ...

. It is also caused by fractures of the forearm bones if they cause bleeding from the major blood vessels of the forearm. The condition may be caused by obstruction on the

brachial artery The brachial artery is the major blood vessel of the (upper) arm. It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa ...

near the elbow, possibly from improper use of a

tourniquet A tourniquet is a device that is used to apply pressure to a limb or extremity in order to create ischemia or stopping the flow of blood. It may be used in emergencies, in surgery, or in post-operative rehabilitation. A simple tourniquet can ...

, improper use of a

plaster cast A plaster cast is a copy made in plaster of another 3-dimensional form. The original from which the cast is taken may be a sculpture, building, a face, a pregnant belly, a fossil or other remains such as fresh or fossilised footprints – ...

, or

Pathophysiology

Volkmann's contracture results from acute

ischaemia Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems ...

and

necrosis Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. The term "necrosis" came about in the mid-19th century and is commonly attributed to German pathologist Rudolf Virchow, who i ...

of the muscle fibres of the flexor group of muscles of the forearm, especially the

flexor digitorum profundus The flexor digitorum profundus or flexor digitorum communis profundus is a muscle in the forearm of humans that flexes the fingers (also known as digits). It is considered an Muscles of the hand#Extrinsic, extrinsic hand muscle because it acts on ...

and

flexor pollicis longus The flexor pollicis longus (; FPL, Latin ''flexor'', bender; ''pollicis'', of the thumb; ''longus'', long) is a muscle in the forearm and hand that flexes the thumb. It lies in the same plane as the flexor digitorum profundus. This muscle is uniq ...

. The muscles become fibrotic and shortened.

Prevention

Prevention of the condition requires restoration of blood flow after injury and reduction of compartmental pressure on the muscles. Any splints, bandages, or other devices that might be obstructing circulation must be removed. A

fasciotomy Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to relieve tension or pressure in order to treat the resulting loss of circulatory system, circulation to an area of biological tissue, tissue or muscle. Fasciotomy is a li ...

may be required to reduce pressure in the muscle compartment.

Treatment

If contracture occurs, surgery to release the fixed tissues may help with the deformity and function of the hand. In established stage reconstructive surgery may be needed.

History

It is named after Richard von Volkmann (1830–1889), the 19th century German doctor who first described it, in a paper on ''"non-Infective Ischemic conditions of various fascial compartments in the extremities"''. Because the contracture occurred at the same time as the paralysis, he considered a nerve cause to be unlikely.

References

External links

{{Trauma , state=autocollapse Early complications of trauma Orthopedic problems