Volkmann's Contracture

When an injury to the muscles in the forearm result in the deformity of the hand, fingers and wrist, it is called the Volkmann’s contracture. It generally occurs when there is a lack of blood flow to the forearm resulting from increased pressure due to swelling often after an injury. Trauma to the arm, like a fracture or a crushing injury can cause edema, which compresses the blood vessels, thus decreasing the blood flow to the arm. A continuous decrease in blood flow results in injury to the nerves and muscles making them shortened and stiff. When the muscle shortens, it pulls on the joint at the end of the muscle. Because it has stiffened, the joint remains bent and cannot straighten.

In Volkmanns contracture there can be three levels of severity. Mid-flexion contracture of two or three fingers only with limited loss of sensation or none at all, moderate when all fingers are flexed and the thumb is stuck in the palm and there may be loss of some sensation in the hand. It is severe when all the muscles in the forearm that flex and extend the wrist and fingers are involved and this can lead to a severely disabling condition.

The most common of injury associated with this condition is an elbow fracture in children. Forearm fracture, burns, bleeding disorders, excessive exercise, and injection of certain medicines in the forearm and animal bites may cause increased pressure in the forearm resulting in Volkmann’s contracture. The main symptom is pain, which does not improve, or go away with rest or non-sedating medicines but will continue to worsen. If this condition is untreated it can lead to decreased sensation in the arm, weakness or paleness of the skin.

The doctor generally identifies the condition by a physical examination, which shows severe pain when a muscle is passively moved. The test that can confirm the diagnosis involves directly measuring the pressure by inserting a needle attached to a pressure meter. If there is a forearm or an elbow fracture, a sling or splint should be used to keep the area still with the arm raised to above heart level. This will prevent further injury or swelling. The best treatment is to release the pressure in the forearm by surgery before any permanent injury happens to the nerves and the muscles. Reconstructive surgery to lengthen and regain some hand function is done.

The result depends on the severity of the disease and the time treatment was started. If the operation is done before there is any permanent damage, then the result should be excellent. If there is high pressure in the forearm for a long time, the nerves and muscles can be damaged permanently. The surgery should be done as early as possible as the first twenty four hours are important. Those with mild muscle contractures on a few fingers can have a better chance to return to normal function than those who lose normal function of all the muscles. These people may need a second reconstructive surgery.

Volkmann’s contracture can result in a condition which is directly proportional to the injury. In severe cases the hand may be nearly useless and without sensation. A person who has suffered trauma to his elbow or forearm which has resulted in a bit of swelling and pain, the doctor should be immediately contacted. There are no ways of preventing compartment syndrome but being aware of this condition and getting an early diagnosis and treatment will prevent any complications.