Volkmann's contracture
Volkmann's contracture is a medical condition that results from ischemia (lack of blood flow) to the forearm muscles. This condition leads to a permanent shortening of the muscles, causing a claw-like deformity of the hand, fingers, and wrist. It is named after the 19th-century German surgeon Richard von Volkmann.
Causes[edit | edit source]
Volkmann's contracture is typically caused by increased pressure within the compartments of the forearm, a condition known as compartment syndrome. This increased pressure can result from various factors, including:
- Fractures of the forearm bones, particularly the supracondylar fracture of the humerus.
- Tight bandages or casts.
- Severe burns.
- Crush injuries.
- Prolonged use of a tourniquet.
Pathophysiology[edit | edit source]
The pathophysiology of Volkmann's contracture involves the following steps:
1. **Ischemia**: Reduced blood flow to the forearm muscles due to increased compartment pressure. 2. **Muscle and Nerve Damage**: Prolonged ischemia leads to muscle and nerve damage. 3. **Fibrosis**: Damaged muscle tissue is replaced by fibrous tissue, leading to contracture. 4. **Deformity**: The fibrous tissue causes the muscles to shorten, resulting in a claw-like deformity.
Symptoms[edit | edit source]
The symptoms of Volkmann's contracture include:
- Pain in the forearm.
- Swelling and tightness in the affected area.
- Weakness and loss of function in the hand and fingers.
- A claw-like deformity of the hand, with the wrist flexed and the fingers extended.
Diagnosis[edit | edit source]
Diagnosis of Volkmann's contracture is based on clinical examination and patient history. Imaging studies such as X-rays and MRI may be used to assess the extent of muscle and nerve damage.
Treatment[edit | edit source]
Treatment of Volkmann's contracture aims to relieve pressure and restore function. Options include:
- **Surgical Intervention**: Fasciotomy to relieve compartment pressure.
- **Physical Therapy**: To improve muscle strength and flexibility.
- **Splinting**: To maintain the hand in a functional position.
- **Reconstructive Surgery**: In severe cases, tendon transfers or other reconstructive procedures may be necessary.
Prevention[edit | edit source]
Preventive measures include:
- Prompt treatment of forearm fractures and injuries.
- Careful monitoring of patients with casts or bandages.
- Avoiding prolonged use of tourniquets.
Prognosis[edit | edit source]
The prognosis for Volkmann's contracture depends on the severity and duration of ischemia. Early diagnosis and treatment can improve outcomes, but severe cases may result in permanent disability.
See Also[edit | edit source]
References[edit | edit source]
External Links[edit | edit source]
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Credits:Most images are courtesy of Wikimedia commons, and templates Wikipedia, licensed under CC BY SA or similar.Contributors: Prab R. Tumpati, MD