Ischemic contracture - Volkmann; Compartment syndrome - Volkmann ischemic contracture
Volkmann contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm. The condition is also called Volkmann ischemic contracture.
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:
Conditions that can cause increased pressure in the forearm include:
Symptoms of Volkmann contracture affect the forearm, wrist, and hand. Symptoms may include:
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 be done include:
The first goal is to prevent the injury that can lead to the contracture. This can be treatment to reduce and fix any fracture and correct any circulation problem. The compartments may need to be released to avoid any excessive swelling that can lead to muscle injury and contractures.
The second goal of treatment is to help people regain some or full use of the arm and hand. Treatment depends on the severity of the contracture:
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.
Untreated, Volkmann contracture results in partial or complete loss of function of the arm and hand.
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.
Netscher D, Agrawal N, Fiore NA. Hand surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 70.
Stevanovic MV, Sharpe F. Compartment syndrome and Volkmann ischemic contracture. In: Wolfe SW, Pederson WC, Kozin SH, Cohen MS, eds. Green's Operative Hand Surgery. 8h ed. Philadelphia, PA: Elsevier; 2022:chap 51.
Thompson NB. Compartment syndrome and Volkmann contracture In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 74.BACK TO TOP
Review Date: 9/20/2022
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 C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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