Volkmann’s ischemic contracture is a condition wherein the wrist, hands and fingers are deformed, resulting in a claw-like appearance. It is primarily due to an injury to the forearm, causing a decrease in blood flow which in turn damages the nerves and muscles of the hand. This is something that can cause not only deformity, but also a lot of pain.
For better understanding, let us discuss the words used in the name of this condition. It is named after the doctor who described it first, Dr. Richard Von Volkmann. Ischemic means there is a decrease in blood supply to a part of the body. Contracture refers to the shortening and hardening of a tissue such as the muscle and tendon.
Cause
This condition happens when the flow of blood to the hand is reduced, and this causes damage to the nerves and muscles in the area. When the nerves and muscles are not supplied with blood for a long period of time, they tend to end up shortened and stiff, which is known as contracture in the medical world.
Because the muscles are shortened, the wrist, hands and fingers become flexed or bent. They remain in that position because, unlike healthy muscles, shortened muscles are stiff. This is the reason why someone with Volkmann’s ischemic contracture develops a claw-like deformity of the hand.
The reduction of blood supply to the wrist, hand and fingers is often due to an injury to the forearm that leads to an inflammation, such as a fracture. The resulting inflammation applies pressure on the blood vessels, thus impeding the blood flow to the hands. If not promptly managed and the decrease in blood supply is prolonged, a contracture happens.
Aside from a fracture, there are other things that may cause an inflammation in the forearm and potentially lead to Volkmann’s ischemic contracture. Some of them include burns, animal bites and bleeding disorders. Injection of certain drugs into the forearm and excessive exercising are other examples.
Signs and Symptoms
The deformity of the wrist, hand and fingers is a telltale sign that the patient is suffering from Volkmann’s ischemic contracture. Since the blood supply to the affected area is diminished, the skin looks pale. Pulse on the wrist may be absent due to the fact that the blood vessels are compressed.
Someone with the condition will experience decreased sensation in the area. This can be expected as the nerves are also compressed alongside the blood vessels. Weakness and even paralysis are also common symptoms. Definitely, there is pain felt not only in the deformed hand, but also in the injured forearm.
The severity of Volkmann’s ischemic contracture is dependent on the signs and symptoms present. Mild is limited to the flexion of only 2 to 3 fingers, and there’s no loss or limitation of sensation. Moderate is characterized by the flexion of all fingers, and sometimes the wrist too. The patient will also report of loss of sensation in the area. Severe Volkmann’s ischemic contracture means that all of the muscles in the wrist, hand and fingers are shortened. Because of this, the severe kind tends to be a very disabling condition.
Treatment
In order to ward off Volkmann’s ischemic contracture, the pressure applied on the blood vessels in the forearm should be dealt with. Usually, such can be done by having the patient undergo immediate surgery. In cases wherein the injury has been around for a long time and the muscles have already shortened, lengthening them may be done via surgery so that the proper functioning of the affected hand may be regained.
Any acute injury to the forearm needs to be treated promptly in order to keep Volkmann’s ischemic contracture from developing. The use of a split or sling helps keep the injured area still, thus promoting faster healing. As much as possible, the affected forearm should be placed above the heart level to prevent inflammation and further injury.
