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Volkmann’s contracture is a condition where muscles in the fingers, wrist, and forearm shorten and stiffen due to inadequate blood supply caused by swelling. It can be caused by compartment syndrome and is treated with surgery to lower pressure in the arm. Treatment options vary depending on the severity of the condition.
Volkmann’s contracture, sometimes known as Volkmann’s ischemic contracture, is a condition in which muscles in the fingers, wrist, forearm, or a combination of the three shorten and stiffen. This means that the joints do not straighten out, producing a crooked appearance. Muscle changes are the result of an inadequate blood supply, commonly caused by swelling within the arm that pinches blood vessels and prevents blood flow. Volkmann’s contracture is often painful and can range in severity from mild to severe. The condition is treated with surgery to lower the pressure in the arm and, if done in time, prevents permanent damage from occurring.
The causes of Volkmann’s contracture are associated with what is called compartment syndrome, in which swelling increases pressure within the arm. One of the most common causes is a broken elbow, which occurs frequently in children. Fractures involving other bones in the forearm and swelling from bites and burns can also lead to compartment syndrome. Crush injuries and bleeding can lead to increased pressure in the arm, as can tight dressings, splints, or casts.
Treatment of a Volkmann’s contracture initially involves removing anything such as a dressing that may be compressing the limb. A surgical procedure known as a fasciotomy is urgently performed to prevent the development of a permanent contracture. Fasciotomy involves cutting the skin and tissue, or fascia, that encloses that section of the arm where pressure is being increased. Cutting the surrounding tissue releases the pressure within the arm compartment and restores blood flow. Any dead parts of muscle are cut off.
In cases where fasciotomy cannot prevent Volkmann’s contracture because permanent muscle contraction has already begun, other forms of treatment can still be done. Milder cases, where the contracture affects only two or three fingers, can be treated with physical therapy and splints. Surgery can be done to stretch the tendons and improve hand function.
Severe cases, where the contracture has affected all of the forearm muscles that bend and straighten the wrist and fingers, may require more extensive surgery to remove damaged muscles and scar tissue. Tendon transfer procedures may be performed, in which an existing tendon is detached before being attached to a different muscle. This allows you to perform movements that were previously not possible due to loss of muscle function as a result of Volkmann’s contracture.
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