Volkmann’s contracture is an ischemic contracture affecting the flexor muscles of the forearm. Soft tissue shortening occurs as part of the disease, particularly in the muscles. Volkmann’s contractures are often the result of insufficient blood flow and damage to the nerves.
What is Volkmann’s contracture?
In Volkmann’s contracture, nerve damage occurs as a result of so-called supracondylar fractures, for example in childhood. Constricting casts, edema, extensive hematomas or foreign material are often the triggers for the contracture. For crimean-congo fever (cchf), please visit nonprofitdictionary.com.
The disease is characterized by a flexion deformity or claw hand. Volkmann’s contracture occurs due to the reduced supply of blood to muscle groups in the arm. As a result of the insufficient supply of blood, the corresponding muscle tissue dies. As a result, it shortens and Volkmann’s contracture can form.
Volkmann’s contracture can occur as a result of various triggers. Damage to the arteries and nerves in the affected forearm usually leads to neurological and muscular deficits. Thus, the disease is due to ischemia or nerve compression.
Even after fractures of the humerus that are localized above the condyle, individual fragments can damage the ulnar nerve, the median nerve, and the brachial artery due to compression. The development of a Volkmann contracture is favored by certain factors.
These include, for example, a plaster bandage that is too tight and unsplit, late treatment with irreversible damage to the soft tissues or inadequate repositioning after fractures, which can result in direct vascular injuries. The undersupply causes necrosis and atrophy of the muscles in the forearm.
Symptoms, Ailments & Signs
Volkmann’s contracture is usually associated with a series of symptoms and signs that occur one after the other. The contracture is usually noticeable at the beginning by an acute onset of pain. Pressure-sensitive, hard tissue then forms. The first signs of reduced blood flow appear. Eventually, the affected patient will experience restricted mobility, which can worsen.
In the early stages of Volkmann’s contracture, pain occurs in the forearm area, which can be associated with numbness and cold sensations in the fingers. In addition, there is a weakening of the pulse, which in most cases occurs together with a blue discoloration of the skin ( cyanosis ).
As the disease progresses, the muscles in the forearm and hand atrophy. This results in flexion and pronation contractures in the hand. The base joints of the fingers are hyperextended and the middle and end joints of the fingers show a claw position (flexion). The thumb of the affected hand is fixed in an extended position. In the context of Volkmann’s contracture, the electrical excitability of diseased muscles is lost.
Diagnosis & course of disease
There are various methods of examination to diagnose Volkmann’s contracture. At the first signs of the disease, a specialist should be consulted immediately, who will discuss the symptoms and medical history with the affected patient. Clinical and radiological methods of diagnosis are then available for selection.
First, the attending physician checks the presence of characteristic symptoms of Volkmann’s contracture. For example, the patient must state whether the sensitivity in the affected area is reduced. Symptoms such as clawing of the finger joints are obvious and lead to confirmation of the diagnosis.
Ultimately, the diagnosis of Volkmann’s contracture can be confirmed by X-ray examinations if there was a fracture and the affected arm is in a cast. X-rays may show evidence of potential inadequate reduction of the fracture, suggesting Volkmann’s contracture.
First and foremost, Volkmann’s contracture causes severe pain. This can occur in the form of rest pain or stress pain, so that those affected are significantly restricted in their everyday life. Pain at rest can lead to sleep disorders, especially at night, and thus to mental disorders or irritability in the person concerned.
The pain continues to spread to the shoulders or neck. Due to the reduced blood circulation, Volkmann’s contracture also leads to paralysis or various sensory disturbances, so that the patient suffers from severe mobility restrictions in his everyday life. The pulse can also be weakened by the Volkmann contracture, so that the skin turns blue due to the reduced oxygen supply.
Furthermore, the muscles will also weaken if the condition is not treated. The treatment of Volkmann’s contracture always depends on the exact cause and the injury. As a rule, there are no complications if the disease is recognized and treated early.
In the worst case, the muscle tissue can die off if left untreated and can no longer be restored. However, Volkmann’s contracture does not negatively affect or reduce the patient’s life expectancy. Even after successful treatment, patients are dependent on various therapies.
When should you go to the doctor?
Since Volkmann’s contracture usually cannot heal itself, the affected person is dependent on examination and treatment by a doctor in any case. This is the only way to prevent or limit further complications and symptoms. The earlier a doctor is consulted, the better the further course is in most cases.
A doctor should be consulted for Volkmann’s contracture if the person affected suffers from severe limitations in movement. As a rule, this also leads to very severe pain, which can severely limit the quality of life and everyday life of the person concerned. Sensory disturbances or paralysis on the forearms can also indicate Volkmann’s contracture and should be examined by a doctor if they occur over a longer period of time and do not go away on their own. A blue discoloration of the affected region also often indicates this disease.
First and foremost, a general practitioner or an orthopedist can be consulted. The further treatment then depends on the severity of the symptoms. In an emergency or if the pain is very severe, you can also go to a hospital.
Treatment & Therapy
With regard to the therapy of Volkmann’s contracture, various treatment methods are available, which the treating doctor weighs up depending on the severity of the disease, the exact localization and the individually shown symptoms. If the affected arm is in plaster, the constricting bandages must be removed immediately. In connection with this, it may be necessary under certain circumstances to perform a fascial splitting of the affected parts in the course of an operation.
If the cause of Volkmann’s contracture is an injury, this injury must first be treated. In some cases, damaged blood vessels may need to be repaired. If a hemorrhage occurs within a tendon sheath, it must be opened in the course of a surgical intervention. The bruise must be rinsed out.
Adequate follow-up treatments must be carried out after the operations. For this purpose, intensive physiotherapy exercises are usually required to regain optimal function of the muscles. If a particularly large amount of muscle tissue has died off as a result of the Volkmann contracture and is consequently permanently shortened, this can result in permanent restricted movement.
In principle, it is already too late for a causal therapy after a Volkmann contracture. The impairment of the affected patient’s quality of life can be reduced by physiotherapy. Those affected can be treated symptomatically by means of surgical installation of so-called arthrodeses in the area of the elbow.
Preventive measures in relation to a Volkmann’s contracture exist and are primarily aimed at adequate treatment of fractures in the area of the forearm.
Supracondylar humerus fractures should be reduced as quickly and gently as possible. When applying plaster casts, care must be taken not to split them. As a result, the development of Volkmann’s contractures can be prevented in a sensible and effective manner and permanent damage can be avoided.
In the case of Volkmann’s contracture, the scope of aftercare is based on the therapeutic measures initiated by the specialist. For the treatment of the disease, the treating specialist may decide to operate or to heal independently. If the lower leg or forearm is affected, the specialist will initiate the operation.
In the event of an operation, aftercare focuses on closing the surgical wound and mobilizing the affected muscles. This is because the wound cannot be closed with a suture during an operation. Alternatively, the wound is closed with a special wound covering (temporary skin replacement or vacuum seal).
The sutures are closed about a week after the operation. Intensive physiotherapeutic exercises and physiotherapeutic treatments (e.g. electrical stimulation) are usually provided to mobilize the affected muscles. In individual cases, however, the movement of the fingers or hand (e.g. making a fist) can remain restricted. In addition, the performance of the affected muscles does not fully regenerate during follow-up care.
On average, a performance reduction of 6 to 19 percent can be expected. The non-surgical therapy can be determined in the case of a Volkmann contracture caused by a bruise in the thigh. The disease can heal on its own within a year. In addition to mobilizing the affected muscles, the affected person must be monitored intensively clinically, neurologically and chemically in the laboratory.
You can do that yourself
If there is a suspicion of a Volkmann contracture, the constricting plaster casts must be removed. Under certain circumstances, an operative fascial splitting is necessary. The resulting tendon and muscle damage can be treated with physiotherapy. It is important to train the affected muscles regularly. The appropriate measures are based on the severity and localization of the contracture. A sports doctor or physiotherapist can name training methods that can be carried out independently by those affected at home.
Positioning splints usually have to be worn at night to avoid further strain on the muscles. Since the forearm muscles, which allow the hand to bend, are severely weakened, vehicles may no longer be driven after a Volkmann contracture. Physical work is only possible with restrictions. The early search for an alternative job makes it easier to return to work.
In the late stages of the disease, it is no longer possible to heal the damaged muscle parts. The self-help measures are limited to relieving the pain by means of cooling, massages and wearing splints and not putting too much strain on the affected arm. Due to the ongoing physical limitations, a therapeutic work-up of the triggering event and its consequences is an option.