Volkmann’s ischemic contracture (VIC) is a serious medical condition where muscles, nerves, and tissues of the forearm and hand become permanently shortened and damaged due to a lack of blood flow (ischemia). It typically results from untreated or delayed compartment syndrome, often after a fracture or traumatic injury. Early detection and intervention are critical to prevent permanent disability (1).
Symptoms
The symptoms of Volkmann’s contracture develop gradually after an ischemic injury and may include:
- Stiffness or rigidity in the fingers, hand, or forearm
- Pain that worsens with finger extension or passive movement
- Clawed fingers or a flexed wrist position
- Loss of muscle strength and fine motor function
- Numbness or tingling due to nerve compression
- Cool or pale skin in the affected limb (in early ischemia)
In severe cases, the hand becomes non-functional with severe deformity (1).
Causes and Risk Factors
Causes:
Volkmann’s contracture is usually caused by prolonged ischemia from:
- Compartment syndrome following fractures (commonly supracondylar fractures of the humerus in children)
- Tight casts or bandages that restrict circulation
- Crush injuries to the arm or forearm
- Arterial injury or obstruction
Risk Factors:
- Delayed treatment of fractures or injuries
- Improper splinting or casting
- Severe trauma or vascular injury
- Young age (children are more susceptible due to supracondylar fractures) (2)
Complications
If not treated promptly, VIC can lead to:
- Permanent muscle and nerve damage
- Deformity of the hand or wrist
- Functional impairment, including inability to grip or extend fingers
- Psychological distress due to visible disability
- Chronic pain or stiffness (2)
Diagnosis
Diagnosis is based on a combination of clinical examination and history of injury. Key tools include:
- Physical assessment: Observing contracture, muscle atrophy, and limited movement
- Doppler studies or angiography: To assess blood flow
- MRI or ultrasound: To evaluate muscle and soft tissue damage
- Electromyography (EMG): For assessing nerve and muscle function
Timely diagnosis during the early ischemic stage can prevent progression (3).
Treatment
Early Stage (Before Contracture Forms):
- Immediate fasciotomy to relieve compartment pressure
- Removal or loosening of casts/splints
- IV fluids and oxygenation to restore circulation
Established Contracture Treatment:
- Physical therapy for minor cases
- Tendon lengthening or muscle slide surgery
- Free tendon transfers for restoring function
- Splinting or bracing to support positioning
- Rehabilitation therapy to improve strength and range of motion (3)
Living With Volkmann’s Contracture
Living with Volkmann’s ischemic contracture involves long-term rehabilitation and adaptation. While severe cases may limit hand use permanently, many patients can improve function with proper therapy and support.
Tips for managing daily life with VIC:
- Stick to physiotherapy routines to preserve mobility
- Use assistive devices to aid with daily tasks
- Join occupational therapy to regain hand coordination
- Stay proactive with follow-ups to prevent further complications
- Seek mental health support, especially if coping with visible deformity
- Educate family and caregivers to provide effective support
Rehabilitation can be slow, but consistency and proper care improve outcomes significantly (3).
References
1. Mubarak, S. J., & Owen, C. A. (1977). Double-incision fasciotomy of the leg for decompression in compartment syndromes. JBJS, 59(2), 184-187.
2. Seddon, H. J. (1956). Volkmann’s contracture: treatment by excision of the infarct. The Journal of Bone & Joint Surgery British Volume, 38(1), 152-174.
3. Tsuge, K. (1975). Treatment of established Volkmann’s contracture. JBJS, 57(7), 925-929.
