What is a Volkmann contracture and what's the treatment for this problem? My brother has Parkinsons, fell and broke his wrist, and now has this problem on top of everything else.
Volkmann ischemic contracture is the sustained contraction of one or more muscles after a long period of time without blood. This usually occurs in association with another condition called acute compartment syndrome (ACS).
Acute compartment syndrome (ACS) is characterized by elevated pressure from increased fluid in one of the many separate compartments of the forearm, wrist, and hand. In fact, the forearm has three separate compartments. Each section is separated by connective tissue called fascia.
The hand has 10 of these compartments. There are a total of 15 compartments in the entire upper extremity (arm) from shoulder to hand. Any condition that changes the pressure in a compartment can reduce blood flow (called ischemia) and cause death of the tissues (necrosis).
The most common cause of ACS is a bone fracture. Repetitive exercise (muscle contractions over and over) is another potential cause. Other causes of ACS of the upper extremity include dressings, tourniquets, or casts that are too tight. Bleeding disorders and burns can also increase the amount of fluid (called fluid volume) inside a compartment. These compartments are tightly packed with very little room for extra fluid. In a smaller number of cases, swelling from a spider or snake bite can also lead to ACS.
Loss of blood to the soft tissues inside the affected compartment(s) can cause irreversible damage. The muscles go into full contraction and cannot let go or relax. The patient's hand, forearm, and/or upper arm assume a telltale position that is called Volkmann contracture.
Patients who progress to the point of having a Volkmann contracture are not likely to regain full use of the affected area even with surgical treatment. Additional surgeries such as muscle or tendon transfers may be needed. The Parkinson disease may interfere with recovery. But with early recognition of the problem and adequate treatment, your brother will be assured of the best outcomes possible.
Mark L. Prasarn, MD, and Elizabeth A. Oullette, MD. Acute Compartment Syndrome of the Upper Extremity. In Journal of the American Academy of Orthopaedic Surgeons. January 2011. Vol. 19. No. 1. Pp. 49-58.
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