Summary about Disease
Volkmann's ischemic contracture (VIC) is a devastating condition that results from ischemia (lack of blood supply) and subsequent necrosis (tissue death) of forearm muscles. This leads to fibrosis (scarring) and shortening of the muscles, resulting in a characteristic claw-like deformity of the hand and wrist. It's a permanent condition that can severely limit hand function.
Symptoms
The main symptoms of Volkmann's ischemic contracture include:
Severe pain in the forearm, particularly with passive finger extension.
Pale, cool, and swollen forearm.
Decreased or absent radial pulse (though this is not always present).
Numbness or tingling in the hand and fingers.
Pain on passive extension of the fingers (a hallmark sign).
Eventual claw-like deformity of the hand and wrist (flexion contractures).
Shiny skin.
Muscle weakness.
Causes
The most common cause of Volkmann's ischemic contracture is a fracture of the distal humerus (supracondylar fracture) in children, or forearm fractures in adults. This can lead to:
Compartment syndrome: Increased pressure within the closed fascial compartments of the forearm, compressing blood vessels and nerves.
Arterial injury: Direct damage to the brachial artery or its branches.
Tight casts or dressings: External compression restricting blood flow.
Prolonged hypotension: Reduced blood pressure resulting in poor perfusion to the forearm muscles.
Medicine Used
Pain management: Analgesics (pain relievers) are used to manage the initial pain associated with compartment syndrome and ischemia.
Anticoagulants: In some cases, anticoagulants (blood thinners) might be used to prevent further clotting, particularly if arterial injury is suspected.
Muscle relaxants: Used to help with muscle spasms Note: There is no medicine that can reverse established Volkmann's Ischemic Contracture. The goal of treatment is to prevent its occurrence or to minimize its severity. Once the contracture is established, treatment focuses on surgical intervention to release the contracted tissues and improve function.
Is Communicable
Volkmann's ischemic contracture is not communicable. It is a consequence of injury or medical condition, not an infectious disease.
Precautions
The main precautions involve preventing and managing compartment syndrome after a fracture or injury:
Prompt medical attention for any suspected fracture or forearm injury.
Close monitoring for signs of compartment syndrome after a fracture, including pain, pallor, pulselessness, paresthesia, and paralysis (the "5 Ps").
Elevation of the limb to promote venous drainage.
Avoidance of tight casts or dressings that could compromise circulation.
If compartment syndrome is suspected, prompt fasciotomy (surgical release of the fascia) to relieve pressure.
How long does an outbreak last?
Volkmann's ischemic contracture is not an "outbreak." It is a condition that develops over time due to ischemia. If compartment syndrome is present, irreversible muscle damage can begin within 4-6 hours of ischemia and be complete within 12-24 hours. The contracture itself develops over weeks to months.
How is it diagnosed?
Diagnosis involves:
Clinical Examination: Assessing pain, swelling, skin color, pulse, and neurological function in the forearm and hand. Pain on passive finger extension is a key finding.
Compartment Pressure Measurement: A needle is inserted into the forearm compartments to measure the pressure. A pressure greater than 30 mmHg is typically considered diagnostic of compartment syndrome.
Angiography or Doppler Ultrasound: May be used to assess blood flow in the forearm arteries, particularly if arterial injury is suspected.
Nerve Conduction Studies: Can help assess nerve damage.
X-rays: To identify fractures
Timeline of Symptoms
Initial Injury: Fracture or trauma to the forearm.
Within Hours: Increasing pain, swelling, and tightness in the forearm. Pain is often out of proportion to the injury.
4-6 Hours: Numbness, tingling, and decreased sensation in the hand and fingers. Muscle weakness may develop.
12-24 Hours: Irreversible muscle damage begins.
Days to Weeks: If untreated, muscle necrosis and fibrosis occur.
Weeks to Months: Development of the characteristic claw-like deformity and fixed contractures.
Important Considerations
Early diagnosis and treatment of compartment syndrome are crucial to prevent Volkmann's ischemic contracture.
Compartment pressure measurements are essential for accurate diagnosis.
Fasciotomy should be performed promptly if compartment syndrome is confirmed.
Even with timely intervention, some degree of muscle damage and contracture may still occur.
Surgical release of the contracture and tendon transfers may be necessary to improve hand function.
Long-term physical therapy is important to maintain range of motion and strength.