Volkmann’s syndrome

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Definition

What is Volkmann’s syndrome?

Volkmann’s syndrome , also called Volkmann’s contracture or ischemic contracture, is the deformity of the hand, fingers, and wrist which occurs as a result of a trauma such as: fractures, crush injuries, burns and arterial injuries.

Following this trauma, there is a deficit in the arterio-venous circulation in the forearm which causes a decreased blood flow and the hypoxia can lead to the damage of muscles, nerves and vascular endothelium. This results in a shortening (contracture) of the muscles in the forearm.

How common is Volkmann’s syndrome?

The incidence of Volkmann’s contracture is low. It counts 0,5%, which means it is a rare disease. This syndrome most often affects children about 5-8 years of age. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of Volkmann’s syndrome?

The clinical presentation of Volkmann`s contracture includes what is commonly referred to as the 5 P s. These are pain, pallor, pulselessness, paresthesias, and paralysis. Pain is the earliest sign.

Special findings:

  • Bleach view at the level of the skin (pallor)
  • The wrist is in palmar flexion
  • Pain occurs with passive stretching of the flexor
  • Palpation of the affected region creates persistent pain
  • It is possible that the pulsations cannot be felt in the swollen arm, mainly in the distal part (pulselessness).
  • There are also neurological limitations noticeable from the muscles that pinch the neural pathways, there is a decreased sensation (paresthesia) and there is an observable motor deficit (paresis).

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you or your loved one has any signs or symptoms listed above or you have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes Volkmann’s syndrome?

This condition is caused by a traumatic ischemia of the limb. These changes are progressive and occur mainly along with the long bone fractures, usually in the upper limb (supracondylar fracture of the humerus in the extensor mechanism, accounting for approximately ¾ of cases and, less commonly, breaking the bones of the forearm). Often it is also the result of too tight plaster cast which may compress the blood vessels and nerves. If the pressure lasts about 5-10 hours, it results in irreversible changes in the muscle, but after 3-6 hours the irreversible changes occur in the nerves.

Among others, less frequent causes of Volkmann’s syndrome are the sprains, bruising, damage to the artery which causes ischemia. Volkmann’s contracture may also affect the lower limb but less frequently than the upper limb. It is then primarily caused by supracondylar femur fractures or tibia fracture.

Risk factors

What increases my risk for Volkmann’s syndrome?

Possible causes can be animal bites, fractures of the forearm, bleeding disorders, burns, excessive exercise and injections of medications at the forearm. Please consult with your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is Volkmann’s syndrome diagnosed?

Pressure monitoring

Intracompartmental pressure (ICP) can be measured by several means including:

  • Wick catheter
  • Simple needle manometry
  • Infusion techniques
  • Pressure transducers
  • Side-ported needles

Critical pressure for diagnosing compartment syndrome is unclear.

Different authors consider surgical intervention if:

  • Absolute ICP greater than 30 mmHg
  • Difference between diastolic pressure and ICP greater than 30 mmHg
  • Difference between mean arterial pressure and ICP greater than 40 mmHg

We can divide into different levels of severity:

Mild: a flexion contracture of 2 or 3 fingers with no or limited loss of sensation

Moderate: All fingers are flexed and the thumb is oriented in the palmar orientation. The fist in this case can remain permanently in flexion and there is usually a loss of sensation in the hand.

Serious: all muscles in the forearm (flexors and extensors) are involved. This is a serious limiting condition.

An objective test to evaluate the ischemia and the pressure in a muscle compartment is an invasive test. It measures the absolute pressure in the compartment of the muscle. This is also called the intracompartimental pressure monitoring (ICP)

How is Volkmann’s syndrome treated?

Initial treatment for Volkmann contracture consists of removal of occlusive dressings or splitting or removal of casts. Analgesics are the mainstay for symptomatic relief in chronic cases.

Emergency fasciotomy is required to prevent progression to Volkmann contracture. There is some disagreement regarding which compartment pressure readings are indications for fasciotomy; however, most agree that patients with compartment pressures exceeding 30 mm Hg should be taken to the operating room for emergency fasciotomy. There are no absolute contraindications for immediate decompression for Volkmann contracture in the acute setting.

Several surgical approaches have been tried. The surgical goal is one and only; the adequate decompressive for the viability of the limb or the prevention of permanent disability. The cosmetic or the location and lengths of incisions should not be considered. In treatment of CS there is no place for short cosmetic incisions. Surgical incisions less than 15cm may be lead in inadequate decompression.

Several surgical approaches have been suggested in the forearm.

After decompression, delayed primary closure can be performed when swelling has subsided, however this may be difficult or unachievable due to skin retraction. Various methods and materials have been described using the elastic properties of the skin to aid wound closure. If the wound edges cannot be approximated, skin grafting may be required.

Both physical therapy and occupational therapy are vital to the improvement of range of motion and the return of function in patients with Volkmann contracture.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage Volkmann’s syndrome?

The following lifestyles and home remedies might help you cope with Volkmann’s syndrome:

After the surgery, it is important to ensure that the mobility is recovered. We can increase the mobility by passive stretching techniques. We force the normal range of motion and by that, we can enhance the range of motion. This range is limited by loss of soft tissue elasticity.

Another part in the therapy is activating and strengthening the weak agonist. By that, we can ensure that the agonist pulls the antagonist in balance.

Inhibition control of the contracted muscles can prove that they can decrease spasticity of the affected muscles.

By the use of an electomyographic device, the patient can train its affected muscles with cooperativity.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: April 11, 2018 | Last Modified: April 11, 2018