Volkmann contracture

Volkmann contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This occurs when there is increased pressure due to swelling, a condition called compartment syndrome.

Injury to the arm, including a crush injury or fracture, can lead to swelling that presses on blood vessels and decreases blood flow to the arm. A prolonged decrease in blood flow injures the nerves and muscles, causing them to become stiff (scarred) and shortened.

When the muscle shortens, it pulls on the joint at the end of the muscle just as it would if it were normally contracted. But because it is stiff, the joint remains bent and stuck. This condition is called a contracture.

In Volkmann contracture, the muscles of the forearm are severely injured. This leads to contracture deformities of the fingers, hand, and wrist.

There are three levels of severity in Volkmann contracture:

• Mild -- contracture of 2 or 3 fingers only, with no or limited loss of feeling.
• Moderate -- all fingers are bent (flexed) and the thumb is stuck in the palm; the wrist may be stuck in a bent position, and there is usually loss of some feeling in the hand.
• Severe -- all muscles in the forearm that both flex and extend the wrist and fingers are involved; this is a severely disabling condition. There is minimal movement of the fingers and wrist.

Conditions that can cause increased pressure in the forearm include:

• Animal bites
• A forearm or elbow fracture
• Bleeding disorders
• Burns
• Injection of certain medicines into the forearm
• Injury of the blood vessels in the forearm
• Surgery on the forearm
• Excessive exercise -- this would not cause severe contractures

Symptoms of Volkmann contracture affect the forearm, wrist, and hand. Symptoms may include:

• Decreased sensation
• Paleness of the skin
• Muscle weakness and loss (atrophy)
• Deformity of the wrist, hand, and fingers that causes the hand to have a claw-like appearance

The health care provider will perform a physical exam, focusing on the affected arm. If the provider suspects Volkmann contracture, detailed questions will be asked about past injury or conditions that affected the arm.

Tests that may be done include:

• X-ray of the arm
• Tests of the muscles and nerves to check their function

The first goal is to prevent the injury that can lead to the contracture. This can be treatment to reduce and fix any fracture and correct any circulation problem. The compartments may need to be released to avoid any excessive swelling that can lead to muscle injury and contractures.

The second goal of treatment is to help people regain some or full use of the arm and hand. Treatment depends on the severity of the contracture:

• For mild contracture, muscle stretching exercises and splinting the affected fingers may be done. Surgery may be needed to make the tendons longer.
• For moderate contracture, surgery is done to repair the muscles, tendons, and nerves. If needed, the arm bones are shortened.
• For severe contracture, surgery is done to remove muscles, tendons, or nerves that are thickened, scarred, or dead. These are replaced by muscles, tendons, or nerves transferred from other body areas. Tendons that are still working may need to be made longer.

How well a person does depends on the severity and stage of disease at the time treatment is started.

Outcome is usually good for people with mild contracture. They may regain normal function of their arm and hand. People with moderate or severe contracture who need major surgery may not regain full function.

Untreated, Volkmann contracture results in partial or complete loss of function of the arm and hand.

Contact your provider right away if you have had an injury to your elbow or forearm and have developed swelling, numbness, and pain keeps getting worse.

Ischemic contracture - Volkmann; Compartment syndrome - Volkmann ischemic contracture; Volkmann's contracture

Netscher D, Agrawal N, Fiore NA. Hand surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 70.

Stevanovic MV, Sharpe F. Compartment syndrome and Volkmann ischemic contracture. In: Wolfe SW, Pederson WC, Kozin SH, Cohen MS, eds. Green's Operative Hand Surgery. 8h ed. Philadelphia, PA: Elsevier; 2022:chap 51.

Thompson NB. Compartment syndrome and Volkmann contracture In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 74.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.