From the Guidelines
Volkmann's contracture is a preventable condition that requires early intervention through fasciotomy to prevent permanent disability and limited hand function. The condition typically results from untreated compartment syndrome, often following fractures near the elbow or crush injuries to the forearm [ 1 ]. Early signs include pain out of proportion to the injury, pain with passive finger extension, and the "5 P's": pain, pallor, paresthesia, paralysis, and pulselessness.
Prevention and Treatment
Prevention through prompt recognition and treatment of compartment syndrome is essential, as established Volkmann's contracture often results in permanent disability with limited hand function. Treatment depends on the stage of development, with early intervention for compartment syndrome through fasciotomy being crucial to prevent contracture [ 1 ]. Once established, treatment may include physical therapy, splinting, and in severe cases, tendon transfers or muscle slide procedures.
Management of Contractures
Contractures that restrict movement of the involved joint or are painful will impede rehabilitation and may limit a patient’s potential for recovery [ 1 ]. Patients with paretic limbs with muscle spasticity are at high risk of developing contractures, and early treatment is key to preventing this disabling complication. Recommendations for treating spasticity and contractures include antispastic positioning, range of motion exercises, stretching, splinting, serial casting, or surgical correction [ 1 ].
Medications for Spasticity
Consideration should be given to the use of medications such as tizanidine, dantrolene, and oral baclofen for spasticity resulting in pain, poor skin hygiene, or decreased function [ 1 ]. However, diazepam or other benzodiazepines should be avoided during the stroke recovery period due to possible deleterious effects on recovery and sedation side effects [ 1 ].
Other Treatment Options
Other treatment options for spasticity include botulinum toxin or phenol/alcohol for selected patients with disabling or painful spasticity, and intrathecal baclofen for chronic stroke patients [ 1 ]. Neurosurgical procedures, such as selective dorsal rhizotomy or dorsal root entry zone lesion, may also be considered for spasticity resulting in pain, poor skin hygiene, or decreased function [ 1 ].
From the Research
Definition and Causes of Volkmann's Contracture
- Volkmann's contracture is a deformity of the hand, fingers, and wrist caused by injury or trauma to the forearm, leading to ischemia and subsequent contracture of the muscles and tendons 2, 3.
- The condition can result from various causes, including supracondylar fractures, wrist fractures, and soft tissue trauma 3, 4.
Prevention and Treatment
- Prevention of Volkmann's contracture is crucial and can be achieved through early recognition and treatment of compartment syndrome, as well as monitoring of high-risk injuries 2.
- Treatment of established contracture requires a thorough examination of the extent of damage and may involve conservative therapy or surgical intervention, such as fasciotomy, neurolysis, and tendon transfer 2, 3, 5.
- Surgical techniques, including muscle slide procedures, can be effective in restoring joint range of motion and strength, allowing patients to return to their professional activities 6.
Outcome and Prognosis
- The outcome of treatment for Volkmann's contracture can vary depending on the severity of the lesions and the effectiveness of treatment 4.
- Studies have shown that patients can achieve good functional outcomes, including return to socioprofessional activities, with proper treatment and rehabilitation 6, 4, 5.
- However, some patients may experience persistent impairments, such as fine motor function deficits, despite intensive therapy 5.
Diagnostic Tools and Investigations
- Various diagnostic tools, including X-rays, electroneurography, magnetic resonance imaging, and ultrasonography, can be used to evaluate the extent of damage and guide treatment decisions 5.
- The Disabilities of the Arm, Shoulder and Hand (DASH) score and other functional outcome measures can be used to assess the effectiveness of treatment and monitor patient progress 6, 4, 5.