Volkmann's contracture, also known as Volkmann's ischaemic contracture, is a permanent deformity of the hand and wrist resulting from injury to forearm muscles, often following untreated compartment syndrome. The condition typically affects children and presents with symptoms such as pain, pulselessness, and paralysis, requiring management that may include medical intervention, surgery, and physical therapy. Early treatment is crucial for better prognosis, with severe cases having a poorer outlook.

1. Volkmann’s Contracture
KIMBERLY WALSH
PT INTERN
SPANISH TOWN HOSPITAL

2. Brief Background
Definition
Clinically Relevant Anatomy
Epidemiology
Etiology
Pathophysiology
Clinical Manifestations

3. Dx
Differential Dx
Mx
Medical
Surgical
Physiotherapy
Prognosis

4. Brief Background
 Richard von Volkmann in 1881 was the first
to describe ischaemic muscle paralysis and
contracture.
 His name was later associated with the
contracture later in 1889 by Hildebrand to
describe the end result of any untreated/
inadequately treated compartment
syndrome

5. Definition
Volkmann’s Contracture (a.k.a Volkmann’s
Ischaemic Contracture) is a deformity of the
hand, fingers and wrist cause by injury to the
muscles of the forearm.

6. Definition cont’d
It is a permanent shortening of forearm
muscles which occur following injury and
results in a claw like deformity of the hand,
fingers and wrist

7. Clinically Relevant Anatomy

8.  The relevant anatomy of Volkmann’s
contracture includes the superficial and
deep flexors of the forearm.

10. Superficial Flexors of the Forearm

11. Pronator Teres

12.  Flexor Capri Ulnaris

13.  Palmaris Longus

14.  Flexor Digitorium
Superficialis

15. Deep Flexors of the Forearm

16. Pronator Quadratus

17. Flexor Pollicis Longus

18. Flexor Digitorium Profundus

19. Epidemiology
Overall, Volkmann’s contractures are rare.
The condition occurs most commonly in
children and follows injuries particularly to the
elbow

20. Etiology
The incidence of Volkmann’s Contracture is low.
Factors that can lead to the condition;
Neglected compartment syndrome
Trauma
Fractures

21. Tight immobilizers
Bleeding disorders
Animal bites
Burns
Excessive exercise

22. Pathophysiology
Volkmann’s Contracture is usually seen in children with
displaced supracondylar fractures of the humerus or
forearm.
It results from severe injury to the deep tissues and
muscles of the volar compartment secondary to
increased compartmental pressures

23. Pathophysiology cont’d
Volkmann’s contracture is the end
result of prolonged ischaemia of
muscles and nerves in the forearm.
The muscles undergoes necrosis,
fibrosis and contracture

24. Pathophysiology (cont’d)
There are three classification of Volkmann’s
Contracture:
Mild

25. Moderate

26. Severe

27. Clinical Manifestations
 The clinical presentation
includes the five “Ps” which are;
 Pain
 Pulselessness
 Pallor
 Paresthesia
 Paralysis

28. Clinical Manifestations cont’d
Special findings include;
Pain with passive stretching of the
flexors
Elbow flexion
Forearm pronation
Finger flexion
MCPJ in extension
The wrist is in palmar flexion

29. Clinical Manifestations cont’d
Palpation of the affected region creates pain.
Also, upon palpation, firmness of the tissues can be
felt.
Swelling
Decreased sensation

30. Diagnosis
X- rays of the humerus, elbow and
forearm are useful for assessing the
amount of displacement of supracondylar
fractures
Non- displaced fractures rarely cause
Volkmann’s contracture

31. Diagnosis cont’d
Manometry : measures
intracompartmental pressure
Angiogram: blood vessel rupture
MRI: fibrosis of the muscles

32. Differential Dx
Pseudo – Volkmann’s Contracture
Entrapment of the flexor digitorium profundus
secondary to fractures of radius or ulna occurs 2 days
– 16 years after close reduction of shafts of radius
and ulna

33. Differential Diagnosis cont’d
The forearm muscles are of normal length
It can be prevented by routine check of PROM
after closed reduction of fractures

34. Management

35. Medical Management
Initial treatment for Volkmann's contracture consist of
removing occlusive dressings or removal of cast
Analgesics provide symptomatic relief in chronic cases.

36. Surgical Management
 Fasciotomy: This is done to prevent
progression to Volkmann’s Contracture

37. Moderate stages may need tenolysis, neurolysis
and extensor transfer procedures.
Severe stages may need debridement of damaged
muscles.

38. Physical Therapy Management
In the mild stages, physical therapy alone can
be use to treat the contracture
The aim is to improve joint motion and muscle
force

39. Physical Therapy Management (cont’d)
Heating Modalities

40. Passive stretching
Muscle re- education using
electrical stimulation (can be
done with functional activities)

41. Strengthening of the remaining
muscle groups

42. Static Progressive Splinting

43. Post operative PT mx (moderate stage sx)
includes;
Immobilization in a splint or cast approx. 4
weeks with PROM exercises during that time.
Tendon/ Neural glides can be done.

45.  Isometric exercises begin at 4 weeks and a thermoplastic
splint may be worn full – time
 At week six, there is a transition to wearing night splint only.

46. Prognosis
The outcome will depend upon the stage at which
treatment is instituted.
The earlier it is undertaken, the better the outcome
likely will be.
The outlook is grave in the severe types.

47. References
 Farzad, M., Hussein,S. Layeghi, F. Non- Surgical Treatment of
Established Forearm’s Volkmann Contracture in Child: A Case
Report. Iranian Rehabilitation Journal,. Vol (8). (2010).
 Reurings, J.,Verhofstad, M. The Volkmann Ischemic
Contracture of the Forearm is Preventable. European Journal
of Trauma and Emergency Surgery.October 2007.

48.  Singh, A. Volkmann Ischemic Contracture Presentation and
Treatment. Bone and
Spine.https://boneandspine.com/Volkmann-ischemic-
contracture/
 Volkmann’s
Contracture.https://www.physiopedia.com/Volkmann%27s_Contr
acture
 Stevanovic, M., Sharpe, F. Compartment Syndrome and
Volkmann Ischemic Contracture.

49. THE END