Volkmann's contracture is a deformity of the hand, fingers, and wrist caused by injury to the muscles of the forearm.

Volkmann's contracture occurs when there is a lack of blood flow (ischemia) to the forearm, usually caused by increased pressure that results from swelling (compartment syndrome).

Trauma to the arm, including a crush injury or fracture, can lead to swelling that compresses blood vessels and can decrease blood flow to the arm. A prolonged decrease in blood flow will injure the nerves and muscles, causing them to shorten and become stiff (scarred).

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 cannot straighten. This condition is called a contracture.

In Volkmann's contracture, the muscles of the forearm are severely injured, resulting in contracture deformities of the fingers, hand, and wrist.

There are three levels of severity in Volkmann's contracture:

• Mild -- flexion contracture of two or three fingers only with no or limited loss of sensation
• Moderate -- all fingers are flexed and the thumb is stuck in the palm; the wrist may be stuck in flexion and there is usually loss of some sensation 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

The injury classically associated with this condition is an elbow fracture in children. Other conditions that can cause increased pressure in the forearm include any forearm fracture, burns, bleeding disorders, excessive exercise, injection of certain medications into the forearm, and animal bites.

The hallmark symptom is pain that does not improve with rest or non-sedating pain medications, and will continue to get worse with time. If the pressure is allowed to persist, there will be decreased sensation, weakness, and paleness of the skin.

Typical physical exam findings include severe pain when a muscle is passively moved. For example, when the doctor moves the fingers up and down in a patient with compartment syndrome in the forearm, the patient will experience severe pain. The forearm may be tensely swollen and shiny. There is also pain when the forearm is squeezed.

The test that will absolutely diagnose this condition involves directly measuring the pressure in the compartment by inserting a needle attached to a pressure meter into the compartment. When the compartment pressure is greater than 45 mmHg or when the pressure is within 30 mmHg of the diastolic blood pressure (the lower number of the blood pressure), a diagnosis of compartment syndrome is made.

Once established, someone with Volkmann's ischemic contracture will have his or her fingers and possibly wrist stuck in flexion.