Volkmann's contracture, also known as Volkmann's ischaemic contracture, is a permanent flexion contracture of the hand at the wrist, resulting

in a clawlike deformity of the hand and fingers. It is more common in children.

Volkmann's contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This usually occurs when there is increased pressure due to swelling, a condition called compartment syndrome Trauma to the arm, including a crush injury or fracture, can lead to swelling that presses on 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 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 cannot straighten. This condition is called a contracture. In Volkmann's contracture, the muscles of the forearm are severely injured. This leads to contracture deformities of the fingers, hand, and wrist.

Mild -- contracture of two or three fingers only, with no or limited loss of feeling 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 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

Animal bites Any forearm fracture Bleeding disorders Burns Excessive exercise Injection of certain medications into the forearm

The main symptom is pain that does not improve with rest or pain medications, and continues to get worse with time. If the pressure is allowed to continue, there will be: Decreased sensation Paleness of the skin Weakness

The doctor will perform a physical exam. If you have compartment syndrome in the forearm, you will have severe pain when the doctor moves the fingers up and down. Your forearm may be very swollen and shiny. You will feel pain when your forearm is squeezed. The diagnosis can be confirmed with a test that directly measures pressure in the area. This involves inserting a needle into the affected area. The needle is attached to a pressure meter. There is a specific pressure level that confirms the diagnosis of compartment syndrome.

If there is a forearm or elbow fracture, you should use a sling or splint to keep the area still and raise the arm above heart level. This helps prevent further injury and excessive swelling. The best treatment is early surgery to release the pressure in the forearm before any permanent injury to the muscles and nerves occurs. Reconstructive surgery to lengthen and sometimes transfer muscles is necessary to try to regain some hand function.

The more severe the contracture, the worse the function of the hand and wrist. In severe cases, the hand may not work at all, and you may have a loss of sensation (feeling) in the area.