Volkman ischamic contracture

Volkman ischamic contracture

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  VOLKMANN'S ISCHAEMIC CONTRACTURE Presented byDr. Simranjeet Kaur (PT) Orthopedic Assistant Professor MMIPR, MMDU,, Mullana, Ambala
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  DEFINITION A Volkmann's contractureis deformity of the hand, fingers, and wrist which occurs as a result of a trauma such as fractures, crush injuries, burns and arterial injuries. Following this trauma, there is a deficit in the arterio-venous circulation in the forearm which causes a decreased blood flow and hypoxia can lead to the damage of muscles, nerves and vascular endothelium. This results in a shortening (contracture) of the muscles in the forearm.
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  ANATOMY The bones arean important factor in Volkmann's contracture. We can see that the humerus of the upper arm is often involved in Volkmann's contracture. A fracture of the supracondylar space causes a deficit in the circulation of the arteria brachialis. It is caused by the blocking of the circulation and a deficit in blood supply to the muscles and nerves malfunction. There is a contracture of the muscles, usually, the flexors of the wrist. Yet there is also a contracture occur in the extensors of the wrist, but this is less common.
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  Muscles that aretypically involved are the: Superficial flexors: Musculus pronator teres (median nerve innervation) Musculus flexor carpi radialis (median nerve innervation) Musculus flexor carpi ulnaris (ulnar nerve innervation) Musculus flexor digitorum superfiscialis (median nerve innervation) Musculus palmaris longus (median nerve innervation) Deep flexors: Flexor pollicis longus (median nerve innervation) Pronator quadratus (median nerve innervation) Flexor digitorum profundus (median nerve innervation)
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  ETIOLOGY The incidence ofVolkmann’s contracture is low. Its prevalence is 05%, which means it is a rare disease. The intracompartmental pressure occurs when there is a bulging caused by a trauma. Thus, there is not enough space for muscles, nerves and blood vessels that lie within this fascia. This results in vascular defects and defects on nerves. Possible causes can be animal bites, fractures of the forearm, bleeding disorders, burns, excessive exercise and injections of medications at the forearm.
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  CLINICAL PRESENTATION Volkmann`s contractureincludes 5Ps:- •Pain •Pallor •Pulselessness •Parasthesias •Paralysis
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  EXAMINATION The deformity seenin this condition can be divided into different levels of severity: MILD: Flexion contracture of 2 or 3 fingers with no or limited loss of sensation MODERATE: All fingers are flexed and the thumb is oriented in the palmar orientation. The fist, in this case, can remain permanently flexed and there is usually a loss of sensation in the hand. SERIOUS: All muscles in the forearm (flexors and extensors) are involved. This is a serious limiting condition.
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  PHYSIOTHERAPY MANAGEMENT After thesurgery, it is important to ensure that the mobility is recovered by: •Passive stretching techniques •Range of motion exercises to enhance soft tissue elasticity. Another part of the therapy programme involves activating and strengthening the weak agonist to ensure equilibrium in agonist and antagonist pull during joint movement.
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  •Progressive Splinting, passive stretchingand tendon gliding, as well as massage can be used in mild to moderate cases of Volkmann's contracture. •By the use of an electromyographic device, the patient can train its affected muscles with cooperativity. The patient is more alert and there is more interaction between the patient and the therapist.
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  DYNAMIC SPLINT
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