Case 4 Volkman Iscahemic Contracture

Case 4

 Volkman Iscahemic Contracture 

Introduction , Permission to ask questions and examine. Tell patient to remind him if the patient is not comfortable during the examination.

When it Occurred ?                 Dominance of hand                            What difficulties are faced ?

Look

Alignment of Upper Extremity

            Proximal / Distal third junction of hand – supinated / pronated

Attitude of Fingers

            Flexed fingers and wrist

            Cascade maintained

           

Skin on forearm – Scarred on volar side midforearm around 10 * 6 cm

Muscles wasting medial side of distal forearm

Atrophy of thenar and hypothenar eminences

Nail look normal

Feel

Temperature

Feel

Forearm , hand superficially and deeper along humerus  , elbow , radius , ulna , wrist , metacarpal bones , phalanges

Movement

Active

                        Elbow – Flexion/ Extension/Supination / Pronation

            Wrist - Flexion / Extension

            Fingers – Flexion / Extension

Active motion is always followed by passive motion .

Note the wrist flexion at which fingers can be extended .

Also note if fingers can be flexed with both the Metacarpophalangeal joints flexed  and extended which means intrinsics are not tight.

Neurovascular Examination

Allen’s test 

Radial

Medial

Ulnar Nerve

Power

1     1)      Brachioradialis ,Pronator Teres , Supinator , FCR,PL , FCU

2      2)      FDS – Middle compartment on volar side is involved if this is affected.

3       3)      FDP / FPL – Deeper compartment on volar side  is involved if this is affected

4      4)      Lumbricals , Opponens Pollicis , Abductor Pollicis , Adductor Pollicis , Flexor Pollicis

5      5)      Palmar and Dorsal Interossei

Discussion

Types 

 Investigation 

Management