chapter 16 (pp.416-425) the wrist, hand, & fingers
TRANSCRIPT
Chapter 16 (pp.416-425)
The Wrist, Hand,& Fingers
skeletal anatomy
complicated…
the radius
• “Thumb Side”• Shorter than the
Ulna• Larger at wrist,
smaller at elbow• Head is proximal
– at the elbow
the radius
Landmarks:• Carpal surface
–Articulates with carpal bones
• Styloid process
the ulna
• “Pinky Side”• Thicker proximally,
smaller distally• Head is distal – at
the wrist
the ulna
Landmarks:• Head• Styloid process
the wrist
• Common term for the carpal bones–Eight carpal
bones in each wrist
carpal bones
Proximal Row
(Lateral to Medial)
• Scaphoid (Navicular)
• Lunate• Triquetrum• Pisiform
Distal Row
(Lateral to Medial)
• Trapezium• Trapezoid• Capitate• Hamate
carpal bones
carpal trick
• Some = scaphoid• Lefties = lunate• Try = triquetrium• Plays = pisiform• That = trapezium• They = trapezoid• Can’t = capitate• Handle = hamate
metacarpals
• Knuckles - 5 per hand– Base is proximal– Head is distal
• Numbered 1-5 from thumb to pinky– ex: Thumb =1– ex: Pinky = 5
metacarpal landmarks
Landmarks:• Proximal to Distal:
– Base– Shaft– Head– Condyles
phalanges
• “Fingers”• 14 bones
– 3 per finger (12)– 2 per thumb (2)
• Landmarks:– Proximal– Middle– Distal
articulations
radiocarpal joint
• “Wrist joint”– Radius, scaphoid, &
lunate• Flex/Ext & Ulnar/Radial
Deviation• Stabilized by Radial
Collateral Ligament
ulnocarpal joint
• “False joint”• Separated & stabilized
by cartilaginous disc (meniscus-like)– TFCC
• Stabilized by Ulnar Collateral Ligament
triangular fibrocartilage complex (TFCC)
• Articular disc – the “meniscus” of the wrist
• Increases stability in the distal radioulnar joint, extends the ulnocarpal joint
radioulnar joint
• Formed by ulnar head and ulnar notch of the radius–Allows for
supination & pronation
intercarpal joints
• Supported by interosseous membrane and capsular ligaments– Too numerous to list (every bone is
connected)
carpometacarpal joints
• MC 1 trapezium• MC 2 trapezoid• MC 3 capitate• MC 4 & 5 hamate
(single joint)
metacarpophalangeal & interphalangeal joints
MCP joints:• “Knuckles”• Numbered 1-5 thumb
to pinky
IP joints:• Proximal & distal in
each finger• Just IP in thumb
DIP
PIP
IP
Soft tissue anatomyligaments & muscles
ligaments
• Dorsal & palmar (volar) radiocarpal ligaments
• Ulnar & radial collateral ligaments• TFCC• Intercarpal ligaments• UCL & RCL for each MCP & IP joint
wrist joint ligaments
radiocarpal ligaments
• Palmar (volar) RCL:– 3 individual ligaments– Capitate, triquetrum,
scaphoid– Limits wrist
hyperextension
• Dorsal RCL:– Posterior surface of
radius (styloid process) lunate & triquetrum
– Limits wrist flexion
radiocarpal ligaments
Palmar (Volar) Ligaments Dorsal Ligaments
collateral ligaments
• Ulnar Collateral Ligament
• Styloid process of ulna TFCC triquetrum & pisiform
• Limits radial deviation
• Radial Collateral Ligament
• Styloid process of radius scaphoid & trapezium
• Limits ulnar deviation
collateral ligaments
MCP & IP ligaments
• Ulnar collateral & radial collateral ligament at each MCP & IP joint
• Stabilizes the joint through flexion & extension
• Named according to anatomical position (i.e. backwards when looking at dorsal aspect of hand)
muscles• Natural Position of hand/fingers is slightly
flexed– Passively extend wrist & watch fingers???
muscles• Wrist extensors & wrist flexors• Extrinsic muscles of the hand
– Muscles of the forearm that provide strength and crude control of the hand and fingers
• Intrinsic muscles of the hand– Muscles originate in the hand and wrist that
provide fine control of the hand
wrist flexors
• Flexor carpi radialis
• Flexor carpi ulnaris
• Palmaris longus
wrist extensors
• Extensor carpi radialis longus
• Extensor carpi radialis brevis
• Extensor carpi ulnaris
extrinsic muscles of the hand
• Muscles that move the hand/fingers– Extensor digitorum– Extensor indicis– Extensor digiti minimi– Flexor digitorum
superficialis– Flexor digitorum
profundus
extrinsic muscles of the hand
• Muscles that move the thumb– Abductor pollicis longus– Extensor pollicis brevis– Extensor pollicis longus– Flexor pollicis longus
*Easier to remember movements if you “rotate” thumb to correspond to fingers
intrinsic muscles of the hand
• Thenar eminence (thumb side)– Adductor pollicis– Opponens pollicis– Abductor pollicis
brevis– Flexor pollicis brevis
• Hypothenar eminence (pinky side)– Abductor digiti minimi– Flexor digiti minimi
brevis (no longus)– Opponens digiti minimi– Palmaris brevis
intrinsic muscles of the hand
• Lumbricles (4)• Dorsal Interossei / Interossei Dorsales (4)• Palmar Interossei / Interossei Palmares
(3 or 4)
Lumbricles PIs DIs
other structures
neurological anatomy
• Ulnar nerve (C8)– Passes above carpal tunnel– Sensory to 4th & 5th digits
neurological anatomy
• Median nerve (C7)– Passes through carpal
tunnel– Motor nerve for thenar
eminence– Sensory to 1st-3rd digits
neurological anatomy
• Radial nerve C6)– Separates in forearm– Sensory to dorsal hand
& 1st digit
carpal tunnel
• Floor: Scaphoid, Trapezium/Pisiform, Hamate
• Roof: Transverse carpal ligament (Flexor Retinaculum)
• Medial Pillars– Pisiform– Hook of Hamate
• Lateral Pillars– Scaphoid Tubercle – Trapezium Tubercle
carpal tunnel
• 10 structures pass through– Four Flexor Digitorum Superficialis tendons– Four Flexor Digitorum Profundus tendons– Flexor Pollicus Longus tendon– Median Nerve
anatomical snuff box• Term for area on radial aspect of wrist, proximal
to thumb• Borders
– Anterior: Abductor Pollicis Longus and Extensor Pollicis Brevis tendons
– Posterior: Extensor Pollicis Longus tendon• Contents: Radial artery • Floor: Scaphoid, Trapezium
objectives
Identify…• Pertinent information to gather during a wrist
& hand evaluation• Important observations to make during a wrist
& hand evaluation
???
the evaluation process
• Must understand differential diagnosis (DDx)– Options that a specific injury could be– Pathologies often have similar S&S
• Rule out emergency situations quickly– If unsure, err on side of caution
history
general history
• Chief complaint• Age• Occupation/sport/position etc.• Hand dominance—why?• General health condition• Activity level• Medications & allergies
previous medical history
• What happened?• Who did you see?• What did they tell you?• How long were you out?• Has it fully resolved?
Anything else??
current history
• Mechanism of injury– How did it happen?
• Tension = sprain; strain• Torsion = sprain; fracture• Compression = contusion;
dislocation; fracture• Shear = fracture; sprain• Bending = fracture
current history
• Ask these questions regarding PAIN• P-rovocation – what causes it? what makes it better?• Q-uality – what does it feel like? neurological
symptoms?• R-egion – where does it hurt? can you point w/one
finger?• S-everity – how bad does it hurt? (1-10)• T-iming – when does it hurt? how long?
current history
Type of Pain Structure
Cramping, dull, aching Muscle
Dull, aching Ligament, joint capsule
Sharp, bright, lightning-like, burning
Nerve
Deep, nagging, dull Bone
Sharp, severe, intolerable
Fracture
Throbbing, diffuse Vasculature
current history
• Sounds & sensations–Did you hear any
sounds? Did you hear any pops, crackles, snaps, clicking?• What could this
indicate???–Did you feel
anything unusual?
specific to the wrist, hand, & fingers
• Must rule out radiating symptoms from other upper extremity injury
• Hand & finger postures– Chronic Injuries– Insidious Onset
specific to the wrist, hand, & fingers
• Length of symptoms– Scaphoid fractures or TFCC may “linger”
before diagnosis• General Health
– Arthritis– Carpal Tunnel
observation
observation
• When does this begin?• Compare each side bilaterally
to identify what is normal forthat person
• We look for:– Deformity, asymmetry,
edema, ecchymosis
general observation
• Hand posture– How are they carrying their hand?
• General position of hand/fingers– Are they flexed or extended?
• Willingness to use functionally– Will they use their hand for normal tasks?
further inspection
• Carrying position of hand• Calluses, creases, scars, etc.• Landmark alignments
– Knuckles, joints, etc.• Size of hands
observable deformities
• Boutonniere deformity
• Swan-neck deformity
• Mallet finger• Claw fingers
• Drop wrist• Nail deformities• Ganglion cysts• Russell’s sign
boutonniere deformityMCP extPIP flexDIP ext
swan-neck deformity
MCP flexPIP extDIP flex
mallet finger
DIP flex
claw fingers
MCP extPIP flexDIP flex
drop wrist deformity
Loss of wrist & finger extension
nail deformities
Multiple variations
ganglion cyst
Russell’s sign
critical thinking
A shot putter comes in complaining of sever pain in his throwing wrist that has been happening for about 2-3 weeks at practice.
1. List 10 relevant questions you would ask this athlete.
2. List 10 relevant landmarks you would observe & palpate for further information.
critical thinking
The catcher of the softball team has come in after catching an intense bullpen session. She says the palm of her hand is hurting.
1. List 10 relevant questions you would ask this athlete.
2. List 10 relevant landmarks you would observe & palpate for further information.
critical thinking
The captain of the tennis team asks you to evaluate his wrist after practice. He feels his grip strength declining after each practice.
1. List 10 relevant questions you would ask this athlete.
2. List 10 relevant landmarks you would observe & palpate for further information.
The wrist, hand, & fingers
Range of Motion
range of motion
For the wrist…• ROM around all
three axis of rotation
• Occurs at the radiocarpal & radioulnar joints
range of motion
For the wrist…• Flexion (Flex) &
extension (Ext)• Radial deviation (RD) &
ulnar deviation (UD)• Pronation (Pro) &
supination (Sup)radiocarpal | radioulnar
wrist movements
• Flexion – decreasing the joint angle between the hand and forearm
• Aka: bend your wrist• Normal: 80-90o
wrist movements
• Extension – increasing the joint angle between the hand and forearm
• Aka: bend your wrist backwards
• Normal: 75-90o
wrist movements
• Radial Deviation– decreasing the joint angle between the thumb and radius
• Aka: thumb out• Normal:
15-25o
wrist movements
• Ulnar Deviation – decreasing the joint angle between the pinky and ulna
• Aka: pinky in• Normal:
30-45o
wrist movements
• Pronation – rotation of the hand medially
• Aka: palm down• Normal: 85-90o
wrist movements
• Supination – rotation of the hand laterally
• Aka: palm up• Normal: 85-90o
range of motionFor the thumb…• ROM occurs at the CMC, MCP, IP joints• Assessed as groups, and individually
range of motion
Groups:• Flex/Ext of CMC,
MCP, IP jt• ABD/ADD of CMC jt• Combining
movements = opposition
thumb movements
• Flexion – decreasing the joint angle between the 1st MC & the Trapezium; 1st MC and prox. Phalange; prox & distal phalanges.
• AKA: bend your thumb
• Normal:60-70o
50-55o
80-85o
thumb movements
• Extension– increasing the joint angle between the 1st MC & the Trapezium; 1st MC and prox. Phalange; prox & distal phalanges.
• AKA: straigten your thumb
• Normal:0-5o
at all jts
thumb movements
• Abduction – increasing the joint angle between the 1st MC & the Trapezium.
• AKA: thumb away from index finger
• Normal:70-80o
thumb movements
• Adduction – decreasing the joint angle between the 1st MC & the Trapezium.
• AKA: thumb towards index finger
• Normal:limited by2nd MC.
range of motion
For the phalanges…• ROM occurs at the
MCP, PIP, & DIP joints
• Assessed as groups, and individually
range of motion
Groups:• Flex/Ext of MCP, PIP, & DIP jts• ABD of MCP jts
finger movements
• Flexion – decreasing the joint angle between the MC prox. phalange; prox & middle phalanges; middle & distal phalanges.
• AKA: bend your fingers
• Normal: 85-105o; 110-120o; 80-90o
finger movements
• Extension – increasing the joint angle between the MC prox. phalange; prox & middle phalanges; middle & distal phalanges.
• AKA: straighten your fingers
• Normal: 20-30o; trace; 20o
finger movements
• Abduction – increasing the joint angle between phalanges.
• AKA: splay / spread your fingers
• Normal: 20-25o
Range of motion
Definition:–Range of motion refers to the distance
and direction a joint can move between the flexed position and the extended position
In true clinical settings, we use a goniometer to measure ROM
Range of motion
• Types–Active range of motion (AROM)–Passive range of motion (PROM)–Resistive range of motion (RROM)
Range of motion
• AROM– The patient’s ability to move a joint under
their own strength• PROM
– The joint’s ability to be moved through a range of motion
• RROM– Measurement of the muscle strength of a
joint through the ROM
Range of motion
• Performed bilaterally on the uninjured side first– Why??
Allows us to get a look at what is normal for that athlete!
patient positioning
• Position the patient however you need to allow for the range of motion to be tested– Flexion is best tested in supination– Extension is best tested in pronation
• RD/UD and Pro/Sup will need the patient to hang their wrist & hand off the edge of the treatment table.
active range of motion
The patient will actively…• Flex/ext, RD/UD, Pro/Sup their wrist • Flex/ext, ABD/ADD their thumb• Flex/ext, ABD their fingers
…on your command
passive range of motion
The examiner will actively…• Flex/ext, RD/UD, Pro/Sup the wrist • Flex/ext, ABD/ADD the thumb• Flex/ext, ABD the fingers
…at all joints (CMC, MCP, PIP, DIP, IP) for each digit.
passive range of motion
passive range of motion
resistive range of motion
The examiner will resist…• Flex/ext, RD/UD, Pro/Sup the wrist • Flex/ext, ABD/ADD the thumb• Flex/ext, ABD the fingers
…at all joints (CMC, MCP, PIP, DIP, IP) for each digit as the patient actively performs the motion.
resistive range of motion
items to note:
• When assessing, make note of:–differences in AROM–Pain during PROM–Decreased strength during RROM
But WHY??
grading ROM
• AROM & PROM are graded as within normal limits (WNL) or decreased/limited & why– AROM: R = WNL, L = decreased Pro due
to pn– PROM: R = WNL, L = pn with Sup
grading ROM
• RROM is graded on a 0-5 scale
0. Absent – no muscle contraction 1. Trace – contraction without movement 2. Poor – full ROM without gravity 3. Fair – full ROM against gravity 4. Good – 3 + some resistance 5. Normal – 3 + full resistance
documenting ROM
When documenting ROM, each movement must be listed & assessed.
AROM: R = WNL, L = WNL
PROM: R = WNL, L = WNL with Pn
RROM: R = 5/5Flex, 5/5Ext, 5/5UD, 5/5RD; 5/5Pro; 5/5Sup at the wrist; 5/5Flex, 5/5Ext, at the 1st CMC, MCP, IP; 5/5Flex, 5/5Ext at 2-5 MCP, PIP, DIP jts.
The Wrist, Hand, & Fingers
Special Tests
so far…
• Gathered clues by taking a history• Observed for signs of injury• Palpated the structures for
abnormalities• Tested ROM to find differences
differential diagnosis
• By now the choices of injury should be narrowed down to a handful of options…
rule them out
• In order to determine the injury, we must rule out the DDx
• To do this we usespecial tests
special tests
• Fractures• Ligamentous stress tests• Joint play (glides)• Provocation• Neurological• Vascular
fracturesspecial tests
long bone compression test
• Patient: Relaxed with joints in neutral• Examiner: Stabilize above structure being
tested • Action: Apply axial load
long bone compression test
long bone compression test
• Positive: Pain, crepitus• Pathology: Fracture• Notes: Can perform tap test for distal phalanx
fractures
ligamentous stress tests
special tests
remember…
• Tests the integrity of ligaments by recreating the injury mechanism
• Stabilize proximal, move distal• Hand placement should be as close to
joint being tested as possible• Graded as 1st, 2nd, 3rd degree with the
use of + and -
ligamentous stress tests
• Wrist joint– Valgus = UCL– Varus = RCL
• 1st MP joint– Valgus = UCL– Varus = RCL
• IP joints– Valgus = UCL– Varus = RCL
valgus/varus stress tests
Which one is which?
valgus/varus stress tests
Which one is which?
joint play (glides)special tests
glides
• Patient: Sitting; Elbow flexed to 90˚, forearm pronated, & fingers in relaxed position
• Examiner: Sitting or standing lateral to patient–One hand grasps distal radius–Other hand grasps proximal carpal row
• Action: Shear force applied gliding distal segment
glides
glides
• Positive: Pain or significant laxity compared bilaterally
• Pathology: Sprain of collateral or intercarpal ligaments–Trauma to TFCC
• Note: Decreased glide may indicate adhesions or capsular stiffness –May also perform carpal (intercarpal) glides
provocationspecial tests
watson test
• Patient: Seated w/elbow flexed & supported on table–Hand/forearm point up (arm wrestling
position)• Examiner: In font of patient• Action: Examiner’s thumb applies
dorsal pressure to the distal pole of the scaphoid & then moves wrist from ulnar to radial deviation
watson test
watson test
• Positive: Reproduction of pain & notable pop at scapholunate articulation
• Pathology: Scapholunate dislocation• Note: May be painful to “normal”
patient–May not be performable in an acute
situation
finkelstein’s test
• Patient: relaxed w/ neutral forearm• Examiner: not active• Action: flexes fingers around thumb (fist
with thumb inside), active hyper-ulnar deviation
finkelstein’s test
finkelstein’s test
• Positive: Pain over APL and EPB tendons
• Pathology: de Quervain’s • Can be painful in normal people, must
compare bilaterally
neurologicalspecial tests
tinel’s sign
• Patient: relaxed and comfortable w/forearm supination
• Examiner: lateral or anterior to patient–One hand supporting forearm, wrist and
hand–One hand free to administer test
• Action: firm tapping of carpal tunnel
tinel’s sign
tinel’s sign
• Positive: reproduction of S&S to the median nerve sensory distribution
• Pathology: carpal tunnel syndrome
phalen’s test
• Patient: relaxed and comfortable• Examiner: not active• Action: forced hyperflexion of wrists w/
dorsum of hands together for 1 minute
phalen’s test
phalen’s test
• Positive: reproduction of S&S to the median nerve sensory distribution
• Pathology: carpal tunnel syndrome (median nerve)
reverse phalen’s test
• Patient: relaxed and comfortable• Examiner: not active• Action: forced hyperextension of wrist for 1
minute
reverse phalen’s test
• Positive: reproduction of S&S to the median nerve sensory distribution
• Pathology: carpal tunnel syndrome (median nerve)– “Prayer Sign”
vascularspecial tests
allen test
• Patient: relaxed w/supinated forearms• Examiner: lateral to patient
–One thumb over radial artery–Other thumb over ulnar artery
allen test
allen test
• Actions:–Patient opens and closes hand rapidly–Examiner occludes radial and ulnar
arteries with thumbs–Patient opens hand–Examiner releases one artery watching
for immediate flush of hand–Repeat to test other artery
allen test
allen test
• Positive: slow circulatory refill (check bilaterally)
• Pathology: radial or ulnar artery insufficiency
The Wrist, Hand, & Fingers
Common Injuries
fractures
• Distal forearm fractures of the radius & ulna– Colle’s fracture– Smith’s fracture– Styloid process fracture– Epiphyseal fractures
distal forearm fractures
• Colles’ Fracture–Distal radius–True Colle’s Fx
• Dorsal displacementof radius
• 1.5” proximal toradiocarpal joint
–Typically from hyperextension
distal forearm fractures
• Smith’s Fracture– “Reverse Colle’s
Fracture”–Distal radius–Palmar displacement
of radius–Typically from
hyperflexion
styloid process fracture
• Typical avulsion fracture
• UCL or RCL stronger than styloid process
• Hyper-UD or RD
epiphyseal fracture
• Fracture through the distal growth plate
fractures
• Carpal fractures– Scaphoid fracture– Hamate fracture
scaphoid fracture
• Most common carpal fracture (~70%)– Especially in 15-30 year olds
• Pain in anatomical snuff box & Scaphoid Tubercle
• FOOSH• Avascular necrosis• Leads to non-union or
malunion healing– No universal treatment– Displaced may require surgery
hamate fracture• May fracture body or
hook– Body = Direct blow or
axial load to 4th & 5th metacarpals
– Hook = FOOSH or swinging bat/golf club
• Movement of 5th finger causes pain when hook is fractured
metacarpal fractures
• Compressive forces– Axial or direct trauma– Can have avulsions
• Sx & Sy:– “Snap,” crepitus, etc. – Depressed knuckle– May not be able to
make fist• Tx depends on
rotation• “Boxer’s fracture”
metacarpal fractures
• Bennett’s fracture– 1st metacarpal– Intra-articular (C-M
joint)– Typically needs fixation
phalanx fractures
• Most common fractures of hand• Thumb and middle finger are most common
sites• Distal phalanx is most common
– Often involves avulsion of flexor/extensor tendon
• Direct blow = transverse or comminuted fx• Rotational force = spiral fracture• Patient will often hear “snap”
spiral fracture
spiral fracture repair
Dislocations/subluxations
• Wrist dislocations – very rare• Carpal dislocations
– Lunate• MCP joint – most common in 1st MCP• PIP & DIP joints – most common
lunate dislocations
• MOI: forced hyperextension of wrist• May move palmar or dorsally • May reduce spontaneously
lunate dislocations
• Mechanism may also cause scaphoid fracture & carpal instability
• Sx & Sy:– 3rd knuckle may become level with other
knuckles– Pain at wrist & along radius– May suffer from parasthesia in middle
finger
lunate dislocations
• Often, patient presents with no significant findings except pain– Will often have pain with carpal glides– X-ray or MRI needed to confirm– Usually require surgery– Rule out scaphoid fracture
lunate dislocation
mcp joint dislocation
• More common in thumb than fingers– Often caused by extension and abduction
• Often occurs w/fracture
pip & dip joint dislocations
• Most common dislocation• May remain displaced or spontaneously
reduce• Often reduced on-site by player, coach, etc.• Often involve fractures• Should ALWAYS be referred for X-rays
pip & dip dislocations
sprains vs. strains
• Hard to distinguish the difference in the wrist– AROM vs. PROM will indicate
• Typically due to hyperflexion or hyperextension
• Strain is to the tendon crossing at the wrist
• Sprain is Dx by r/o all other injuries
TFCC injury
• Often results from trauma or repeated stress• “WB” activities (gymnastics) can cause
degenerative injuries• Sx & Sy:
– Forced hyperextension often causes pain– Pain with weight-bearing activities – i.e., push
ups– May have pain at ulnar styloid process
• Refer if suspected – often requires surgery
sprains
• IP joint sprains–Very common w/ variety of
mechanisms–Typically involve collateral ligaments–May result in dislocation–May wait to report injury
sprains• MP joint sprains (thumb)
–Most often ulnar (medial) collateral ligament
–MOI: hyperabduction/ extension
– “Gamekeeper’s thumb” or “skier’s thumb”
–Loss of grip strength in opposition
observable deformities
• Boutonniere deformity
• Swan-neck deformity
• Mallet finger• Claw fingers
• Drop wrist• Nail deformities• Ganglion cysts• Russell’s sign
boutonniere deformityMCP extPIP flexDIP ext
swan-neck deformity
MCP flexPIP extDIP flex
mallet finger
DIP flex
claw fingers
MCP extPIP flexDIP flex
drop wrist deformity
Loss of wrist & finger extension
nail deformities
Multiple variations
ganglion cyst
russell’s sign
de quervain’s syndrome
• Tenosynovitis• Structures Involved:
– Extensor Pollicis Brevis– Abductor Pollicis Longus
• Repeated RD and gripping• Wrist movement & pinching
increases symptoms• Special test?
carpal tunnel syndrome
• Compression of the median nerve– Symptoms often
occur at night & relieved by shaking
– Neurological symptoms, loss of grip strength, “ache”
carpal tunnel syndrome
• Etiology: repetitive microtrauma of flexor tendons– Most patients 40-60 years old; more common in
females– Often results from tenosynovitis or trauma
Volkmann’s ischemic contracture
• Begins with fracture in humerus, where total arm cast is applied
• Tight casting causes muscle spasm, swelling, or bone pressure on brachial artery, inhibiting circulation to forearm
Volkmann’s ischemic contracture
• Can become permanent
• May be loss of motor & sensory function
• Results from insufficient bloodflow & return to forearm and hand
Volkmann’s ischemic contracture
• Sx & Sy:– Pain in forearm - ↑ w/ passive extension
of fingers– Pain is followed by loss of brachial and
radial pulses, coldness in arm– ↓ motion
• Management– Remove elastic wraps or casts – Close monitoring must occur