Volkmann's contracture
February 19, 2012 | 30,00 EUR | answered by Dr. med. Ive Dr. Schaaf
Eight months ago, my grandmother in Russia, age 73, unfortunately received a too tight bandage on her hand after a thrombosis, which then caused a contracture. This was not detected and resulted in a Volkmann's contracture. She can only grip with her hand very poorly. The fingertips have no feeling, there is a strongly disturbing cold and metallic feeling in the hand. She experiences pain during the day, but at night her hand becomes claw-like and she feels no pain. She underwent massages and physical therapy for about 6 weeks, which brought some progress compared to the initial stage.
Since then, she has been doing daily finger exercises, but they do not seem to have any effect. The hand has become thinner, but there is no more progress.
My questions:
1) Is it advisable to have surgery? What are the chances of success?
For example, I found this link, but it is from 1998:
http://www.handmikrochirurgie.com/de/pdf/gracilis_transplantation.pdf
2) What types of surgeries are available nowadays, perhaps better ones?
3) Do you need specialized centers or can most hospitals (I am referring to Germany) perform these surgeries?
4) Are there any other conservative methods that promise success?
Good evening,
unfortunately, there are no really good news for you or your grandmother.
Since the acute problem situation is associated with severe pain, there are few such cases, the later diagnosis is used as an umbrella term, behind which individually different changes are hidden and the treatment is based on the predominant symptoms, without general advice being possible.
The sensitive disorders - feeling of cold etc. often recover quite well within a time frame of about a year, after that there is usually a standstill. Since only 8 months have passed, there may still be an improvement here. This results from the recovery capacity of the nerve, which cannot really be influenced. At most, one can pay attention to an adequate supply of vitamin B complex, as this is necessary for nerve function.
Wearing a splint in extension position against claw hand at night is quite useful, so that the collagen fibers, which have been successfully stretched during the day (by using the hand), do not regularly contract again overnight.
Medication with painkillers is useful as long as they are tolerated by the stomach. It is less about pain therapy and more about the anti-inflammatory component, which can positively influence the irritation in the affected tissue.
Physical therapy makes sense and should be continued - actively and passively, but always gently. Massage and lymphatic drainage can be very soothing and helpful as a supplement.
Surgery is rarely an option, definitely only after exhausting conservative measures, tendentially only after a year and only when it becomes apparent that conservative therapy will not lead to a result that can cope with everyday life. The surgery can only lead to an improvement in function, nerve problems are tendentially rather difficult to influence, unless it is shown intraoperatively that nerve fibers are constricted. Exposing them can then provide relief.
As a surgeon, I would choose an experienced hand surgeon, tendentially I would look for where an "old surgeon" is located, because presumably he may have the most experience. Probably no one will have treated really many cases, for the reasons mentioned above. Only the surgeon will be able to assess the chances of success approximately. He will do this preoperatively, as the procedure can only lead to an improvement and is associated with a risk that needs to be weighed.
Personally, I would inquire at the trauma clinic in Murnau or present your grandmother there, as relatively many "complications" or complicated courses are treated there both surgically and rehabilitatively. The fact that both are offered provides a more thoughtful basis for a possible decision on surgery. There is probably something similar further north or east, but "down here" I only know this address.
Do you have any further questions? If I can, I am happy to help.
Best regards,
Dr. Ive Schaaf
