This article was originally presented as an independent educational activity under the direction of CME LLC. The ability to receive CME credits has expired. The article is now presented here for your reference. CME LLC is no longer responsible for the presentation of the article.
A 62-year-old woman admitted to behavioral hospital unit because of agitation complicating end-stage Parkinson disease. The disease has progressed over 20 years.
States that hand deformities arose more recently. Gives equivocal answer when routinely queried about remote or recent abuse by others; denies that interpersonal violence ever caused a fracture. Claims that a fall down stairs led to hand changes.
Profoundly dysphonic woman, polite but often unfocused in discussion. Hands as shown. Wrists cannot be passively extended; metacarpophalangeal joints cannot be flexed. Interphalangeal joints are somewhat mobile, distal more so than proximal; passive motion does not produce pain.
Hands warm and well perfused; pulses can’t be felt because of constant abnormal involuntary movements. Movements may be partly psychogenic. Forearms do not feel woody. Elbows show normal passive range of motion. Sensation testing intact.
Legs: atrophy of muscles. Right clubfoot deformity, left foot somewhat inverted and adducted.
What’s Your Diagnosis?
1. Von Volkmann R. Ischaemic muscle paralyses and contractures. 1881. Bick
EM, trans. Clin Orthop Relat Res. 2007;456:20-21.
2. Benkeddache Y, Gottesman H, Hamidani M. Proposal of a new classification
for established Volkmann's contracture. Ann Chir Main. 1985;4:134-142.
3. Von Schroeder HP, Botte MJ. Definitions and terminology of compartment
syndrome and Volkmann's ischemic contracture of the upper extremity. Hand
4. Hovius SE, Ultee J. Volkmann's ischemic contracture. Prevention and treatment.
Hand Clin. 2000;16:647-657.
5. Klenerman L. The evolution of the compartment syndrome since 1948 as
recorded in the JBJS (B).
J Bone Joint Surg Br. 2007;89:1280-1282.
6. Lester B. Compartment syndrome. In: Lester B, ed. The Acute Hand. Stamford,
CT: Appleton & Lange; 1999:347-359.
7. Thoder JJ. Compartment syndrome. In: Jebson P, Kasdan M, eds. Hand Secrets.
3rd ed. Philadelphia: Mosby Elsevier; 2006:102-107.
8. Jain V, Sen B, Agrawal M, et al. Volkmann sign of non-ischaemic origin. J Hand
Surg Eur. 2008;33:462-464.
9. Hill RL, Brooks B. Volkmann's ischemic contracture in hemophilia. Ann Surg. 1936;103:444-449.
10. Orizaga M, Ducharme FA, Campbell JS, Embree GH. Muscle infarction
and Volkmann's contracture following carbon monoxide poisoning: a case report.
J Bone Joint Surg [Am]. 1967;49:965-970.
11. Okechukwu C, Schneiderman H. Clubfoot deformity (talipes equinovarus).
12. Schneiderman H, Noteroglu EH. Bilateral talipes equinus deformities in an
aged bedbound demented woman. Consultant. 2005;45:783-789.