Volkmann's contracture / by Leonard S. Dudgeon.

  • Dudgeon, Leonard S., 1876-1938.
Date:
1902
Catalogue details

Licence: In copyright

Credit: Volkmann's contracture / by Leonard S. Dudgeon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Table II. was under the age of 10 years, except in three instances, and two of these could hardly be included, as in one it was due to Esmarch’s bandage and in the other to thrombosis of the axillary artery, and therefore they did not present the usual history). Splints have gener- ally been applied and the contracture of the fingers has come on rapidly. This point, Volkmann 24 lays great stress on and says : ‘ * The paralysis and contracture arise simul- taneously, not as in paralysis of nervous origin, where con- traction is a later phenomenon and of gradual onset.” A child presenting such a history as this and with the deformity of the hand as described in the paragraph on the symptoms, as well as with normal electrical reactions, is diagnostic of Volkmann’s contracture. We must now consider what other conditions produce such a deformity. I find that the following is a list of nerve lesions which are given as offering points of diagnosis : (1) ulnar, median, or muscular spiral paralysis ; (2) the con- traction after acute anterior poliomyelitis; (3) Little’s disease ; and (4) functional disease. The peripheral nerve palsies are alone worth considering fully ; in the others the diagnosis is so obvious that a brief account is sufficient. 1. In ulnar paralysis the paralysis generally comes on rapidly after wounds of the arm. The fingers cannot be flexed at the first joint or extended at the other joints. Adduction of the thumb is lost and so are most movements of the little finger. Anesthesia occurs in most cases, corresponding with the inner side of the hand, the little finger, and the inner half of the ring finger. The reaction of degeneration in the wasted ulnar muscles is present, but no reaction to stimula- tion of the ulnar nerve with the faradic current. After a long period the “claw hand” is developed. There will be no contraction of the wrist. The hypothenar eminence may disappear.^ The palm is hollow and trophic changes may be present. Therefore the points of diagnosis are many and should not offer much difficulty. In median nerve palsy there is paralysis of pronation beyond the mid-position ; the thumb is extended and adducted. The fingers are not contracted. There is little power to flex the wrist. Electrical reactions show reaction of degeneration in the affected muscles. Anaes- thesia corresponding to the radial side of the palm, the front of the thumb, the first two fingers and half the third, and in some