Progress in diagnosis and treatment of finger flexion deformity caused by forearm flexor muscle lesions_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIANG Yingliang ,  WEI Jianwei

Department of orthopedics, Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P. R. China;

Corresponding?author：

WEI Jianwei, Email: doctorway@csu.edu.cn

Keywords：

Forearm flexor muscle lesions; finger flexion deformity; Volkmann’s contracture; pseudo-Volkmann’s contracture; congenital flexor muscle lesions; diagnose; treatment

DOI：

10.7507/1002-1892.202511014

Video：

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Objective To summarize the current research progress of finger flexion deformity caused by forearm flexor muscle lesions, providing a reference for clinical diagnosis and treatment. Methods The domestic and international literature about finger flexion deformity caused by forearm flexor muscle lesions was extensively reviewed and a summary analysis from the etiology and pathogenesis, diagnosis and differential diagnosis, and treatment methods was conducted. Results The three types of forearm flexor pathology leading to finger flexion deformity include Volkmann’s contracture, pseudo-Volkmann’s contracture, and congenital flexor muscle lesions with different pathogenesis. The diagnosis is mainly based on the patient's medical history, clinical features, and imaging examinations, with attention paid to differential diagnosis. Currently, conservative treatment for such deformities is not very effective, and surgical treatment is mainly adopted. According to the causes and severity, options such as resection of the contracture band, resection of contracture band, release of compressed muscle (tendon), and flexor origin muscle sliding surgery, could be performed to correct hand deformities and restore hand function, and thus resulting in favorable outcomes. Conclusion Volkmann’s contracture, pseudo-Volkmann’s contracture, and congenital flexor muscle lesions causing finger flexion deformity have different causes and pathogenesis, which can be distinguished by carefully inquiring about the medical history, the clinical characteristics of the three, and imaging examinations, thereby selecting appropriate treatment methods.

1.	Dias J, Tharmanathan P, Arundel C, et al. Collagenase injection versus limited fasciectomy for Dupuytren’s contracture. N Engl J Med, 2024, 391(16): 1499-1510.
2.	Schoenfeld JD, Agaram NP, Lefkowitz RA, et al. Sorafenib in Dupuytren and Ledderhose disease. Oncologist, 2022, 27(3): e294-e296.
3.	Chiang LJ, Shieh SJ. Ganglion cyst in zone 2 of Guyon’s canal causing ulnar neuropathy with claw hand deformity: a case report and literature review. Ann Plast Surg, 2025, 94(3S Suppl 1): S90-S94.
4.	韓嶸燦, 李成利, 郭新峰, 等. 逆行肌肉松解法治療輕中型前臂缺血性肌攣縮. 中國修復重建外科雜志, 2021, 35(4): 483-487.
5.	Osborn PM, Schmidt AH. Diagnosis and management of acute compartment syndrome. J Am Acad Orthop Surg, 2021, 29(5): 183-188.
6.	Neri I, Magnano M, Pini A, et al. Congenital volkmann syndrome and aplasia cutis of the forearm: a challenging differential diagnosis. JAMA Dermatology, 2014, 150(9): 978-980.
7.	Hansen-Jaumard D, Elfassy C, Montpetit K, et al. A review of the orthopedic interventions and functional outcomes among a cohort of 114 children with arthrogryposis multiplex congenita. J Pediatr Rehabil Med, 2020, 13(3): 263-271.
8.	Wordsworth P, Chan M. Melorheostosis and osteopoikilosis: a review of clinical features and pathogenesis. Calcif Tissue Int, 2019, 104(5): 530-543.
9.	中華醫學會骨科學分會外固定與肢體重建學組, 中國醫師協會創傷外科醫師分會創傷感染專業委員會, 中國醫師協會骨科醫師分會創傷專家工作委員會. 中國急性骨筋膜室綜合征早期診斷與治療指南 (2020版). 中華創傷骨科雜志, 2020, 22(8): 645-654.
10.	Khoshhal KI, Alsaygh EF, Alsaedi OF, et al. Etiology of trauma-related acute compartment syndrome of the forearm: a systematic review. J Orthop Surg Res, 2022, 17(1): 342. doi: 10.1186/s13018-022-03234-x.
11.	Tsuge K. Treatment of established Volkmann's contracture. J Bone Joint Surg (Am), 1975, 57(7): 925-929.
12.	Holden CE. The pathology and prevention of Volkmann’s ischaemic contracture. J Bone Joint Surg (Br), 1979, 61-B(3): 296-300.
13.	Hardwicke J, Srivastava S. Volkmann’s contracture of the forearm owing to an insect bite: a case report and review of the literature. Ann R Coll Surg Engl, 2013, 95(2): e36-e37.
14.	Jain V, Sen B, Agrawal M, et al. Volkmann sign of non-ischaemic origin. J Hand Surg (Eur Vol), 2008, 33(4): 462-464.
15.	Jeffery CC. Contracture of fingers due to fixation of the flexor profundus digitorum to the ulna. Hand, 1976, 8(1): 32-35.
16.	Littlefield WG, Hastings H, Strickland JW. Adhesions between muscle and bone after forearm fracture mimicking mild Volkmann's ischemic contracture. J Hand Surg (Am), 1992, 17(4): 691-693.
17.	黨洪勝, 張世瓊, 王平年, 等. 指深屈肌腱粘連致假性缺血性肌攣縮的臨床分析. 中華手外科雜志, 2005, 21(3): 156-157.
18.	Geissler J, Westberg J, Stevanovic M. Pseudo-Volkmann contracture: A case report and review of the current literature. J Am Acad Orthop Surg Glob Res Rev, 2018, 2(11): e031. doi: 10.5435/JAAOSGlobal-D-18-00031.
19.	Rayan GM, Hayes M. Entrapment of the flexor digitorum profundus in the ulna with fracture of both bones of the forearm. Report of a case. J Bone Joint Surg (Am), 1986, 68(7): 1102-1103.
20.	Kolkman KA, van Niekerk JL, Rieu PN, et al. A complicated forearm greenstick fracture: case report. J Trauma, 1992, 32(1): 116-117.
21.	Littlefield WG, Hastings H, Strickland JW. Adhesions between muscle and bone after forearm fracture mimicking mild Volkmann’s ischemic contracture. J Hand Surg (Am), 1992, 17(4): 691-693.
22.	Hendel D, Aner A. Entrapment of the flexor digitorum profundus of the ring finger at the site of an ulnar fracture. A case report. Ital J Orthop Traumatol, 1992, 18(3): 417-419.
23.	Shaw BA, Murphy KM. Flexor tendon entrapment in ulnar shaft fractures. Clin Orthop Relat Res, 1996(330): 181-184.
24.	Deeney VF, Kaye JJ, Geary SP, et al. Pseudo-Volkmann’s contracture due to tethering of flexor digitorum profundus to fractures of the ulna in children. J Pediatr Orthop, 1998, 18(4): 437-440.
25.	Watson PA, Blair W. Entrapment of the index flexor digitorum profundus tendon after fracture of both forearm bones in a child. Iowa Orthop J, 1999, 19: 127-128.
26.	Hendel D. Prevention of chronic entrapment of the ring finger flexor profundus muscle in ulnar shaft fractures in children--a case report. Acta Orthop Scand, 2004, 75(4): 503-504.
27.	Akita S, Kawai H. Entrapment of the flexor digitorum superficials in the radius fracture site. J Hand Surg, 2005, 30(2): 308-311.
28.	Fernandez ML, Segal LS. Entrapment of the flexor digitorum profundus following paediatric forearm fractures. Acta Orthop Belg, 2007, 73(6): 780-784.
29.	Song DJ, Kennebrew GJ Jr, Jex JW. Isolated ring finger flexor digitorum profundus entrapment after closed reduction and intramedullary fixation of both-bone forearm fracture. Orthopedics, 2012, 35(8): e1283-e1285.
30.	Brogan K, Nicol S. Flexor digitorum profundus entrapment in paediatric forearm fractures. J Surg Case Rep, 2014, 2014, (5): rju038. doi: 10.1093/jscr/rju038.
31.	Kolua??k S, Y?lmaz ?, Aslantürk O. Treatment of a neglected flexor digitorum profundus entrapment after closed reduction of both bone forearm fracture: A case report. Jt Dis Relat Surg, 2021, 32(3): 810-813.
32.	湯鵬, 魏建偉, 董忠根, 等. 前臂屈肌病變致手指屈曲攣縮的診斷與治療. 中國修復重建外科雜志, 2023, 37(4): 447-451.
33.	Mestarihi S, Almigdad A, Hurani K, et al. Pseudo-Volkmann contracture: A case report. Cureus, 2024, 16(4): e57607. doi: 10.7759/cureus.57607.
34.	O'Brien JP, Hodgson AR. Congenital abnormality of the flexor digitorum profundus, a cause of flexion deformity of the long and ring fingers. Clin Orthop Relat Res, 1974(104): 206-208.
35.	Takagi T, Takayama S, Ikegami H, et al. Congenital shortening of the flexor digitorum profundus muscle. J Hand Surg (Am), 2007, 32(2): 168-171.
36.	Xiong G, Yongbin G, Zhu J, et al. Congenital contracture of the ulnar digits and its differentiation from ischemic contracture. J Hand Surg (Am), 2022, 47(6): 579. e1-579. e9.
37.	Li H, Guan S. Progressing flexion deformity of the middle, ring, and small fingers with a rare congenital anatomic difference of flexor digitorum profundus. J Pediatr Orthop, 2020, 40(7): e603-e608.
38.	張雨, 許前, 冒海軍, 等. 三例先天性前臂尺側指深屈肌攣縮臨床特點及治療分析. 中國修復重建外科雜志, 2024, 38(1): 51-55.
39.	Xiong G, Sun Y, Wang S. Congenital flexion deformity of the long, ring, and little fingers with an aberrant origin of the flexor digitorum profundus: case report. J Hand Surg (Am), 2008, 33(8): 1358-1361.
40.	Osborn CPM, Schmidt AH. Management of acute compartment syndrome. J Am Acad Orthop Surg, 2020, 28(3): e108-e114.
41.	Gawel RJ, Wang Y, Kemler BR, et al. Return to sport after fasciotomy for chronic exertional compartment syndrome of the forearm: a systematic review. Am J Sports Med, 2024, 52(11): 2931-2938.
42.	宋晗, 高順紅, 張云鵬, 等. WALANT麻醉下肌腱延長治療前臂缺血性肌攣縮環小指屈曲畸形. 中華手外科雜志, 2022, 38(4): 295-297.
43.	Jerome JTJ. Flexor pronator slide under local anesthesia without a tourniquet for non-ischemic contractures of the forearm. JBJS Essent Surg Tech, 2024, 14(1): e23.00048. doi: 10.2106/JBJS.ST.23.00048.
44.	Sharma P, Swamy MK. Results of the Max Page muscle sliding operation for the treatment of Volkmann’s ischemic contracture of the forearm. J Orthop Traumatol, 2012, 13(4): 189-196.
45.	汪巍, 彭昊, 王炳勛, 等. 屈肌滑移術治療前臂Volkmann缺血性肌攣縮的療效分析. 武漢大學學報: 醫學版, 2012, 33(1): 110-112.
46.	Aydin U, Chung KC. Free functional muscle transfer-technical considerations. Clin Plast Surg, 2024, 51(4): 505-514.
47.	Sabapathy SR, Venkatramani H, Bhardwaj P, et al. Technical considerations and outcome of free functioning gracilis muscle transfer for finger flexion in patients with Volkmann’s Ischemic Contracture. Injury, 2021, 52(12): 3640-3645.

1. Dias J, Tharmanathan P, Arundel C, et al. Collagenase injection versus limited fasciectomy for Dupuytren’s contracture. N Engl J Med, 2024, 391(16): 1499-1510.
2. Schoenfeld JD, Agaram NP, Lefkowitz RA, et al. Sorafenib in Dupuytren and Ledderhose disease. Oncologist, 2022, 27(3): e294-e296.
3. Chiang LJ, Shieh SJ. Ganglion cyst in zone 2 of Guyon’s canal causing ulnar neuropathy with claw hand deformity: a case report and literature review. Ann Plast Surg, 2025, 94(3S Suppl 1): S90-S94.
4. 韓嶸燦, 李成利, 郭新峰, 等. 逆行肌肉松解法治療輕中型前臂缺血性肌攣縮. 中國修復重建外科雜志, 2021, 35(4): 483-487.
5. Osborn PM, Schmidt AH. Diagnosis and management of acute compartment syndrome. J Am Acad Orthop Surg, 2021, 29(5): 183-188.
6. Neri I, Magnano M, Pini A, et al. Congenital volkmann syndrome and aplasia cutis of the forearm: a challenging differential diagnosis. JAMA Dermatology, 2014, 150(9): 978-980.
7. Hansen-Jaumard D, Elfassy C, Montpetit K, et al. A review of the orthopedic interventions and functional outcomes among a cohort of 114 children with arthrogryposis multiplex congenita. J Pediatr Rehabil Med, 2020, 13(3): 263-271.
8. Wordsworth P, Chan M. Melorheostosis and osteopoikilosis: a review of clinical features and pathogenesis. Calcif Tissue Int, 2019, 104(5): 530-543.
9. 中華醫學會骨科學分會外固定與肢體重建學組, 中國醫師協會創傷外科醫師分會創傷感染專業委員會, 中國醫師協會骨科醫師分會創傷專家工作委員會. 中國急性骨筋膜室綜合征早期診斷與治療指南 (2020版). 中華創傷骨科雜志, 2020, 22(8): 645-654.
10. Khoshhal KI, Alsaygh EF, Alsaedi OF, et al. Etiology of trauma-related acute compartment syndrome of the forearm: a systematic review. J Orthop Surg Res, 2022, 17(1): 342. doi: 10.1186/s13018-022-03234-x.
11. Tsuge K. Treatment of established Volkmann's contracture. J Bone Joint Surg (Am), 1975, 57(7): 925-929.
12. Holden CE. The pathology and prevention of Volkmann’s ischaemic contracture. J Bone Joint Surg (Br), 1979, 61-B(3): 296-300.
13. Hardwicke J, Srivastava S. Volkmann’s contracture of the forearm owing to an insect bite: a case report and review of the literature. Ann R Coll Surg Engl, 2013, 95(2): e36-e37.
14. Jain V, Sen B, Agrawal M, et al. Volkmann sign of non-ischaemic origin. J Hand Surg (Eur Vol), 2008, 33(4): 462-464.
15. Jeffery CC. Contracture of fingers due to fixation of the flexor profundus digitorum to the ulna. Hand, 1976, 8(1): 32-35.
16. Littlefield WG, Hastings H, Strickland JW. Adhesions between muscle and bone after forearm fracture mimicking mild Volkmann's ischemic contracture. J Hand Surg (Am), 1992, 17(4): 691-693.
17. 黨洪勝, 張世瓊, 王平年, 等. 指深屈肌腱粘連致假性缺血性肌攣縮的臨床分析. 中華手外科雜志, 2005, 21(3): 156-157.
18. Geissler J, Westberg J, Stevanovic M. Pseudo-Volkmann contracture: A case report and review of the current literature. J Am Acad Orthop Surg Glob Res Rev, 2018, 2(11): e031. doi: 10.5435/JAAOSGlobal-D-18-00031.
19. Rayan GM, Hayes M. Entrapment of the flexor digitorum profundus in the ulna with fracture of both bones of the forearm. Report of a case. J Bone Joint Surg (Am), 1986, 68(7): 1102-1103.
20. Kolkman KA, van Niekerk JL, Rieu PN, et al. A complicated forearm greenstick fracture: case report. J Trauma, 1992, 32(1): 116-117.
21. Littlefield WG, Hastings H, Strickland JW. Adhesions between muscle and bone after forearm fracture mimicking mild Volkmann’s ischemic contracture. J Hand Surg (Am), 1992, 17(4): 691-693.
22. Hendel D, Aner A. Entrapment of the flexor digitorum profundus of the ring finger at the site of an ulnar fracture. A case report. Ital J Orthop Traumatol, 1992, 18(3): 417-419.
23. Shaw BA, Murphy KM. Flexor tendon entrapment in ulnar shaft fractures. Clin Orthop Relat Res, 1996(330): 181-184.
24. Deeney VF, Kaye JJ, Geary SP, et al. Pseudo-Volkmann’s contracture due to tethering of flexor digitorum profundus to fractures of the ulna in children. J Pediatr Orthop, 1998, 18(4): 437-440.
25. Watson PA, Blair W. Entrapment of the index flexor digitorum profundus tendon after fracture of both forearm bones in a child. Iowa Orthop J, 1999, 19: 127-128.
26. Hendel D. Prevention of chronic entrapment of the ring finger flexor profundus muscle in ulnar shaft fractures in children--a case report. Acta Orthop Scand, 2004, 75(4): 503-504.
27. Akita S, Kawai H. Entrapment of the flexor digitorum superficials in the radius fracture site. J Hand Surg, 2005, 30(2): 308-311.
28. Fernandez ML, Segal LS. Entrapment of the flexor digitorum profundus following paediatric forearm fractures. Acta Orthop Belg, 2007, 73(6): 780-784.
29. Song DJ, Kennebrew GJ Jr, Jex JW. Isolated ring finger flexor digitorum profundus entrapment after closed reduction and intramedullary fixation of both-bone forearm fracture. Orthopedics, 2012, 35(8): e1283-e1285.
30. Brogan K, Nicol S. Flexor digitorum profundus entrapment in paediatric forearm fractures. J Surg Case Rep, 2014, 2014, (5): rju038. doi: 10.1093/jscr/rju038.
31. Kolua??k S, Y?lmaz ?, Aslantürk O. Treatment of a neglected flexor digitorum profundus entrapment after closed reduction of both bone forearm fracture: A case report. Jt Dis Relat Surg, 2021, 32(3): 810-813.
32. 湯鵬, 魏建偉, 董忠根, 等. 前臂屈肌病變致手指屈曲攣縮的診斷與治療. 中國修復重建外科雜志, 2023, 37(4): 447-451.
33. Mestarihi S, Almigdad A, Hurani K, et al. Pseudo-Volkmann contracture: A case report. Cureus, 2024, 16(4): e57607. doi: 10.7759/cureus.57607.
34. O'Brien JP, Hodgson AR. Congenital abnormality of the flexor digitorum profundus, a cause of flexion deformity of the long and ring fingers. Clin Orthop Relat Res, 1974(104): 206-208.
35. Takagi T, Takayama S, Ikegami H, et al. Congenital shortening of the flexor digitorum profundus muscle. J Hand Surg (Am), 2007, 32(2): 168-171.
36. Xiong G, Yongbin G, Zhu J, et al. Congenital contracture of the ulnar digits and its differentiation from ischemic contracture. J Hand Surg (Am), 2022, 47(6): 579. e1-579. e9.
37. Li H, Guan S. Progressing flexion deformity of the middle, ring, and small fingers with a rare congenital anatomic difference of flexor digitorum profundus. J Pediatr Orthop, 2020, 40(7): e603-e608.
38. 張雨, 許前, 冒海軍, 等. 三例先天性前臂尺側指深屈肌攣縮臨床特點及治療分析. 中國修復重建外科雜志, 2024, 38(1): 51-55.
39. Xiong G, Sun Y, Wang S. Congenital flexion deformity of the long, ring, and little fingers with an aberrant origin of the flexor digitorum profundus: case report. J Hand Surg (Am), 2008, 33(8): 1358-1361.
40. Osborn CPM, Schmidt AH. Management of acute compartment syndrome. J Am Acad Orthop Surg, 2020, 28(3): e108-e114.
41. Gawel RJ, Wang Y, Kemler BR, et al. Return to sport after fasciotomy for chronic exertional compartment syndrome of the forearm: a systematic review. Am J Sports Med, 2024, 52(11): 2931-2938.
42. 宋晗, 高順紅, 張云鵬, 等. WALANT麻醉下肌腱延長治療前臂缺血性肌攣縮環小指屈曲畸形. 中華手外科雜志, 2022, 38(4): 295-297.
43. Jerome JTJ. Flexor pronator slide under local anesthesia without a tourniquet for non-ischemic contractures of the forearm. JBJS Essent Surg Tech, 2024, 14(1): e23.00048. doi: 10.2106/JBJS.ST.23.00048.
44. Sharma P, Swamy MK. Results of the Max Page muscle sliding operation for the treatment of Volkmann’s ischemic contracture of the forearm. J Orthop Traumatol, 2012, 13(4): 189-196.
45. 汪巍, 彭昊, 王炳勛, 等. 屈肌滑移術治療前臂Volkmann缺血性肌攣縮的療效分析. 武漢大學學報: 醫學版, 2012, 33(1): 110-112.
46. Aydin U, Chung KC. Free functional muscle transfer-technical considerations. Clin Plast Surg, 2024, 51(4): 505-514.
47. Sabapathy SR, Venkatramani H, Bhardwaj P, et al. Technical considerations and outcome of free functioning gracilis muscle transfer for finger flexion in patients with Volkmann’s Ischemic Contracture. Injury, 2021, 52(12): 3640-3645.

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