Question

Which of the following clinical sign indicates ischaemia of forearm?

• A. \( \text{Carpal tunnel syndrome} \)
• B. \( \text{Hand of benediction} \)
• C. \( \text{Ulnar claw} \)
• D. \( \text{Volkmann's Contracture} \)

Hint:

Volkmann’s Contracture is a hallmark of untreated or prolonged forearm ischaemia, often secondary to compartment syndrome. Always associate contractures with vascular damage rather than isolated nerve injury.

Answer 1

The Correct Option is D

To solve this problem, let's explore the clinical signs associated with forearm ischaemia, which results from reduced blood flow to the tissues of the forearm.

1. What is Forearm Ischaemia?

Forearm ischaemia occurs when there is a reduction or complete loss of blood flow to the forearm, leading to insufficient oxygen and nutrients reaching the muscles, nerves, and other tissues. This can be caused by various conditions such as trauma, compression, or blockage of the blood vessels. If not treated promptly, ischaemia can lead to permanent damage to the tissues and nerves in the forearm.

2. Explanation of Each Option:

- Option 1: "Carpal Tunnel Syndrome" – This is incorrect. Carpal tunnel syndrome occurs when the median nerve, which passes through the carpal tunnel at the wrist, becomes compressed. This leads to symptoms like numbness, tingling, and weakness in the hand and fingers, but it is not related to forearm ischaemia. Carpal tunnel syndrome is typically caused by repetitive movements or pressure on the wrist and does not result from a lack of blood supply to the forearm.

- Option 2: "Hand of Benediction" – This is incorrect. The "hand of benediction" is a clinical sign that occurs when there is damage to the median nerve. It is characterized by the inability to flex the second and third fingers, making the hand look like it is in a benediction position (as if giving a blessing). This is a nerve injury, not a sign of ischaemia. It typically happens due to nerve compression or injury, not due to lack of blood supply to the forearm muscles.

- Option 3: "Ulnar Claw" – This is incorrect. The "ulnar claw" refers to a deformity caused by injury or damage to the ulnar nerve, which controls some of the hand's small muscles. When the ulnar nerve is affected, the fourth and fifth fingers remain flexed. While this can cause difficulty with hand function, it is not directly related to ischaemia in the forearm. It is a result of nerve injury, not blood flow issues.

- Option 4: "Volkmann's Contracture" – This is the correct answer. Volkmann's contracture is a serious condition that results from untreated or prolonged forearm ischaemia. When blood flow to the forearm is blocked or reduced for a long time, the muscles and tissues begin to die due to lack of oxygen and nutrients. This results in the muscles of the forearm shortening and becoming tight, leading to a permanent deformity in the hand, often resembling a claw. This is called Volkmann's contracture. It can cause significant disability and pain if not treated early.

3. Why This Matters:

Understanding and recognizing the signs of ischaemia, especially Volkmann's contracture, is crucial for medical professionals, as early intervention can help prevent long-term damage. If the blood flow is restored early enough, it can prevent muscle death and deformity. If left untreated, Volkmann's contracture can cause permanent damage to the muscles, nerves, and tissues in the forearm, resulting in severe functional impairment.

4. Final Answer:

The clinical sign indicating forearm ischaemia is Volkmann's Contracture.