Snapshot A 50-year-old man presents to his physician’s office two months after he was treated for compartment syndrome in his forearm. He reports having difficulty using his hands. Physical exam shows that his right fingers and wrist are flexed into a claw-like contracture. He is referred for surgical correction. Introduction Clinical definition claw-like deformity of the hands with permanent shortening of the forearm muscles, resulting from ischemia and necrosis of the forearm muscles Epidemiology demographics adults risk factors compartment syndrome supracondylar humerus fracture crush injuries bleeding disorders Pathogenesis ischemia and necrosis of the forearm muscles from obstruction of the brachial artery (compartment syndrome or restrictive cast) fracture of the forearm bones causing bleeding from the major blood vessels this results in scarring, stiffening, and shortening of the forearm muscles, causing the contracture Presentation Symptoms inability to extend fingers or wrist or open hand Physical exam flexion contracture of several or all fingers wrist may also be involved may have ↓ sensation pain with passive extension of fingers or wrist unable to passively extend fingers or wrist fully Studies Making the diagnosis most cases are clinically diagnosed Differential Pseudo-Volkmann contracture distinguishing factors primarily in children forearm muscles are a normal length Treatment Conservative physical and occupational therapy indication for all patients Operative surgical treatment indication to restore function of the hand Complications Permanent contracture of hands