Two days after application of a tight plaster cast for a forearm fracture, a patient reports severe pain out of proportion, worsened by passive stretching of the fingers. The hand appears pale and the pulses are still palpable. The earliest and most reliable clinical sign demanding urgent fasciotomy is:

• A Absent radial pulse
• B Loss of two-point discrimination in all digits
• C Fixed claw deformity of the hand
• D Pain on passive extension of the fingers ✓

Explanation

In Volkmann ischaemia of the forearm flexor compartments, pain on passive stretch of the affected muscles is the earliest and most dependable warning sign, often accompanied by pain disproportionate to the injury. Peripheral pulses frequently remain palpable because intracompartmental pressure rises above capillary closing pressure but below systolic pressure, so a present pulse never excludes the diagnosis. Claw deformity represents established late contracture, long after the window for salvage.

Reference: Apley's System of Orthopaedics and Fractures, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.