Three days after surgical repair, the athlete reports forearm pain and decreased finger extension. Which diagnosis should be considered?

• A. Ape hand
• B. Dupuytren's contracture
• C. Pronator teres syndrome
• D. Volkman's ischemic contracture

Answer: (D)

The scenario targets ischemic injury to the forearm muscles leading to contracture (Volkman’s ischemic contracture). After surgery, severe forearm pain raises concern for compromised blood flow. If the ischemia continues, forearm muscles—especially the flexor group—can become necrotic and then fibrose, producing a fixed flexion of the digits. That fibrotic tightening of the flexors makes it hard or impossible to extend the fingers, which is why decreased finger extension is noted.

Other options don’t fit as well. Ape hand implies median nerve dysfunction with thenar wasting and an inability to oppose the thumb, not an acute ischemic process. Dupuytren’s contracture is a slow, palmar fascia thickening that gradually causes finger flexion, not an acute postoperative issue. Pronator teres syndrome involves median nerve entrapment with forearm pain and sensory symptoms, not a primary loss of active finger extension due to muscle necrosis.