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Hand Infections

What is a hand infection?

Hands and the structures within are especially prone to infections, whether bacterial, viral, or fungal. The anatomy of the hand is complex and a seemingly minor injury can cause a disproportionate amount of harm. The extremities in general have a less robust blood supply than the structures of the trunk and as a result, wounds of the extremities heal slower. Those with chronic illness, such as diabetes, or those who are immunocompromised, or abuse IV drugs are even more prone to aggressive infections in the hands.

One common type of infection of the hand is a felon. A felon is an abscess of the pulp of the fingertip. The cushiony pulp of the fingertip contains multiple small spaces called septae. Infection in these spaces can cause a buildup of fluid and pressure which can potentially decrease blood supply to the fingertip with disastrous results. Rarely, a felon can lead to infection of the underlying bone.

A Herpetic Whitlow is a painful cluster of blisters on the finger related to exposure to the herpes viruses.

Pyogenic flexor tenosynovitis is an infection of the tendon sheath that surrounds the flexor tendons of the hand.

Cellulitis is an infection of the soft tissue of the skin of the hand. The hand also contains areas of open space within it where there is no muscle, tendon, or bone. These spaces can become infected and filled with pus, and are known as deep space infections.

Septic arthritis infects the joints of the hand while osteomyelitis is an infection of the bones of the hand.


What causes a hand infection?

A Felon usually results from penetrating trauma to the fingertip or from an infection of the fingernail left untreated. Herpetic Whitlow is caused by exposure to one of the numerous herpes viruses. Potential methods of transmission include exposure of a health care worker to an infected patient, exposure to a sexual partner with genital herpes, or caregiver exposure to a child with gingivastomatitis, a common viral infection of early childhood whose symptoms include blisters in the mouth.

Pyogenic flexor tenosynovitis, deep space infections, septic arthritis of the hand joints, and osteomyelitis of the hand bones share common causes. They can result from hand trauma that disrupts the integrity of the skin and introduces bacteria into the hand. A superficial wound such as an ulcer or laceration can progress to cellulitis and then spread to tendons, deep spaces, joints and bones in the hand. Bacterial, viral, and fungal infections which have spread into the circulatory system from remote areas can seed the tendons, deep spaces, joints and bones of the hand with organisms that cause infection.


What are the symptoms of a hand infection?

A Felon presents with throbbing pain in the hand, redness and swelling of the fingertip, and a feeling of increased pressure in the finger pad. Herpetic whitlow begins with a prodrome of pain, itching, redness and swelling of one finger, followed by the appearance of vesicles filled with clear fluid. Pyogenic flexor tenosynovitis symptoms include fever, swelling of the hand, and pain with passive extension of the finger. Deep space infection symptoms include fever, pain, swelling, edema and sometimes fluctuance of the affected area. Septic arthritis of the hand presents with low grade fevers, pain, and decreased range of motion of the affected joint. Osteomyelitis of the hand is a serious condition and presents dramatically with high fevers, chills, severe pain. Redness, swelling, and tenderness over the tissues surrounding the affected area of the bone also occurs.


How is a hand infection diagnosed?

The diagnosis of a hand infection is often a clinical one. The symptoms described above paired with a means to introduce infection into the hand will shed light on the cause of the hand infection. Blood tests such as a CBC may show an increase in white blood cells. Another blood test, the sed rate, may be elevated. Cultures are important to determine which organism is causing the infection and to guide appropriate antimicrobial therapy. If purulent drainage is encountered, as in a felon, cellulitis, or sometimes in a deep space infection, it should be cultured. Joint aspirate can be cultured in septic arthritis, the fluid contained in a herpetic vesicle can be cultured for virus. Aspiration and culture of the synovial fluid in pyogenic flexor tenosynovitis will also be helpful.

Imaging studies are helpful in diagnosis as well. While plain film X rays can be used as a screening tool to indicate whether bony abnormalities are present, they can also point out associated conditions which complicate hand infections such as fractures and foreign bodies. MRI is a better tool for evaluation of soft tissue abscesses and deep space infection. Bone scans and CT scans are useful for osteomyelitis.


How is a hand infection treated?

Non surgical

Treatment of a hand infection requires identification of the offending organism. Cultures are taken, but require several days for definitive results. In the interim antimicrobial therapy is started based on the most likely causative organism. This may involve antibiotics, antiviral medications, or antifungal medications. The medication may be administered orally or through an IV. Once the culture results are obtained, the medication can be tailored to the specific pathogen. A Tetanus booster is also given if one has not been given in the past year. With herpetic whitlow, oral antiviral medication is prescribed to decrease the risk of recurrence and the wound is covered to prevent further transmission of the disease.

Surgical

Abscesses require incision and drainage by a hand surgeon. Deep wounds require surgical exploration. Debridement of damaged tissue and irrigation to remove purulent material is also performed. Sometimes the wound is left open for continuous irrigation before being loosely closed at a later date.

Arthrotomy, irrigation, and debridement are used to treat septic arthritis.

In Osteomyelitis surgical debridement of the affected bone is performed. Once the infection has been cured, another surgery to reconstruct the damaged bone may be needed.

Following surgical treatment of a hand infection, the hand is placed in a splint and elevated. Physical therapy is prescribed once the infection has healed and helps the hand regain its original range of motion.


How can Dr. Knight help you with Hand infections?

Infections are among the more serious problems that can affect your hand, and it is important to have them seen and treated as soon as possible. Generally, infections will most likely be treated in an Emergency Room rather than by a specialist, but it is still important to Dr. Knight that everyone be educated about any problems they may have with their hand, should they need to seek medical attention.


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HandAndWristInstitute.com does not offer medical advice. The information presented here is offered for informational purposes only. Read Disclaimer