Hand Infections – TN2013

Principles

  • Trauma is the most common cause, 90% gram + organisms
  • Most common organisms – S aureus, S viridans, GAS, S. epidermidis, bacteroides melaninogenicus
  • 5 cardinal signs: rubor (red), calor (hot), tumour (swollen), dolor (painful), functio laesa (loss of function)

 

Types of infections

  1. Deep Palmar Space infections – uncommon, involve thenar / mid-palm
    • Tx in OR
  2. Felon: subcut abscess in the fingertip, often following severe paronychia or a puncture wound into digit pad
    • may assoicated with osteomyelitis
    • Tx elevation, warm soaks, coxacillin 500mg po q6h, I&D if abscess
  3. Flexor Tendon Sheath Infection accute suppurative tenosynovitis
    • Staph>strep>gram – rods
    • Often caused by penetrating injury & can lead to tendon necrosis + rupture if not Tx
    • Kanavel’s 4 cardinal signs:
      1. Point tenderness along flexor tendon sheath (earlier & most important)
      2. Severe pain on passive extension (2nd most important)
      3. Fusiform swelling of entire digit
      4. Flexed posture (increased comfort)
    • Tx: OR I&D, irrigation, IV abx, resting hand splint until infection resolves
  4. Herpetic Whitlow – painful vesicle(s) around fingertip
    • HSV1/2 – often found in dental/medical personnel & children
    • Can be associated with fever, malaise, LN – pt is infectious until lesion has completely healed
    • Tx: routine Cx & viral prep protection (cover), +/- acyclovir
  5. Paronychia – infection of soft tissue around fingernail (beneath eponychial fold)
    • acute (staph) – caused by a hangnail, artificial nails, and nial biting 
      • Tx: warm compress & keflex 500mg po q6h + I&D if abscess present
    • chronic (candida) – caused by prolonged exposure to moisture
      • Tx: anti-fungals with possible debridement & marsupialization, removal of nail plate
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Posted in 51 Infections, 99 Priority Topics, FM 99 priority topics, ID

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