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)

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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