Overview of hand infections
- Sandeep Sebastin, MMed, FAMS
Sandeep Sebastin, MMed, FAMS
- Consultant, Department of Hand & Reconstructive Microsurgery
- National University Hospital, Singapore
- Kevin C Chung, MD, MS
Kevin C Chung, MD, MS
- Chief of Hand Surgery
- Charles B.G de Nancrede Professor of Surgery
- University of Michigan Health System
- Shimpei Ono, MD, PhD
Shimpei Ono, MD, PhD
- Assistant Professor
- Department of Plastic, Reconstructive, and Aesthetic Surgery
- Nippon Medical School
Infections of the upper limb are common and account for up to 35 percent of patients admitted to a hand surgery service. The majority of patients with acute hand infections are healthy and active young adults who have neglected or delayed appropriate treatment for minor trauma  More severe infections with significant morbidity are seen in patients with impaired immune status.
Early and superficial infections of the hand may respond to nonsurgical management; however, most hand infections are surgical emergencies. Prompt evaluation and proper treatment of hand infections can mean the difference between an excellent outcome and permanent disability.
INITIAL EVALUATION AND MANAGEMENT
The initial evaluation and management of a hand infection includes a focused history and examination, and often involves laboratory evaluation and imaging. The area of erythema should be marked to help document progression of the infection. Elevation of the hand and arm and application of a heat pack, along with appropriate pain control, will decrease swelling and provide comfort. Empiric antibiotics should be started. These measures are discussed below.
History — A focused medical history should determine the possible source of infection, progress of the infection, the immune status of the patient, and any relevant past medical history:
●Symptoms ─ The onset of pain, loss of function, fever and/or chills, and any spontaneous drainage should be documented. Severe throbbing pain is suggestive of an abscess in a confined space. A rapid deterioration in general condition is suggestive of severe infections like necrotizing fasciitis and gas gangrene. (See 'Necrotizing fasciitis' below and "Necrotizing soft tissue infections".)
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- INITIAL EVALUATION AND MANAGEMENT
- Clinical examination
- Laboratory evaluation
- - Plain films
- - Ultrasound
- Outline the area of erythema
- Antibiotic therapy
- BITE WOUNDS
- Animal bites
- Human bites
- SUPERFICIAL HAND INFECTIONS
- Pulp space infections
- Herpetic whitlow
- Subcutaneous abscess
- Web space abscess
- DEEP INFECTIONS
- Synovial space infections
- Deep fascial space infections
- Septic arthritis
- Necrotizing fasciitis
- MYCOBACTERIAL INFECTIONS
- MIMICKERS OF ACUTE HAND INFECTIONS
- Acute calcific tendinitis
- Retained foreign bodies
- Chemotherapeutic infiltration
- Pyoderma gangrenosum
- Metastatic tumor
- SUMMARY AND RECOMMENDATIONS