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Overview of hand infections

Authors
Sandeep Sebastin, MMed, FAMS
Kevin C Chung, MD, MS
Shimpei Ono, MD, PhD
Section Editors
Charles E Butler, MD, FACS
Marc G Jeschke, MD, PhD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

The majority of patients with acute hand infections are healthy and active young adults who neglect treatment for minor trauma; more severe infections are seen in patients with impaired immune status.

The initial evaluation and management of 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. Empiric antibiotics should be started. Elevation of the hand and arm and application of a heat pack, along with appropriate pain control, will decrease swelling and provide comfort.

Deep hand infections are surgical emergencies. Prompt evaluation and proper treatment of hand infections can mean the difference between an excellent outcome and permanent disability.

The basic principles of evaluating and treating hand infections and considerations for specific hand infections are reviewed here. An overview of the evaluation of hand pain is discussed separately. (See "History and examination of the adult with hand pain".)

GENERAL PRINCIPLES

The general principles of evaluating and treating hand infections are outlined in the next few paragraphs. The specific management of bite wounds, superficial hand infections, and deep space infections are reviewed below. (See 'Bite wounds' below and 'Superficial hand infections' below and 'Deep infections' below.)

                              

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Literature review current through: Jun 2017. | This topic last updated: Jun 26, 2017.
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References
Top
  1. Tosti R, Ilyas AM. Empiric antibiotics for acute infections of the hand. J Hand Surg Am 2010; 35:125.
  2. O'Malley M, Fowler J, Ilyas AM. Community-acquired methicillin-resistant Staphylococcus aureus infections of the hand: prevalence and timeliness of treatment. J Hand Surg Am 2009; 34:504.
  3. McDonald LS, Bavaro MF, Hofmeister EP, Kroonen LT. Hand infections. J Hand Surg Am 2011; 36:1403.
  4. Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol 1995; 33:1019.
  5. Patzakis MJ, Wilkins J, Bassett RL. Surgical findings in clenched-fist injuries. Clin Orthop Relat Res 1987; :237.
  6. Canales FL, Newmeyer WL 3rd, Kilgore ES Jr. The treatment of felons and paronychias. Hand Clin 1989; 5:515.
  7. Jebson PJ. Infections of the fingertip. Paronychias and felons. Hand Clin 1998; 14:547.
  8. Hochman LG. Paronychia: more than just an abscess. Int J Dermatol 1995; 34:385.
  9. Linscheid RL, Dobyns JH. Common and uncommon infections of the hand. Orthop Clin North Am 1975; 6:1063.
  10. Stern PJ. Selected acute infections. Instr Course Lect 1990; 39:539.
  11. Watson PA, Jebson PJ. The natural history of the neglected felon. Iowa Orthop J 1996; 16:164.
  12. Haedicke GJ, Grossman JA, Fisher AE. Herpetic whitlow of the digits. J Hand Surg Br 1989; 14:443.
  13. Louis DS, Silva J Jr. Herpetic whitlow: herpetic infections of the digits. J Hand Surg Am 1979; 4:90.
  14. Boles SD, Schmidt CC. Pyogenic flexor tenosynovitis. Hand Clin 1998; 14:567.
  15. Neviaser RJ. Tenosynovitis. Hand Clin 1989; 5:525.
  16. Kanavel A. Infections of the hand. In: A guide to the surgical treatment of acute and chronic suppurative processes in the fingers, hand, and forearm, 7th ed, Lea & Febiger, Philadelphia, PA 1939.
  17. Burkhalter WE. Deep space infections. Hand Clin 1989; 5:553.
  18. Jebson PJ. Deep subfascial space infections. Hand Clin 1998; 14:557.
  19. Freeland AE, Senter BS. Septic arthritis and osteomyelitis. Hand Clin 1989; 5:533.
  20. Murray PM. Septic arthritis of the hand and wrist. Hand Clin 1998; 14:579.
  21. Gonzalez MH. Necrotizing fasciitis and gangrene of the upper extremity. Hand Clin 1998; 14:635.
  22. Dellinger EP. Severe necrotizing soft-tissue infections. Multiple disease entities requiring a common approach. JAMA 1981; 246:1717.
  23. Stone DR, Gorbach SL. Necrotizing fasciitis. The changing spectrum. Dermatol Clin 1997; 15:213.
  24. Giuliano A, Lewis F Jr, Hadley K, Blaisdell FW. Bacteriology of necrotizing fasciitis. Am J Surg 1977; 134:52.
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