Hand and finger infections: Difference between revisions

Latest revision as of 19:20, 25 October 2023

Background

Wrist and hand deeper palmar dissection

Distal interphalangeal dislocation (DIP), proximal interphalangeal dislocation (PIP), and metacarpophalangeal dislocation (MCP) joints of the finger shown.

Volar/anterior finger anatomy.

Lateral finger anatomy.

Patients with systemic symptoms due to a hand infection are seriously ill and require inpatient management

Hand Anatomy

Volar = anterior = palmar
Dorsal = posterior

Nailtip Anatomy

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.

The perionychium includes the nail bed and the paronychium.
The paronychium is the lateral nail fold (soft tissue lateral to the nail bed).
The hyponychium is the palmar surface skin distal to the nail.
The lunula is that white semi-moon shaped proximal portion of the nail.
The sterile matrix is deep to the nail, adheres to it and is distal to the lunule.
The germinal portion is proximal to the matrix and is responsible for nail growth.

Clinical Features

Hand and Finger Infections Images

Differential Diagnosis

Hand and finger infections

Look-Alikes

Digital mixoid cyst

Evaluation

See hand exam

Management

Depends on specific diagnosis

Disposition

Depends on specific diagnosis

External Links

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Pts w/ systemic symptoms due to a hand infection are seriously ill; require inpatient management
+[[File:Wrist and hand deeper palmar dissection.svg|thumb|Wrist and hand deeper palmar dissection]]
+[[File:DIP, PIP and MCP joints of hand.jpg|thumb|Distal interphalangeal dislocation (DIP), proximal interphalangeal dislocation (PIP), and metacarpophalangeal dislocation (MCP) joints of the finger shown.]]
+[[File:Gray337.png|thumb|Volar/anterior finger anatomy.]]
+[[File:Gray338.png|thumb|Lateral finger anatomy.]]
+*Patients with systemic symptoms due to a hand infection are seriously ill and require inpatient management
-==Hand Cellulitis==
+{{Hand anatomy}}
-===Background===
+{{Fingertip anatomy}}
-*Remove rings if infections are near the digits
-===Clinical Features===
+==Clinical Features==
-*Erythema, warmth, and edema
-*Range of motion of digits, hand, and wrist should not be painful
-**Pain predicts extensive involvement and the need for inpatient management
-===Treatment===
+{{Hand and finger infections images}}
-*Mild/moderate cellulitis
-**TMP/SMX DS 1-2 tab PO x 7-10d + (cephalexin 500mg PO QID x7-10d OR dicloxacillin 500mg PO QID x 7–10d
-*Severe cellulitis
-**Vancomycin 1gm IV q12hr
-===Disposition===
+==Differential Diagnosis==
-*Consider admission for:
+{{Hand Infection DDX}}
-**Immunocompromised
-**Clinical toxicity
-**Evidence of deep-space involvement
-**Rapidly spreading infections
-==Flexor Tenosynovitis==
+==Evaluation==
-===Background===
+*See [[hand exam]]
-*Surgical emergency; flexor sheaths are contiguous w/ deep spaces of the hand
-*Usually associated with penetrating trauma
-===Clinical Features===
+==Management==
-#Percussion tenderness
+*Depends on specific diagnosis
-##Tenderness over entire length of flexor tendon sheath
-#Uniform swelling
-##Symmetric finger swelling along length of the tendon sheath
-#Pain w/ passive extension
-#Flexion posture
-##Flexed posture of involved digit at rest to minimize pain
-===Management===
+==Disposition==
-#Antibiotics
+*Depends on specific diagnosis
-##Start immediately
-##Vanco 1gm IV q12hr + (ampicillin-sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR piperacillin/tazobactam 3.375gm IV q6h)
-#Consult hand surgery in the ED
-==Deep Space Infection==
+==See Also==
+*[[Hand and Finger Diagnoses]]
-===Background===
+==External Links==
-*Volar surface contains potential deep spaces that may become infected
-*Dorsal aspect contains the veins and lymphatics; will always swell whenever there is an inflammatory process
-===Clinical Features===
+==References==
-*Tenderness, induration, or fluctuance over volar aspect of hand
+<references/>
-*Pain w/ range of motion of digits
+[[Category:ID]]
+[[Category:Orthopedics]]
-===Management===
-*Parenteral antibiotics
-*Hand surgeon consult
-==Closed Fist Infection "Fight Bite"==
-===Background===
-*Result of striking another individual's teeth with clenched fist
-*Most commonly affects dorsal aspects of third, fourth, and fifth MCP joints
-*Although may appear benign, significant morbidity can result from late presentation or inadequate initial management
-===Clinical Features===
-The physical examination should document the extent of the infection. Hand x-rays are indicated because closed fist injuries are often associated with fractures, or may contain tooth fragments. Infections are typically polymicrobial. The most common organisms reflect the natural flora of the mouth and include Streptococcus species (82%), S. aureus (57%), E. corrodens (32%), Fusobacterium (27%), Peptostreptococcus (14%), and Candida (3.6%) species. If infection is detected or examination suggests injury to the joint, joint capsule, tendons, or deep spaces, a hand surgeon should be consulted for open debridement and irrigation in the operating room. Administer parenteral antibiotics. Elevate the hand and immobilize it in the position of function. Prophylactic antibiotics should be initiated for all but the most superficial wounds caused by a clenched fist
-==Source==
-*Tintinalli
-[[Category:Ortho]]