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}}
+{{Fingertip anatomy}}
-==[[Flexor Tenosynovitis]]==
+==Clinical Features==
-==[[Hand Deep Space Infection]]==
+{{Hand and finger infections images}}
-==[[Closed Fist Infection (Fight Bite)]]==
+==Differential Diagnosis==
+{{Hand Infection DDX}}
-==Diagnosis==
+==Evaluation==
-*Imaging indicated to rule-out fracture, tooth fragments
+*See [[hand exam]]
-==Treatment==
+==Management==
-*Prophylactic abx should be initiated for all but the most superficial wounds
+*Depends on specific diagnosis
-**If no visible signs of infection:
-***Amoxicillin-clavulanate 875/125mg PO BID x5d
-**For signs of infection:
-***Ampicillin-sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR piperacillin/tazobactam 3.375gm q6h
-***Penicillin allergy: clindamycin plus ciprofloxacin
-==Paronychia==
+==Disposition==
-===Background===
+*Depends on specific diagnosis
-*Infection of lateral nail fold or perionychium
-*Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails)
-===Management===
+==See Also==
-*If no fluctuance is identified:
+*[[Hand and Finger Diagnoses]]
-**Warm soaks, elevation
-**TMP/SMX DS 1-2 tab PO x 7-10d + (cephalexin 500mg PO QID x7-10d OR dicloxacillin 500mg PO QID x 7–10d)
-*If unclear if wound is fluctuant:
-**Have pt apply pressure to distal aspect of affected digit
-**A larger than expected area of blanching, reflecting a collection of pus, may identify the need for drainage
-*If fluctuance or pus is identified:
-.18 After suppuration has occurred, the infection will exhibit either fluctuance or identifiable pus that will necessitate drainage. Minor infections can be treated with elevation of the perionychium or eponychium with a flat probe #11 blade (Figure 280-5) or needle slid along the surface of the nail.19 If only elevating the eponychium from the nail, this procedure can be performed without placing a digital block or providing analgesia.20 In general, only nonviable tissue can be incised without provoking pain.
+==External Links==
+==References==
+<references/>
-==Source==
+[[Category:ID]]
-*Tintinalli
+[[Category:Orthopedics]]
-[[Category:Ortho]]