Hand and finger infections

Background

• Pts w/ systemic symptoms due to a hand infection are seriously ill; require inpatient management

Hand Cellulitis

Background

• Remove rings if infections are near the digits

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

• 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

• Consider admission for:
  • Immunocompromised
  • Clinical toxicity
  • Evidence of deep-space involvement
  • Rapidly spreading infections

Flexor Tenosynovitis

Background

• Surgical emergency
• Usually associated with penetrating trauma

Clinical Features

1. Percussion tenderness
   1. Tenderness over entire length of flexor tendon sheath
2. Uniform swelling
   1. Symmetric finger swelling along length of the tendon sheath
3. Pain w/ passive extension
4. Flexion posture
   1. Flexed posture of involved digit at rest to minimize pain

Management

1. Antibiotics
   1. Start immediately
   2. Vanco 1gm IV q12hr + (ampicillin-sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR piperacillin/tazobactam 3.375gm IV q6h)
2. Consult hand surgery in the ED

Source

• Tintinalli