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| ==Background== | | ==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 |
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| ==Hand Cellulitis==
| | {{Hand anatomy}} |
| ===Background===
| | {{Fingertip anatomy}} |
| *Remove rings if infections are near the digits
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| ===Clinical Features===
| | ==Clinical Features== |
| *Erythema, warmth, and edema
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| *Range of motion of digits, hand, and wrist should not be painful
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| **Pain predicts extensive involvement and the need for inpatient management
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| ===Treatment===
| | {{Hand and finger infections images}} |
| *Mild/moderate cellulitis
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| **TMP/SMX DS 1-2 tab PO x 7-10d + (cephalexin 500mg PO QID x7-10d OR dicloxacillin 500mg PO QID x 7–10d)
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| *Severe cellulitis
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| **Vancomycin 1gm IV q12hr
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| ===Disposition=== | | ==Differential Diagnosis== |
| *Consider admission for:
| | {{Hand Infection DDX}} |
| **Immunocompromised
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| **Clinical toxicity
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| **Evidence of deep-space involvement
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| **Rapidly spreading infections
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| ==Flexor Tenosynovitis== | | ==Evaluation== |
| ===Background===
| | *See [[hand exam]] |
| *Surgical emergency; flexor sheaths are contiguous w/ deep spaces of the hand | |
| *Usually associated with penetrating trauma
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| ===Clinical Features=== | | ==Management== |
| #Percussion tenderness
| | *Depends on specific diagnosis |
| ##Tenderness over entire length of flexor tendon sheath
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| #Uniform swelling
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| ##Symmetric finger swelling along length of the tendon sheath
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| #Pain w/ passive extension
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| #Flexion posture
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| ##Flexed posture of involved digit at rest to minimize pain
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| ===Management=== | | ==Disposition== |
| #Antibiotics
| | *Depends on specific diagnosis |
| ##Start immediately
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| ##Vanco 1gm IV q12hr + (ampicillin-sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR piperacillin/tazobactam 3.375gm IV q6h)
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| #Consult hand surgery in the ED
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| ==Deep Space Infection== | | ==See Also== |
| | *[[Hand and Finger Diagnoses]] |
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| ===Background=== | | ==External Links== |
| *Volar surface contains potential deep spaces that may become infected
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| *Dorsal aspect contains the veins and lymphatics; will always swell whenever there is an inflammatory process
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| ===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===
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| *Parenteral antibiotics
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| *Hand surgeon consult
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| ==Closed Fist Infection "Fight Bite"==
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| ===Background===
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| *Result of striking another individual's teeth with clenched fist
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| *Although may appear benign, significant morbidity can result from late presentation or inadequate initial management
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| ===Clinical Features===
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| **Pain/swelling over dorsal aspect of MCP joint (most commonly third, fourth, and/or fifth MCP joints)
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| ==Diagnosis==
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| *Imaging indicated to rule-out fracture, tooth fragments
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| ==Treatment==
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| *Prophylactic abx should be initiated for all but the most superficial wounds
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| **If no visible signs of infection:
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| ***Amoxicillin-clavulanate 875/125mg PO BID x5d
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| **For signs of infection:
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| ***Ampicillin-sulbactam 1.5gm IV q6h OR cefoxitin 2gm IV q8h OR piperacillin/tazobactam 3.375gm q6h
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| ***Penicillin allergy: clindamycin plus ciprofloxacin
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| ==Paronychia==
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| ===Background===
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| *Infection of lateral nail fold or perionychium
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| *Usually caused by minor trauma (e.g. nail-biting, manicures, hangnails)
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| ===Management===
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| *If no fluctuance is identified:
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| **Warm soaks, elevation
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| **TMP/SMX DS 1-2 tab PO x 7-10d + (cephalexin 500mg PO QID x7-10d OR dicloxacillin 500mg PO QID x 7–10d)
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| *If unclear if wound is fluctuant:
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| **Have pt apply pressure to distal aspect of affected digit
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| **A larger than expected area of blanching, reflecting a collection of pus, may identify the need for drainage
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| *If fluctuance or pus is identified:
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| .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.
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| ==Source==
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| *Tintinalli
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| [[Category:Ortho]] | |
