Common Acute Hand Infections

Abstract

Up to 35% of admissions to a clinical hand service is for infections. The patient typically has localized pain, swelling, and erythema over the affected part of the hand. There may be overlying cellulitis or a history of recent trauma. Systemic symptoms are rare and usually seen only in patients with overwhelming infections. The peculiar anatomy of the hand, with its many closed spaces and vital structures in proximity to each other, is a suitable environment for the rapid multiplication and spread of bacteria. The multiplying bacteria release toxins and proteolytic enzymes that destroy cartilage in septic joints and, in pyogenic flexor tenosynovitis, can cause the necrosis of tendons. The damage done by delayed or inappropriate treatment of hand infections can lead to significant morbidity. Thus, for example, inadequately treated felon may lead to suppurative flexor tenosynovitis, septic arthritis, and osteomyelitis, and ultimately to amputation of the distal phalanx. Flexor tenosynovitis often results in loss of full range of motion of the affected digits. Osteomyelitis can lead to chronic pain, stiffness, deformity, and weakness despite eradication of the infection. For such reasons, the prompt diagnosis and treatment of hand infections are necessary to minimize morbidity and provide the best functional outcomes. This article provides an overview of the diagnosis and management of the most common acute infections of the hand.

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