Courtesy:
Stewart Elkowitz MD
Assistant Clinical Professor,
NYU Langone Orthopaedics
Hand Infections
Common Causative Organisms
Most Common Pathogens
- Staphylococcus aureus infection
- Beta-hemolytic Streptococcus
Key Facts
- ~60% of hand infections — Staphylococcus aureus
- Increasing incidence of:
- MRSA
Other Organisms
- Gram-negative bacteria
- Mycobacteria
- Fungal organisms
Polymicrobial Infections
- Common in:
- Farm injuries
- Animal bites
- Immunocompromised patients
Organisms Based on Injury Type
- Human bites — Eikenella corrodens
- Animal bites — Pasteurella multocida
Cellulitis of the Hand
Definition
- Infection of:
- Skin and subcutaneous tissue
- No abscess formation
Management
- Oral antibiotics
- Splinting
- Elevation
Indications for IV Antibiotics
- No improvement
- Lymphangitis
Paronychia
Definition
- Infection of nail fold
Treatment
Early Stage
- Warm soaks
- Oral antibiotics
Abscess
- Drainage
- Possible nail removal
Chronic Paronychia
Cause
- Fungal (Candida, Trichophyton)
Treatment
- Antifungals
- Nail removal (severe cases)
- Marsupialization
Felon
Definition
- Abscess of fingertip pulp
Pathophysiology
- Compartmental pressure — ischemia
Complications
- Osteomyelitis
- Tendon sheath infection
Treatment
- Surgical drainage
Key Surgical Point
- Break fibrous septa
- Protect neurovascular structures
Herpetic Whitlow
Cause
- Herpes simplex virus infection
Features
- Painful vesicles
- Clear fluid
Management
- Antivirals (e.g., acyclovir)
- No incision and drainage
Flexor Tendon Sheath Infection
Definition
- Infection of flexor tendon sheath
Spread
- Radial bursa
- Ulnar bursa
- Thenar space
- Forearm (space of Parona)
Clinical Signs (Kanavel Signs)
- Flexed posture
- Tenderness along sheath
- Pain on passive extension
- Fusiform swelling
Treatment
Early
- IV antibiotics
- Splinting
Late (>24 hrs or worsening)
- Urgent surgical drainage
Bite Injuries
Human Bite
Features
- Often MCP joints
- May involve:
- Joint
- Extensor tendon
Treatment
- Surgical debridement
- Leave wound open
Animal Bite
Features
- Dog — crushing
- Cat — deep puncture (higher infection risk)
Common Organism
- Pasteurella multocida
Deep Space Infections
Spaces Involved
- Thenar
- Mid palmar
- Hypothenar
- Web spaces
- Dorsal subaponeurotic
Thenar Space Infection
Features
- Thumb abducted
- Thenar swelling
Treatment
- Surgical drainage (palmar + dorsal)
Mid Palmar Space Infection
Features
- Loss of palmar concavity
- Pain with finger movement
Treatment
- Surgical drainage
Web Space Abscess (Collar Button Abscess)
Mechanism
- Infection spreads between:
- Palmar and dorsal spaces
Treatment
- Dual incision drainage
Necrotizing Fasciitis
Overview
- Rapid, life-threatening infection
Cause
- Group A Streptococcus
Features
- Severe pain
- Systemic toxicity
- “Dishwater pus”
Treatment
- Emergency debridement
- Repeated surgeries
- Possible amputation
Septic Arthritis (Hand)
Causes
- Penetrating injury
- Hematogenous spread
- Local spread
Common Organisms
- Staphylococcus aureus
- Streptococcus
Special Cases
- Gonorrhea (sexually active)
- Haemophilus (unvaccinated)
Diagnosis
- Joint aspiration
Treatment
- Surgical drainage
Chronic Hand Infections
Types
- Tuberculosis
- Atypical mycobacteria
- Fungal infections
Example
- Mycobacterium marinum (marine exposure)
Other Conditions
- Cat scratch disease
- Tularemia
- Actinomycosis
- Anthrax
- Orf virus
Fungal Infections
Example
- Sporotrichosis
Features
- Nodules along lymphatics
Treatment
- Medical (surgery not curative)
Key Clinical Considerations
- Assess:
- Occupation
- Exposure history
- Immune status
- Mechanism of injury
- Duration of symptoms
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