The Hip: Preservation, Replacement and Revision

Work Up and Treatment: Hand Infections


- History and Physical:
    - time of injury and symptoms;
    - exact position of hand (finger flexion) during the injury
    - kanavel's signs:
          - used to distinguish deep infectious tenosynovitis from superficial cellulitis;
          - pain w/ finger extension may be the earliest sign present;
    - bite wounds
          - bacteriology of hand infections:
          - bites distal to the wrist are at higher risk for malignant infections due to the proximity of superficial spaces, flexor tendons, and joints;

- Diff Dx: (simulators of hand infections)
    - acute calcific tendinitis
         - look for calcific deposit at tendon insertion (FCU most common);
    - pyogenic granuloma
    - pyoderma gangrenosum
    - gout:
         - gout should be considered in older males who present w/ acute tenosynovitis in the hand, joint swelling, or soft tissue swelling;
    - brown recluse spider bite

- Radiographs:
    - w/ osteomyelitis, amputation is considered;
    - w/ gas in the soft tissues consider emergent Incision and Drainage;

- Non Operative Treatment:
    - IV antibiotics are used for superficial cellulitis;
    - if infectious tenosynovitis is diagnosed within 24 to 48 hrs of onset of symptoms, it may also be treated w/ antibiotics, along w/ splinting and hand elevation;
         - note, however, that operative treatment is usually required;

- Surgical Treatment:
    - see: closed suction drainage:
    - if there is no dramatic improvment after 24 hrs of antibiotics or if injury is more than 48 hours old, surgical drainage is indicated;
    - if tendon sheath infection is seen late or is not treated properly early, skin loss, tendon necrosis, & subsequent osteomyelitis can result;

- Deep Infections:
    - dorsal subaponeurotic infections:
         - deep penetrating injury
         - dorsal swelling, erythema, pain;
         - I & D with two longitudinal incisions between the extensor tendons;
         - wound is left open but the extensor tendons are covered;
    - web space infections: (see thenar space infections)
         - web space penetration, calloused palmar skin or blister;
         - begins palmarly then dorsally (collar button abscess)
         - separation of adjoining fingers;
         - I and D of dorsal and palmar incisions



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, August 14, 2012 3:38 pm