Hand infections

March 2018 | by EMauthor

Acute paronychia

•A collection of pus over the nail fold, usually to the side

•Treat with incision and drainage under LA

Terminal pulp space infection

•Throbbing pain over the terminal phalanx pad

•Swelling and tenderness

•There is a risk of avascular necrosis of the terminal phalanx due to increased pressure in pulp (end arteries)

•Treatment is incision and drainage after LA. Seek senior advice if you lack the experience

•Dress the wound with jelonet and place the arm in a sling

•Review after 48 hours. No antibiotics are required

Tendon sheath infection

•There is usually a fusiform swelling of the finger, redness and flexion deformity

•There is tenderness along the line of the tendon

•There may excessive pain on stretching the tendon

•The patient will need analgesia, x-ray to exclude bone infection

•Refer all these cases to orthopaedics

Web space infection

•There is swelling and redness over the web space, and over the dorsum of the hand

•Typically the fingers will diverge from each other

•They need drainage under GA, so refer to orthopaedics

Palmar space infection

•The hand will be swollen, with difficulty in moving the finger

•They may be systemically unwell with pyrexia

•Request a FBC and X-ray

•Refer all these cases to orthopaedics

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