Hand Infection

Excerpt

A broad spectrum of hand infections is commonly encountered by hand surgeons, primary care physicians, and emergency medicine practitioners. Acute hand infections vary significantly with regard to their location and etiology, but when misdiagnosed or untreated, they may result in significant morbidity or mortality to patients. Hand infections may broadly be characterized as being superficial or deep, dependent upon whether they involve the skin and subcutaneous soft tissues, or whether they involve the deeper structures, respectively. Differentiation between superficial and deep infections of the hand has general implications on the requisite treatment modality and setting. Given the anatomical complexity of the hand and its delicate function, however, further characterization of the specific structures involved is necessary to establish the diagnosis and treatment fully.

Superficial infections are more common and may include the skin, nail fold, fingertip pulp, or subcutaneous tissues. Superficial infections are more likely to resolve with conservative management alone than deeper infections. Deep infections may involve the tendons, and their sheaths, bone, joint, or deep spaces of the hand and frequently require aspects of surgical management in addition to antimicrobial therapy to achieve resolution. Regardless of the respective diagnosis, prompt evaluation and treatment are paramount to resolve the infection and optimize outcomes for patients. This article reviews the broad spectrum of infectious conditions affecting the hand and details their basic evaluation and general principles of treatment with the goal of improving recognition of pathology and understanding the acuity of treatment necessary.