Hand

Question 1

Paronychia

• patho
• pathogens
• treatment

Answer 1

Patho

• infection of cuticle
• poor nail hygeine: biting nails, pulling hang nails

Pathogens

• Staph aureus and Strep Epidermidis.
• Also consider MRSA
• Bacterial superinfections with fungal onychomycosis is possible, esp. with pseudomonas
• With recurrent infection think of fungal origin like candida

Treatment

• usually includes oral antibiotics +/- I&D
• marsupialization

Question 2

Felon

• Patho
• Sxs
• Tx

Answer 2

Less common than paronychia

Patho

• infection locked in b/w fibrous septae of distal phalanx
• abscess confined to one or two septal compartments

Symptoms

• may “point” prior to spontaneously draining
• exquisitely painful

Treatment

• I&D, marsupilization performed by hand surgeon because have to cut b/w bone and digital nerves

Question 3

Bites

(Human vs. Animal Bites)

Answer 3

Human Bites

• AKA fight-bites
• commonly involve joint and or articular surface
• usually polymicrobial and require urgent I&D
• beware of occult extensor tendon injury
• examine hand in position it was injured

Animal bites

• Pasteurella multocida
• rapid onset of lymphangitis is common
• beware of retained FB (tooth fragments)

Question 4

Ganglion Cysts

Answer 4

Grows out of joint, similar to a balloon on a stalk; Filled with synovial fluid

Largely cosmetic in nature

Commonly found over dorsal scapholunate joint, volar scapholunate joint, DIP joints

When over DIP joints AKA “mucus cysts” and can caues nail deformity and can spontaneously drain, leading to increased risk fo infection

Tx: Surgical excision may be warranted if painful, spontaneously draining, impairing ROM. Recurrence frequent.

Question 5

Dupuytren’s Contracture

(Doop-uh-trins)

Answer 5

Autosomal dominant condition

Localized formation of fibrosis of palmar fascia on palm