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Surgery M4 part 1 > Hand infections > Flashcards

Hand infections Flashcards

1
Q

Which muscles put the fingers in the writing position?

A

LUMBRICALS

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2
Q

What is the relevance of the pulp space?

A
  • contains fat & is partitioned by septae
  • terminal space is a closed compartment -> if pressure increases when there is an infection -> compression on terminal artery will lead to thrombosis resulting in osteomyelitis of terminal phalanx & gangrene
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3
Q

What is the most dangerous zone in hand injuries?

A

Zone II (no man’s land)

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4
Q

What are the precipitating causes of hand infections? What is the most common organism responsible?

A
  • diabetes
  • immunosuppression
  • trauma
  • HIV infection
  • steroid therapy
  • vascular diseases
  • manual workers

STAPH AUREUS

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5
Q

What are the local clinical features of hand infections?

A
  • pain
  • hotness & redness
  • swelling: edema over dorsum (FROG HAND)
  • loss of function
  • tender palpable axillary lymph nodes
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6
Q

Why should x-ray be done in case of hand infections?

A

to check for osteomyelitis

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7
Q

What are the complications of hand infections?

A
  • stiffness of digits & hand (ankylosis)
  • deformity & disability
  • local spread -> osteomyelitis, suppurative arthritis of joints
  • distant spread -> bacteremia & septicemia
  • gangrene & sloughing
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8
Q

What treatment should be done for hand infections?

A

CONSERVATIVE

  • hot fomentation
  • antibiotic
  • position of rest (glass holding position)
  • position of function
  • elevation of hand to reduce edema

INCISION & DRAINAGE
if there’s pus

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9
Q

What is the most common hand infection & where does it occur?

A

ACUTE PARONYCHIA

  • under eponychium due to minor injury to finger
  • suppuration occurs very rapidly
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10
Q

What are the clinical features of of acute paronychia?

A
  • severe throbbing pain & tenderness

- visible pus under nail root (hang nail or floating nail)

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11
Q

How should acute paronychia be treated?

A

OBLIQUE INCISION over eponychium to drain pus

if floating nail -> nail extraction

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12
Q

What is the difference between acute & chronic paronychia?

A

ACUTE -> bacterial (staph a)

CHRONIC -> fungal

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13
Q

What infection occurs beneath free edge of nail & pus comes to the surface?

A

SUBUNGUAL INFECTION

- in space between subungual epithelium & periosteum

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14
Q

What are the features of a subungual infection & how should it be treated?

A
  • excruciating tenderness with small visible pus under the tip of the nail
  • V INCISION over the summit for drainage + antibiotics
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15
Q

What is the terminal pulp space infection?

A
  • 2nd most common
  • in index & thumb
  • due to minor finger prick
  • could lead to osteomyelitis of terminal phalanx & gangrene (X-ray)
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16
Q

how should terminal pulp space infection be treated?

A

OBLIQUE deep incision in terminal pulp

  • treat osteomyelitis
  • if there is gangrene in terminal phalanx -> amputate
17
Q

What is a characteristic sign of a web space infection?

A

V sign (separation of fingers)

18
Q

How should a web space infection be treated?

A
  • horizontal incision on volar skin of the web & deepened to reach the space by dividing palmar fascia
  • edges of the wound are cut to leave diamond shaped opening in the front
  • counter-incision over dorsal web
19
Q

which hand infection will lead to a loss of concavity of the palm?

A

MID PALMAR SPACE INFECTION

20
Q

How should a mid palmar space infection be treated?

A

HORIZONTAL INCISION placed on volar aspect without crossing skin creases
- should be extended deep to palmar aponeurosis

21
Q

How is a thenar space infection treated?

A

OBLIQUE incision over medial aspect of thenar eminency

- stop 2cm distal to distal crease to avoid injury of motor branch of median nerve

22
Q

What are the types of acute suppurative tenosynovitis?

A

suppurative ulnar bursitis
suppurative radial bursitis
suppurative bursitis of middle 3 fingers

23
Q

What are the clinical features of acute suppurative tenosynovitis?

A
  • symmetrical swelling of entire finger
  • flexion of finger (hook sign)
  • severe pain on extension
24
Q

What is Kanavel signs?

A
  • swollen finger held in flexion

- exquisite pain on passive extension

25
Q

What is the treatment of acute suppurative tenosynovitis?

A

suppurative ULNAR bursitis -> radial aspect of hypothenar eminence
suppurative RADIAL bursitis -> ulnar aspect of thenar eminence
suppurative bursitis of MIDDLE 3 finger -> longitudinal or transverse incision (don’t cross skin crease)

Surgery M4 part 1 (47 decks)

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