Hand infections Flashcards
Which muscles put the fingers in the writing position?
LUMBRICALS
What is the relevance of the pulp space?
- 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
What is the most dangerous zone in hand injuries?
Zone II (no man’s land)
What are the precipitating causes of hand infections? What is the most common organism responsible?
- diabetes
- immunosuppression
- trauma
- HIV infection
- steroid therapy
- vascular diseases
- manual workers
STAPH AUREUS
What are the local clinical features of hand infections?
- pain
- hotness & redness
- swelling: edema over dorsum (FROG HAND)
- loss of function
- tender palpable axillary lymph nodes
Why should x-ray be done in case of hand infections?
to check for osteomyelitis
What are the complications of hand infections?
- stiffness of digits & hand (ankylosis)
- deformity & disability
- local spread -> osteomyelitis, suppurative arthritis of joints
- distant spread -> bacteremia & septicemia
- gangrene & sloughing
What treatment should be done for hand infections?
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
What is the most common hand infection & where does it occur?
ACUTE PARONYCHIA
- under eponychium due to minor injury to finger
- suppuration occurs very rapidly
What are the clinical features of of acute paronychia?
- severe throbbing pain & tenderness
- visible pus under nail root (hang nail or floating nail)
How should acute paronychia be treated?
OBLIQUE INCISION over eponychium to drain pus
if floating nail -> nail extraction
What is the difference between acute & chronic paronychia?
ACUTE -> bacterial (staph a)
CHRONIC -> fungal
What infection occurs beneath free edge of nail & pus comes to the surface?
SUBUNGUAL INFECTION
- in space between subungual epithelium & periosteum
What are the features of a subungual infection & how should it be treated?
- excruciating tenderness with small visible pus under the tip of the nail
- V INCISION over the summit for drainage + antibiotics
What is the terminal pulp space infection?
- 2nd most common
- in index & thumb
- due to minor finger prick
- could lead to osteomyelitis of terminal phalanx & gangrene (X-ray)
how should terminal pulp space infection be treated?
OBLIQUE deep incision in terminal pulp
- treat osteomyelitis
- if there is gangrene in terminal phalanx -> amputate
What is a characteristic sign of a web space infection?
V sign (separation of fingers)
How should a web space infection be treated?
- 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
which hand infection will lead to a loss of concavity of the palm?
MID PALMAR SPACE INFECTION
How should a mid palmar space infection be treated?
HORIZONTAL INCISION placed on volar aspect without crossing skin creases
- should be extended deep to palmar aponeurosis
How is a thenar space infection treated?
OBLIQUE incision over medial aspect of thenar eminency
- stop 2cm distal to distal crease to avoid injury of motor branch of median nerve
What are the types of acute suppurative tenosynovitis?
suppurative ulnar bursitis
suppurative radial bursitis
suppurative bursitis of middle 3 fingers
What are the clinical features of acute suppurative tenosynovitis?
- symmetrical swelling of entire finger
- flexion of finger (hook sign)
- severe pain on extension
What is Kanavel signs?
- swollen finger held in flexion
- exquisite pain on passive extension
What is the treatment of acute suppurative tenosynovitis?
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)
