Hand Infections Flashcards
What are acute paronychia?
They are the most common infection of the hand; infection of the folds surrounding the fingernail; S. aureus; treat with antibiotics 10-14 and drainage under digital block anesthesia if more advanced
What is the cause of and treatment for chronic paronychia?
from candida; excision of thickened eponychium to level of germinal matrix
What is a Felon?
infection involving volar fingertip; usually from penetrating trauma to fingertip; x-ray to r/o osteomyelitis; treat with splint/elevation/antibiotics, drainage if fluctuance present of symptoms worsen
What is a Herpetic Whitlow?
painful vesicular infection from Herpes simplex virus; dental/healthcare workers; may diagnose with viral cultures/Tzanch test; treat with acyclovir
What are the causes and presentation of Suppurative Flexor Tenosynovitis?
usually after penetrating injury to the finger with subsequent infection traveling to flexor tendon sheath; 1.Symmetric enlargement of the affected finger 2. Semiflexed position of the finger 3. Pain along the flexor tendon sheath 4. Severe pain on passive extension of the finger along the tendon
What is the treatment for Suppurative Flexor Tenosynovitis?
IV antibiotics again S. aureus/GAS for early infection; surgical drainage and debridement of necrosed tissue of delayed presentation or failure to improve
What causes Deep infections of the hand and what spaces define them?
Penetrating injury; Staph/GAS; within thenar/hypothenar/midpalmar/interdigital space, dorsal subaponeurotic space, Parona’s space
Describe Web-space infection location and their treatment?
From secondarily infected palmar callus; treat with surgical drainage- access palmar space with zigzag incision starting at edge of the web space to just distal to distal palmar crease
Who gets Dorsal subcutaneous and subaponeurotic space infections and how are they treated?
Usually IV drug users; treat with antibiotics/splint/elevation unless fluctuance- then surgical drainage, leaving wound open or closed over drain
Describe Thenar space infection and their treatment
Characterized by edema, pain with movement of the thumb and tenderness on palpation; treat is surgical drainage
Describe midpalmar space infections and their treatment
Infection deep to palmar fascia, from penetrating trauma or pyogenic flexor tenosynovitis , or distal abscess. Causes volar/dorsal edema and pain/tenderness. Treat with Incision and blunt dissection to protect neurovascular structures
Describe hypothenar space Infections and their treatment
Infection between hypothenar fascia and musculature causing edema and tenderness in hypothenar eminence and pain with small finger flexion, treated by incision lateral to midpalmar crease and blunt dissection to protect ulnar nerve and artery
Describe perona’s space infections and their treatment
Infection deep to forearm flexor tendons (communicates with radial and ulnar bursas), causing volar, distal forearm edema and tenderness, with pain on passive wrist/finger flexion. Treat with incision between flexor tendons, ending at wrist crease.
Describe septic arthritis and its treatment
From trauma, bites, joint infection, or adjacent spread. Joint aspiration can diagnose. Early treatment with arthrotomy and irrigation prevents destruction of articular cartilage. Arthroscopic options for wrist.
Describe osteomyelitis and its treatment
From penetrating injury or (rare) hematogenous spread. Usually S. aureus, treated with debridement and antibiotics, sometimes amputation (fingers, for example)
