Hand Infections Flashcards
What is paronychia?
-Infection of nail fold
- The protective cuticle layer gets damaged between the nail fold and nail plate
- Meaning foreign objects/bacteria can enter causing an abscess
-Can happen during manicure.
Mx of paronychia abscess?
- Drain the abscess
- No use of Abx
What is subanchal abscess?
-abscess under the nail.
Pulp space abscess:
- infection at the finger tip, at the cutaneous site of the finger tip
- exquisite pain at night
Mx of Pulp space abscess (Felon)
- Regional anaesthetic block (ring block)
- torniquet at the bottom of the finger
- incision over the maximal tenderness
- drain pus
- take pus swab
- wash open
- leave the cleaned abscess open, dont close
What is the complication of pulp space abscess?
- Infection spreading to the bone = osteomyelitis /osteoitis
- may need to be amputated
What is webspace abscess?
-cardinal sign= splaying of fingers (fingers are pushed apart by the abscess)
o/e= exquisite tenderness at the webspace,
swelling at the dorsum of the hand
Mx of web-space abscess?
- anaesthisia (regional/general)
- Above ElbowTorniquet, elevate hand for 2/3 minutes, inflate torniquet
- For incision, dont make straight line at the flexor lines (you get scar contraction), go zig-zag or make straight line at the abscess on the webspace
What is flexor sheath infection?
- tendons line under the flexor sheath, that is bathed with synovial fluid
- due to penetrating injury
- presents with acute inflammation along the whole flexor sheath
What are the signs of flexor sheath infection?
- 4 Signs (Kanavel)
- The whole finger is swollen (uniform swelling)
- Finger is held in slightly flexed position, wont be able to actively flex (flexion posture)
- Pain on passive extension of the finger
- Tenderness along the flexor tendon sheath
Mx of flexor sheath infection:
-Refer to hand unit for surgery as soon as possible
What is mid-palm infection?
- Hand is swollen
- Fingers are swollen
- a hill like dome forms on the palm, feels they are holding a tennis ball
- Deep inside the palm
- Between the lumbricals/ flexor tendons and interossi there is adventitial bursal space that can get filled up with pus.
Mx of mid-palm infection?
-Referred as it is a difficult surgery
Human bite at the hand:
- can present acutely (give prophylactic tx)
- can come after few days (Interventional tx)
Types of human bite:
- Circumferential bite
- Sign bite
can be complete/incomplete
- Bite-punch injury, when hitting with a punch, tooth goes in
- usually at the metacarpal phalangeal joints
