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Infections

There are various types of infections which involve the hand and wrist. Hand infections are best described by the tissues or sites involved. Most severe hand infections are caused by trivial injuries, which produce wounds that often times are neglected.

• Infections which involve the skin are termed “Cellulitis.” This presents as a superficial skin infection. This type of infection is characterized by swelling, redness, heat, and tenderness, and usually occurs after a trivial penetrating wound or injury. Treatment for Cellulitis includes application of moist heat, as well as oral antibiotics.
• “Lymphangitis” is an uncommon type of a superficial spreading infection, which involves the lymphatics. This infection usually starts as Cellulitis, then progresses on to red streaks, which are noticed to spread into the upper extremity. High fevers and sepsis are usually associated with Lymphangitis. Similar to Cellulitis, Lymphangitis usually starts with a trivial penetrating wound or injury. Because of the potential for progression into the blood stream (sepsis), patients with Lymphangitis are usually best treated in a hospital setting with potent, intravenous antibiotics.
• An “abscess” is characterized by the presence of a pus filled cavity. Abscesses maybe form under the skin (subcutaneous), or deep within the tissues of the extremity. An abscess may form following a penetrating injury, from untreated Cellulitis, or other more superficial infections. Treatment involves surgical opening of the abscess (incision and drainage), followed by appropriate antibiotics.
• Infections involving joint spaces (septic arthritis), or flexor sheaths (purulent flexor tenosynovitis), are severe because of the potential to cause rapid destruction of the articular surface and flexor tendons. These conditions require urgent evaluation and surgical drainage in order to minimize permanent damage to these critical structures.
• Necrotizing fasciitis is an uncommon, severe and life-threatening infection caused by virulent Streptococcus or Staphylococcus organisms, which involve tissues which enclose muscles (fascia). In this condition, infection travels up the soft tissue plane (just on top of muscles) and beneath the fat – causing rapid destruction of tissue. Treatment involves urgent surgical debridement of involved tissue, high-dose intravenous antibiotics, and often times, hyperbaric oxygen (HBO).
• A “paronychia” is one of the most common infections of the hand, which involves the skin around the nail. Initially, this infection starts as a Cellulitis with redness and swelling at the base of the nail. Left untreated, this progresses to form an abscess, which then requires surgical incision and drainage. A chronic paronychia results in a combined infection involving both bacteria and fungus, which involves the tissue under the nail plate (nail bed). This presents as a slowly progressive discoloration under the nail, which then may lead to loss of the nail plate’s ability to adhere. Treatment involves combinations of topical salves, oral antibiotics, systemic antibiotics, nail plate removal, and debridement.

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