Hand Infections

When talking about a hand infection, one refers to an inflammation caused by an invasive pathogen, usually bacteria. Due to the particular anatomical characteristics of the hand, there can be many special forms of infection.

All inflammations have the following symptoms in common: swelling; rash and pain on pressure. Usually there is pulsating pain and warmth in the infected area, and a certain degree of limitation to movement and function of the hand.

Infections of the hand are often initially caused by seemingly trivial injuries such as rips to the nail bed or minor pin-pricks or cuts in the skin. Germs then penetrate via the lymph system, causing localised inflammation and ulceration. In abscesses, the pus cavity is limited to within the area of the surrounding tissue. A phlegmon is the spreading of the inflammation through the tissue. Due to the previously mentioned particular anatomical aspects of the hand, a v-shaped phlegmon may develop meaning that the infection spreads out in a v-shape from the thumb to the little finger or vice versa. Germs in phlegmons of the hand spread between the skin and the palmar fascia.

An inflammation of the nail bed is called panaritium. There are different forms of panaritium depending on their extent and localisation. If the inflammation is only present on the skin, it is a cutaneous panaritium. Here there is a pus sac on the nail fold which can also progress into what is known as deep hand space. The joints, tendons and bones of the hand can also possibly be affected in the advanced stages of inflammation.

If the paranitium is in connection with a joint or tendon, then it is called a collar button abscess. A subcutaneous panaritium causes softening of the underlying tissue and if the complete nail fold is affected it is referred to as paronychia.

The goal of operative therapy is to enable accumulated pus to drain thus preventing the infection from progressing to deep tissue. For simple cutaneous panaritium a short incision under local anaesthetic is usually adequate. In advanced cases of infection, the infected and dead tissue must be removed right down to the healthy tissue. Involved tendons and joints must be thoroughly flushed. In addition, it may be necessary to open larger areas of the hand. Furthermore, it is possible to insert beads or sponges containing antibiotics which prevent the bacteria from spreading again. In general, it is also usual to be prescribed some sort of antibiotic as an infusion or in tablet form. The implantation of drainage tubes also allows post-operative drainage of secretions. More major operations require regional anaesthetic to the entire arm or a general anaesthetic.

In the above described phlegmons it is also necessary to create an adequate enough opening of the inflamed area. In cases of major tissue swelling, it may occur that the wounds cannot be directly closed. In some cases there is also adhesion of the tendon sheaths, which must be released in a second operation.

Aftercare can take the form of daily flushing through the implanted drainage tubes and regular changing of bandages. In every case the hand should be initially immobilized in a cast, cooled and held raised. However, the hand should be made mobile as soon as possible through physiotherapy.