Infections of the hand: an overview

Abstract

Infections of the hand are common entities that are frequently encountered by orthopaedic surgeons and primary care physicians. A high clinical suspicion and a thorough medical history with information about the social and working history of the patients, correct identification of the type and cause of the infection, and prompt initiation of appropriate treatment by the infectious diseases physicians and orthopaedic surgeons are required. Late diagnosis and inappropriate treatment may be a significant cause of morbidity for the hand and mortality for the patients. This article reviews the clinical spectrum and microbiology of the most common infections of the hand, and discusses the current concepts for their treatment. The aim is to increase the awareness of the treating physicians of the diagnosis and management of infections in the hand. Cite this article: EFORT Open Rev 2019;4:183-193. DOI: 10.1302/2058-5241.4.180082

Infections of Deep Hand and Wrist Compartments

“…The synovial sheaths of both the flexor polices longus continues proximally as radial bursa, whereas the tendon sheaths of the ulnar digits or only the little fingers, continue proximally as the ulnar bursa, where both communicate with each other via the carpal tunnel to the space of Parona. This is a potential space at the level of the distal forearm, between the profundus tendons and the pronator quadratus [27,29,32] (Figure 7). Ulnar bursitis of the hand is characterized by the development of hand oedema, especially upon the dorsal aspect, and it is often difficult to be diagnosed due to its deep location.…”

“…Deep space abscesses involving the thenar, the mid-palmar, the Parona's space, or the interdigital web spaces of the hand usually arise from direct inoculation or contiguous spread (Figure 7). Marked swelling, oedema, warmth, and pain are prominent, and the ultrasonography or magnetic resonance imaging may help in the differentiation from a superficial infection [27,29,32].…”

“…Particular care must be undertaken for tetanus prophylaxis. Full vaccination should be provided if there is any doubt whether the patient is adequately immunized against tetanus [29,32]. Prophylaxis is rarely necessary for the rabies potential exposure from any scratch or bite wound by an animal that may be infected, or from contact of such an animal's saliva with a human's mucous membrane.…”

“…Surgeons advocating the limited approach claim a better final range of motion, while others believe that a limited approach should be used in less severe cases, although there are no level I studies comparing the type of incision. Giladi and colleagues in 2015, advocate that intra-operative and postoperative closed sheath catheter irrigation with normal saline for 2–3 days, until the resolution of the acute inflammation, achieved improved range of motion when compared with open washout [ 6 , 22 , 24 , 28 , 29 , 30 , 31 ].…”

Epidemiology of acute infections of the upper limb in a European hospital

“…The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. (Flevas et al, 2019;Koshy and Bell, 2019). The purpose of this study was to define the current epidemiology of adult acute upper limb infections in a European hospital.…”