The Infected Hand
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Transcript of The Infected Hand
The Infected HandA Survey of Selected Conditions
Jeremy Webb, MS4 WFUSOM
Topics at HandInitial Evaluation and Treatment
Cellulitis
Paronychia/Eponychia
Felon
Septic Flexor Tenosynovitis
Deep Space Infections
Fight Bite
Herpetic Whitlow
Initial EvaluationHistory
Timing, Pain, Loss of fxn, Drainage, FeverSource, Hx of trauma, Predisposition, FBs
Tetanus Status
PhysicalExposure, Observation, Palpation, ROM, Sensation,
LAD, Lymphangitis
TestingRadiographs, Gram Stain, Cx
Conservative Treatment
RestWarm Soaks
ElevationFunctional Immobilization
Anti-inflammatory/AnalgesicsPO Antibiotics for Associated Cellulitis
Tetanus PPXClose Follow Up
Organisms/Antibiotics
Secondary to Minor Trauma
Commonly Gram Positive Organisms
Broad Initial Rx Therapy Directed
Tx for MRSA if indicated
Cellulitis
Physical Exam
Erythema
Swelling
Pain
Occasional LAD
Lymphangitis
Treatment
Conservative Therapy
Parenteral Antibiotics If: extensive/circumferential involvement, ascending lymphangitis, rapid spread,
immunocompromised
Paronychia
Treatment
No Fluctuance: Conservative Therapy
Fluctuance: Drainage Necessary
Felon
Signs and Symptoms
Throbbing Pain Poor Sleep
Red, Tender Pulp Space
Spontaneous Drainage
Necrosis if Delay in Dx
Treatment
Septic Flexor Tenosynovitis
Classic Signs and Symptoms
Tenderness over flexor tendon sheath
Symmetric swelling of the finger (index, middle, ring)
Pain with passive extension (most constant)
Flexed posture of involved digit at rest
Special Note
Recent Hx of STD Suspect Disseminated Neisseria gonorrhoeae
Treatment
Early Infection (<48 hrs): Parenteral ABX
Failure to Respond/Delayed Presentation: Surgical Management
Deep Space Infections
Physical Exam
Palpate Volar Surface: tenderness, induration, fluctuance
Sensory Evaluation
ROM
Beware Collar Button Abscess
Treatment
Parenteral Antibiotics
Surgical Drainage
Fight Bite
Fight Bite
Inoculation from opponent’s teeth
May lead to serious infection
Variety of organisms including staph, strep, anaerobes, and Eikenella corrodens
Work Up/Treatment
MUST inspect carefully to r/o deep injury
Examine extensor tendon fxn and look for loss of knuckle height
Radiographs mandatory: fx, tooth FB, air in joint space
Broad spectrum antibiotics
Herpetic Whitlow
History is Crucial
Commonly misdiagnosed as felon or paronychia
I & D is contraindicated, and may worsen condition
Time Course
Prodromal Phase Burning pain 24-72 hours prior to development of
skin changes
EruptionSkin changes over 2 weeks, including erythema,
vesicular formation
Resolution
Treatment
Conservative Management
Do not I & D unless secondary bacterial infection
Acyclovir in severe cases or immunocompromised populations
The End