Hand & Wrist Specialists of the Palm Beaches
Laura Kolshak, M.D.
Board Certified Orthopaedic Hand Surgeon, Fellowship-Trained
Palm Beach County, FL
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Call (561) 508-7066
Fax (561) 508-5738
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Therefore, it is essential to have early and aggressive treatment of hand infections. Some types of infections can be treated with local rest, soaking and antibiotics, when seen early. However, many kinds of infections begin to cause severe problems, even after a day or two, if not treated with antibiotics, surgical drainage, and removal of infected tissues. In order to determine the type of bacteria causing the infection and the right kind of antibiotic for treatment, drainage or pus should be sent for laboratory testing.
Paronychia is an infection of the cuticle area around the fingernail. Acute Paronychia is caused by bacteria that causes redness, swelling, pain and eventually pus. If caught in early stages, it may be treated with soaks and antibiotics. However, if pus is seen or suspected, drainage by lifting the cuticle and/or nail, or lancing the area, is required also. Fungus will cause Chronic Paronychia and the cuticle area to become mildly red and swollen, with scant or no drainage and mild tenderness. It occurs in people whose hands are frequently wet, such as bartenders. It may be treated with reduction or elimination of the constant exposure to moisture, which promotes this fungal infection, and with special medication.
Occasionally, surgery is needed to remove infected tissue. Commonly mistaken for a bacterial infection, prolonged treatment is common with chronic paronychia.
An infection that occurs in the closed space of the fatty tissue of the finger tip and pulp, called “felon”, is a more serious and usually more painful, throbbing infection. This usually requires surgical drainage and antibiotics. If this condition is not treated early, destruction of the soft tissues and even bone can occur.
A viral infection of the hand, usually on the fingers, caused by a herpes virus, is called “Herpetic Whitlow.” You will see this more commonly in healthcare workers whose hands are exposed to the saliva of patients carrying herpes. Characterized by small, swollen, painful blood-tinged blisters, and sometimes numbness, this condition is typically treated conservatively and typically heals in several weeks without many after-effects.
When a wound is in or near a joint, or a draining cyst from an arthritic joint, it can cause a severe infection of the joint known as “Septic Arthritis”. In just two days, the joint can be destroyed by the bacteria eroding the cartilage surface of the joint. In addition to antibiotics, surgical drainage is required. If this treatment is delayed, infection of the bone can occur, causing a condition called “Osteomyelitis.” It usually requires one or more operations to remove infected tissue, and many patients require weeks of intravenous antibiotics.
Deep Space Infections
In between the different layers of structures in the hand, there are spaces which can become infected, even from a small puncture wound.
These may affect:
the thumb area (thenar space)
the palm (deep palmar space)
the web area between the bases of fingers (collar-button or web space abscess)
Surgical drainage is required for these conditions, and they have the potential to spread to other areas, even to the wrist and forearm.
Tendon Sheath Infections
An infection of the flexor tendon can occur if a small laceration or puncture wound occurs over the middle of a finger, especially near a joint on the palm side. These can often cause severe stiffness, even destruction and rupture of the tendon. These present acutely with:
stiffness of the finger in a slightly bent posture
diffuse swelling and redness of the finger
tenderness on the palm side of the finger
severe aggravation of pain with attempts to straighten the finger
Immediate surgical drainage of the tendon sheath and antibiotics is required for this kind of infection.
Atypical Mycobacterial Infections
In very few instances, a tendon sheath infection can be caused by an “Altypical Mycobacterium.” These develop gradually and can be associated with stiffness and swelling without much pain or redness. This infection is treated with special antibiotics for several months. It may also be necessary for surgical removal of the infected lining of the tendons. Despite treatment, residual stiffness is common. These infections may involve other soft tissues as well. Mycobacterium marinum is a common form and typically develops after puncture wounds from fish spines, or contamination of a simple wound or abrasion from stagnant water in nature or from aquariums. It can be difficult to identify the organism. AIDS patients or cancer patients with impaired immune systems, are more susceptible to atypical mycobacterial infections.
Infections From Bite Wounds
Infections that occur from humans or animals are typically associated with several kinds of bacteria. Streptococcus and Staphylococcus can be involved, if driven in from the skin by a tooth. However, other organisms common to the mouth may also be seen and typically require other or additional antibiotics. Eikenella Corrodens is often seen with human bite injuries, and Pasteurella Multocida is seen with dog and especially cat bite wounds.
In order for any infection to drain out, wounds frequently are not closed after treatment, and deep structures such as joints may be involved. Surgical trimming of infected/crushed tissue is often required. Rabies infection caused from an infected animal may be serious, even fatal. The level of risk determines the type of treatment that is required. Fortunately, the reported cases of rabies in humans are rare. The incidence of rabies is also low in domestic animals, most cases coming from bites of wild animals.
For more information about simple, safe, and effective treatments for hand infections, or any other conditions of the hands or upper extremities, schedule an appointment with Dr. Sagini by calling 239-337-2003.
Urgency of Treatment
Infections of the hand can cause severe problems that continue even after the infection has resolved, such as:
loss of strength
loss of tissues such as skin, nerve and even bone
Watch the "Health Matters" News Segment about animal bites and hand infections