Hand Infection

Aka: Hand Infection, Infected Hand, Infected Finger, Finger Infection

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II. Types

  1. Finger tip (superficial Hand Infections)
    1. Acute Paronychia
    2. Chronic Paronychia
    3. Felon
    4. Herpetic Whitlow
  2. Deep Hand Infections
    1. Infected open Fracture (e.g. fifth Metacarpal Fracture)
    2. Suppurative Tenosynovitis
    3. Human Bite (Fight Bite due to clenched fist injury)
  3. Regional Infections
    1. Cellulitis
    2. Nodular Lymphangitis
      1. Atypical organism infections due to soil or water borne organisms

III. Differential Diagnosis: Non-infectious Causes of Hand Lesions

  1. Acute calcific Tendinitis
  2. Chronic Paronychia
  3. Hand Dermatitis
  4. Contact Dermatitis
  5. Dyshidrotic Eczema
  6. Foreign body skin reaction
  7. Inflammatory Arthritis
  8. Pyogenic Granuloma

IV. Management

  1. Treat for specific causes above
    1. Felon
    2. Paronychia
    3. Herpetic Whitlow
    4. Fight Bite
    5. Suppurative Tenosynovitis
  2. General measures
    1. See Cellulitis for general measures
    2. Tetanus Prophylaxis for open wounds
    3. Irrigate open wounds
    4. Incision and Drainage for abscesses
    5. Surgical Debridement for necrotic tissue within wound
    6. Rest and elevate the affected hand (reduces edema)
    7. Apply warm compresses to the affected hand (increases local Blood Flow and Antibiotic delivery)
    8. Splint in a position of function (decreases risk of flexion contractures)
  3. Oral Antibiotic selection (mild to moderate infections)
    1. Hand Infections
      1. Cover Gram Positive Cocci
      2. Cephalexin (Keflex)
    2. Fingertip infections
      1. Cover Staphylococcus Aureus including MRSA
      2. Trimethoprim Sulfamethoxazole
      3. Doxycycline
    3. Oral flora exposure (e.g. Human Bite)
      1. See Fight Bite
      2. See Infected Animal Bite
      3. Cover Gram Positive, Gram Negative and Anaerobic Bacteria
      4. Amoxicillin Clavulanate (Augmentin)
  4. Severe Infections (e.g. Suppurative Tenosynovitis)
    1. Admit for IV Antibiotics
    2. Orthopedic Consultation
    3. Antibiotic coverage
      1. Vancomycin AND
      2. Piperacillin/tazobactam (Zosyn) 3.375 g every 6 hours

V. References

  1. Jordan and Sandelich (2025) Crit Dec Emerg Med 39(6): 25-7
  2. Rerucha (2019) Am Fam Physician 99(4):228-36 [PubMed]

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