Hands become infected more frequently as it is one of the commonly injured parts of our body. Hand infections, if left untreated or treated improperly can cause disabilities such as stiffness, contracture, weakness, and loss of tissues (skin, nerve and bone) that persist even after the infection resolves. Therefore, prompt treatment of hand infections is important.
Infections of the hand include:
Paronychia is an infection of the nail fold or cuticle area present around the fingernail. Paronychia may be an acute or chronic infection. Acute paronychia is a bacterial infection and causes pain, redness, and swelling around the nail. It is caused by superficial trauma that may occur during nail biting or finger sucking. It can be treated with antibiotics and if pus forms, it needs to be drained. Chronic paronychia is a result of fungal infection and it causes milder symptoms such as mild pain, redness or swelling, with little or no pus. It occurs most commonly in people whose hands are often wet or are immunocompromised. The treatment for chronic paronychia consists of avoiding constant exposure to moisture and application of topical steroid and antifungal ointments.
Felon is a serious infection of the fatty pulp of the fingertips which results in throbbing pain. It is caused due to direct entry of bacteria during a penetrating injury or by spread of infection from untreated paronychia. If there is an abscess, surgical drainage is required following which antibiotics will be prescribed.
Herpetic whitlow is a herpes simplex virus infection of the fingers. It is more common in healthcare workers whose hands are exposed to the patient’s saliva which may carry the virus. Herpetic whitlow presents small, swollen, painful blisters. Diagnosis can be difficult, especially with a late presentation. Conservative treatment for herpetic whitlow involves application of a dry gauze dressing to the affected finger to avoid spread of infection.
Septic arthritis is a severe infection of the joint caused by a wound or a draining cyst. The bacterial infection may cause destruction of the joint by eroding away the joint cartilage. Surgical drainage should be done as soon as possible because the condition may get complicated if the infection spreads to the bone, causing osteomyelitis.
Deep space infections
Deep fascial spaces are the potential spaces in between the different structures of the hand. These spaces tend to get infected through penetrating wounds or spread of infection from blood. Deep space infections may occur in the thumb, the palm or in the area between the bases of fingers. Treatment for deep space infections includes antibiotic therapy, pain relieving medications, and surgical drainage.
Tendon sheath infection
Tendon sheath infection is the infection of the flexor tendon which occurs because of a small laceration or penetrating wound on the finger, near a joint. Rarely it may be a complication of steroid injection for trigger finger. It causes severe stiffness of the finger accompanied by redness, swelling and pain. This condition may also lead to destruction and rupture of the tendon. Therefore, it demands the immediate surgical drainage and irrigation of the tract.
Atypical mycobacterial infections
Atypical mycobacterial infections are tendon sheath infections caused by an atypical mycobacterium which often grows in a watery environment. These infections cause stiffness and swelling without much pain and redness. A biopsy is required to confirm the diagnosis. Antibiotic treatment is given for several months following which surgical removal of the infected tendon sheath may be done.
Infections from bite wounds
Infections from animal or human bites are associated with rare bacterial infection. These wounds are given initial cleaning and may need surgical trimming of infected or crushed tissue. They may need to be left open to allow the infection to drain out.