the infected hand
TRANSCRIPT
![Page 1: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/1.jpg)
The Infected HandA Survey of Selected Conditions
Jeremy Webb, MS4 WFUSOM
![Page 2: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/2.jpg)
Topics at HandInitial Evaluation and Treatment
Cellulitis
Paronychia/Eponychia
Felon
Septic Flexor Tenosynovitis
Deep Space Infections
Fight Bite
Herpetic Whitlow
![Page 3: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/3.jpg)
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
![Page 4: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/4.jpg)
Conservative Treatment
RestWarm Soaks
ElevationFunctional Immobilization
Anti-inflammatory/AnalgesicsPO Antibiotics for Associated Cellulitis
Tetanus PPXClose Follow Up
![Page 5: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/5.jpg)
Organisms/Antibiotics
Secondary to Minor Trauma
Commonly Gram Positive Organisms
Broad Initial Rx Therapy Directed
Tx for MRSA if indicated
![Page 6: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/6.jpg)
Cellulitis
![Page 7: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/7.jpg)
![Page 8: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/8.jpg)
Physical Exam
Erythema
Swelling
Pain
Occasional LAD
Lymphangitis
![Page 9: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/9.jpg)
Treatment
Conservative Therapy
Parenteral Antibiotics If: extensive/circumferential involvement, ascending lymphangitis, rapid spread,
immunocompromised
![Page 10: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/10.jpg)
![Page 11: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/11.jpg)
Paronychia
![Page 12: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/12.jpg)
![Page 13: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/13.jpg)
![Page 14: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/14.jpg)
![Page 15: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/15.jpg)
![Page 16: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/16.jpg)
![Page 17: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/17.jpg)
Treatment
No Fluctuance: Conservative Therapy
Fluctuance: Drainage Necessary
![Page 18: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/18.jpg)
![Page 19: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/19.jpg)
![Page 20: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/20.jpg)
![Page 21: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/21.jpg)
Felon
![Page 22: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/22.jpg)
![Page 23: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/23.jpg)
Signs and Symptoms
Throbbing Pain Poor Sleep
Red, Tender Pulp Space
Spontaneous Drainage
Necrosis if Delay in Dx
![Page 24: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/24.jpg)
Treatment
![Page 25: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/25.jpg)
![Page 26: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/26.jpg)
Septic Flexor Tenosynovitis
![Page 27: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/27.jpg)
![Page 28: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/28.jpg)
![Page 29: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/29.jpg)
![Page 30: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/30.jpg)
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
![Page 31: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/31.jpg)
![Page 32: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/32.jpg)
Special Note
Recent Hx of STD Suspect Disseminated Neisseria gonorrhoeae
![Page 33: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/33.jpg)
Treatment
Early Infection (<48 hrs): Parenteral ABX
Failure to Respond/Delayed Presentation: Surgical Management
![Page 34: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/34.jpg)
![Page 35: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/35.jpg)
Deep Space Infections
![Page 36: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/36.jpg)
![Page 37: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/37.jpg)
![Page 38: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/38.jpg)
Physical Exam
Palpate Volar Surface: tenderness, induration, fluctuance
Sensory Evaluation
ROM
Beware Collar Button Abscess
![Page 39: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/39.jpg)
![Page 40: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/40.jpg)
![Page 41: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/41.jpg)
Treatment
Parenteral Antibiotics
Surgical Drainage
![Page 42: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/42.jpg)
![Page 43: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/43.jpg)
Fight Bite
![Page 44: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/44.jpg)
![Page 45: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/45.jpg)
![Page 46: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/46.jpg)
![Page 47: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/47.jpg)
Fight Bite
Inoculation from opponent’s teeth
May lead to serious infection
Variety of organisms including staph, strep, anaerobes, and Eikenella corrodens
![Page 48: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/48.jpg)
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
![Page 49: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/49.jpg)
Herpetic Whitlow
![Page 50: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/50.jpg)
![Page 51: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/51.jpg)
History is Crucial
Commonly misdiagnosed as felon or paronychia
I & D is contraindicated, and may worsen condition
![Page 52: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/52.jpg)
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
![Page 53: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/53.jpg)
Treatment
Conservative Management
Do not I & D unless secondary bacterial infection
Acyclovir in severe cases or immunocompromised populations
![Page 54: The Infected Hand](https://reader036.vdocuments.net/reader036/viewer/2022081512/5517ee08497959957a8b45ae/html5/thumbnails/54.jpg)
The End