This document provides an outline and overview of hand infections. It begins with an introduction to hand infections and their prevalence among manual workers. It then reviews anatomy of the hand and predisposing factors to infection such as diabetes, immunocompromised states, and injuries. The document classifies different types of hand infections including cutaneous, tendon sheath, deep fascial space, joint/bone infections, and mycobacterial or fungal infections. For each type of infection, it provides details on etiology, clinical presentation, and treatment approach. Images are included to illustrate anatomy and some pathologies.

1. By U12MD1021 And U12MD1022
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2. U12MD1021(ODUOYE MALIK OLATUNDE)
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3. OUTLINES
 Introductions
 Brief description of the hand
 Anatomy /functions of the hand
 Predisposing factors to hand infection
 Classification of hand infections
 Conclusion
 Refrences
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4. Intro 1
 Hand infections are disease conditions affecting the
hand and its appendages
 Infections of the hand are common and can be
disabling hence urgent treatment is required to
prevent further complications
 Mostly common among manual workers and
housewives whose hands are subject to minor injuries
such as pricks and abrasions.
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5. Brief description of the hand
 The hand is the manual part of the upper limb
 It is distal to the forearm
 Its action is established by pronation and supination of
the forearm
 While its working position or attitude (tilt) is adjusted
by movement at the wrist joint
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6. Review of anatomy of the hand
 The skeleton of the hand comprises :
1. Carpals in the wrist (8)
2. Mertarcapals in the hand proper(5)
3. Phalanges in the digits(14)
 There are two aspects of the hand viz:
 Dorsal aspect
 Palmar aspect
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7. Bones of the hand
Carpal bones -8 in numbers
 Arranged in proximal and distal rows of four
 They give flexibity to the wrist and augmenting
movement at the wrist joint
 Bones in the proximal row include:
1. Scaphoid
2. Lunate
3. Triquetrum
4. Pisiform
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8. Bones of the hand 2
 Bones in the distal row of carpals are:
1. Trapezium
2. Trapezoid
3. Capitate
4. Hamate
 N:B- the most frequently fractured carpal bone
is the scaphoid bone, often result from a fall on
the palm when the hand is abducted
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9. Bones of the hand 2
 The metacarpals
There are 5 metarcapals
Each consist of a base, shaft and head
The first (thumb) is the thickest and shortest
 The phalanges
There are 14 phalanges
All digits have 3 except the thumb with 2 phalanges
proximal phalanges are the largest, the middle ones are
intermediate in size, and the distal ones are the
smallest
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10. Muscles of the hand 1
 These are the intrinsic muscles
 Located in five compartments
Thenar muscles in the thenar compartment
(a) Abductor pollicis brevis
(b) Flexor pollicis brevis
(c) Opponens pollicis
 Adductor pollicis in the adductor compartment
 Hypothenar muscles in the hypothenar
compartment
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11. Skeleton of the hand
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12. Muscles of the hand 2
(a) Abductor digiti minimi
(b) Flexor digiti minimi brevis
(c) Opponens digit minimi
 The lumbricals are in the central compartment with
the flexor muscles
 The interossei muscles
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13. Palmal aspect of the hand
 This consists of a central cavity,a crease separating the
two prominences:
(a).Thenar prominence
(b). Hypothenar prominence
 The fascia of the palm,is thin over these prominences
,but thick at the center to form the fibrous palmar
aponeourosis and the digital sheaths(the
palmar) at the finger
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14. Functions of the hand 1
 The structure and function of the hand is essential for
all persons involved in maintaining or restoring its
activities
 These include:
1. Free motion
2. Power grasping
3. Precision in handling
4. pinching
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15. Functions of the hand 2
 Power grip- a forcible motion of the digits acting
against the palm
 Precision handling –involves a change in the position
of a handled object
 This requires fine control of the movement of the
fingers
 Examples: holding a pencil,manipulating a
coin,buttoning
 Pinching refers to compresion of something betweeen
the thumb and the index finger.
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16. predisposing factors1
 Host factors :
Age i.e extreme of ages –nail-fold infection
Diabetic mellitus
Immunocompromised state,e.g HIV patients(Pyogenic
flexor tenosynovitis , cutaneous abscesses , fungal
hand infections)
Intravenous drug use (Mixed aerobic and anaerobic
hand infection )
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17. Predisposing factors 2
Tropical fish aquarium exposure(The culprit organism
is more likely to be Mycobacterium marinum.)-
fishmonger’s infection
Sexually transmitted disease exposure(Flexor
tenosynovitis as well as cutaneous abscesses)
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18. Predisposing factors 3
 Causative agents
Bacterial agents-e.g
(a). Staphylococcus aureus-pyogenic tenosynovitis
(b). Streptococcous spp-septic athritis
©.Hemophilus influenzae- esp in children
(d) .Mycobacterium spp
Fungal agents-e.g
Trichophyton rubrum-onychomycosis
Sporothrix schenckii- sporotrichosis
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19. Predisposing factors 4
Opportunistic fungal infections- i.e (Candidal flexor
tenosynovitis infection )
 Viral agents –e.g HIV, herpex simplex virus
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20. Classification of hand infections
 Cutaneous /subcutaneous infections
 Tendon sheath infection
 Deep fascial space infection
 Infections involving the joint and bones
 Infections from bites
 Mycobacterial infections
 Fungal infections
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21. Cutaneous/subcutaneous hand
infections
 These are infections that commonly affect the nails
and the fingers
 They iclude:
1. Paronychia
2. Felon
3. Herpetic whitlow
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22. Paronychia 1
 It is an infection of the lateral nail-fold ,surrounding
the nail-plate
 If extends to overlying proximal nail ,it is called
eponychia
 The commonest hand infection
 Most often seen among children and older people
 Often occur due to trauma and infective agents.
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23. Paronychia 2
 Chronic paronychia occur due to:
 Inadequate drainage of an acute infection
 A fungal infection,e.g candida spp
 Some important history to be ellicited include:
1. history of nail biting or manicuring- esp in the acute
form
2. history of repeated exposure to water and/or irritants -
esp in chronic form
3. history of finger sucking
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24. Paronychia 3
 Clinical presentations may include:
Erythema and pain in early stages
frank abscess formation
Swelling and tenderness
 Treatment :
Acute paronychia
---Soaks, elevation, antibiotics (Augmentin)
----incision at the corner of the nail-fold should be done if pus is
present
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25. Paronychia 4
 use of pledget of paraffin guaze to keep the nail-fold
open
 Partial or total removal of the nail should be done
Treatment of chronic paronychia should involve:
Thorough drainage of the pus
Use of topical or oral antifungal agents
Marsupialization of the nail bed
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26. Paronychia 5
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27. Felon (pulp infection) 1
 Purulent infection of the pulp of the distal finger or
thumb
 Aetiologies –
(a). Prick injuries (b). Blackthorn injuries ©
staphylococcus aureus infection
 Clinical features –
Throbbing pain in the finger tip
Swelling
Redness and tenderness
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28. Felon 2
 Treatment
Antibiotics- (7-10 days)
Hand elevation
Warm soaks
For late presentation:
Incision of site of max tenderness
Drainage of the pus
Dressing of the finger with a loose packing of guaze
Modified antibiotic treatment
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29. Herpetic whitlow(HW) 1
 A painful herpes simplex infection of a finger
 Most common viral infection of the hand
Mode of entrance of the organism:
Through direct inoculation of the perionychial fold
Auto-inoculations from the mouth or genitalia
Cross infections during dental surgery
 Common among :
--Kids with herpetic gingivostomatitis
--Adults more likely HSV 2
--Health care workers
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30. HW 2
 Clinical presentations:
Single finger
Pain
Pruritus and swelling
 pathology:
Formation of small vesicles over the finger-tip
Coalescence over 2 weeks
Ulcer formation
Bleeding may result
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31. HW 3
 Treatment :
Usually a self limiting condition
Can subsides after about 10 days
Use of aciclovir may be effective in early stage
N:B- surgery is unhelpful and may be harmful
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32. HW 4(Painful vesicles which have a
clear fluid discharge)
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33. Tendon sheath
infection(suppurative
tenosynovitis)
 This is an inflammation of the tendon( flexor) and its
enveloping sheath
 It may also spreads to midpalmar, thenar, lumbrical
compartments
 Usually follows a penetrating injury
 Causative organisms are:
Staphylococcus aureus—most common
Streptococcus spp
Gram-negative organisms
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34. Tenosynovitis 2
 Clinical presentations:
 Pain and swellings of the
affected digit
Usually held in slight
flexion
Tender,
Patient will disallow
movement of the
affected digit
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35. Tenosynovitis 3
 Early diagnosis is based on clinical findings
 Treatment :
This must be started once diagnosis is suspected
The hand is elevated and splinted
Intravenous administeration of antibiotics-
--broad spectrum penicillin
-- or systemic cephalosporin,e.g Cefazolin
 Surgical drainage is done if there is no improvement after
24 hours
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36. Tenosynovitis 4
 Complications of tendosynovitis include:
Horse-shoe abscess
Median nerve compression
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37. Deep fascial space infections
 Infections that affect the closed compatments of the
hand i.e:
 Dorsal subaponeurotic space.
 Interdigital Subfascial web space.
 Thenar space.
 Midpalmar space.
 These compartments are prone to infection from
penetrating trauma, local spread and haematogenous
dissemination.
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38. 1/16/2018 38

39. Deep space infections 2
 Organisms implicated include:
1.S. aureus.
2.Strepts.
3.Coliforms and
4.Anaerobes.
 Clinical features are
Painful hand
Swelling of the palm with bulged dorsum
Extensive tenderness
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40. Deep space infections 3
 Dorsal subaponeurotic abscess may present as :
Swelling and erythema on dorsum of hand
Pain with passive movement of extensor tendons
 cellulitis
 In case of subfascial Web Space Infection
Secondary to infection of palmar blisters
Spreads dorsally - “collar button abscess”.
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41. Deep space infections 4
 Thenar Space Infection :
Pain and swelling of thenar eminence and first web
space
Can be from tenosynovitis of 2nd digit with rupture
proximally
Thumb is held abducted and flexed
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42. Septic arthritis 1
 This is an acute inflammation of synovial membranes
with purulent effusion into the joint
 Usually occur with the metarcapophalangeal joint
 Mode of occurrence are:
Direct contact by a penetrating injury or intra-articular
injection
Indirectly from adjacent structures
By hematogeneous spread from a distant site
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43. Septic arthritis 2
 Bacteria: Staph. aureus, Strepts., Haemophilus
influenzae, Neisseria gonorrhoea, E. coli are
implicated
 For septic arthritis to occur, organism must reach the
synovial membrane of the joint
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44. Septic arthritis 3
 Clinical features include:
 Usually affects one joint (mono-arthritis)
 Rapid onset of joint pain
 Redness, tenderness, and swelling – signs of
inflammation
 +/- Fever
 -Previous history of trauma
 Marked limitation of movement.
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45. Septic arthritis 4
 Treatment involves:
Intravenous antiobiotics
Splintage of the hand in the position of safety for
48hours
Open drainage ,if pus is suspected
Application of copius dressings
Movement of the hand after splintage is done
 N:B- The antibiotics are continued till all signs of
sepsis have disappeared
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46. Osteomyelitis 1
 This is an inflammation of the bone marrow and
adjacent bone
 Staph. aureus and Strepts are the most commonly
implicated organisms.
 Others include: Haemophilus influenzae,
Enterobacter spp, Salmonella spp.
 Routes of infection:
 Haematogenous route.
 Contiguous spread from local areas of infection (as in
cellulitis).
 Penetrating trauma.
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47. Osteomyelitis 2
 Presentation:
 Local pain, erythema, swelling.
 History of open fracture, penetrating trauma.
Investigations
- Blood culture – +ve in 50% of cases.
- Bone biopsy and culture.
- X-ray – Periosteal thickening or elevation, cortical
thickening, sclerosis and irregularity.
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48. Osteomyelitis 3
 Treatment involve:
 Prolonged antibiotic therapy.
 Adequate drainage, extensive debridement of necrotic
tissue.
 Adjunctive hyperbaric Oxygen therapy could also be of
use
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49. Infections due to bites 1
 Hand infections can occur due to:
- animal bites
- human bites
Animal bites
 Animal bites are usually inflicted by cats,dogs,farm
animals or rodents
 Common pathogens are staphylococci and
streptococci
 Pasteurella multocida are often reported
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50. Infections due to bites 2
Human bites
 Generally thought to be even more prone to infection
 Approximately 10%-15% of human bite wounds
become infected
 Over 40 different strains of bacteria
 Commonest bacteria are Staphylococcus
aureus,Streptococcus Group A , and Eikenella
corrodens
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51. Infections due to bites 3
 The tell-tale signs of a human bite are lacerations
 Wounds sustained during a fist fight i.e ‘fight bite’ over
the MCP knuckles should be assumed to be infected
 Treatment :
Careful examination of fresh wounds
Fragment of tooth, divot of articular cartilage should
be search for
Splinting and elevation of the hand
Antibiotic prophylatic therapy
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52. Infections due to bites 4
 Infected bites will need:
Debridements
Wash outs
Intravenous antibiotic treatment– e.g amoxicillin with
clavulanic acid and cephalosporins
Anti rabies ,if dog bite is suspected
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53. 1/16/2018 53

54. Mycobacterial infections 1
 These are : Tuberculous tenosynovitis and
fishmonger’s infection
 Fishmonger’s infection
A chronic infection of the hand
It is caused by Mycobacterium marinum
The organism is introduced by :
---prick injuries from fish spines or hard fins
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55. Mycobacterial infections 2
 Definitive diagnosis usually requires biopsy for
histological examinations and cultures
 Treatment :
Superficial lesions often heal on their own
Deep lesions require surgical synovectomy
Prolong antibiotic treatment to prevent recurrence
N:B- recommended drug is tetracycline,e.g
minocycline , or chemotherapy with ethambutol and
rifampicin
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56. Fungal infections 1
 Superficial infection – i.e tinea infections
Tinea of the nail(onychomycosis) is caused by
trichophyton rubrum
 Subcutaneous infection-( sporotrichosis )
By sporothrix schenckii ,following a thorn prick
Recommended treatment is oral potassium iodide
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57. Fungal infections 2
 Deep mycotic infection –
May involve tendons or joints
Diagnosis should be confirmed by microscopy and
microbiological culture
Treatment is by local excision and administration of an
intravenous antifungal agents
 Opportunistic fungal infections are more seen in
debilitated and immunosuppressed patients
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58. conclusion
 Hand infections
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59. References
 Apley’s system of orthopaedics and fractures -9th
edition by Louis Solomon et al
 Stedman’s medical dictionary -28th edition
 Medscape– hand infections
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