Infections of the Hand
Hand infections are surgical emergencies. The closed compartments of the hand allow pressure to build rapidly, leading to tissue necrosis ("Compartment Syndrome of infection").
1. Common Infections
- Paronychia: Infection of the nail fold (Most common). Eponychia if it crosses the nail base.
- Felon: Infection of the distal finger pulp. Causes throbbing pain due to septae compartmentalization.
- Web Space Abscess ("Collar Button"): Infection between fingers. Fingers abduct (spread apart).
- Deep Palmar Abscess: Thenar or Mid-palmar space infections. Loss of palm concavity.
2. Suppurative Tenosynovitis
Infection inside the flexor tendon sheath. Diagnosed by Kanavel's Cardinal Signs:
Kanavel's 4 Signs:
1. Fusiform swelling of the finger (Sausage digit).
2. Finger held in slight flexion.
3. Pain on passive extension (Most sensitive sign).
4. Tenderness along the tendon sheath.
1. Fusiform swelling of the finger (Sausage digit).
2. Finger held in slight flexion.
3. Pain on passive extension (Most sensitive sign).
4. Tenderness along the tendon sheath.
3. Management
- Early: Antibiotics, Elevation, Splinting.
- Abscess: Incision and Drainage (I&D).
- Tenosynovitis: Surgical irrigation/drainage immediately.
25 Practice MCQs
Q1. Most common hand infection is:
Answer: A). Nail biting/manicures are common causes.
Q2. A Felon affects which space?
Answer: A). The pulp has vertical septae causing high pressure.
Q3. The most sensitive Kanavel sign for Tenosynovitis is:
Answer: B). Stretching the inflamed sheath causes immense pain.
Q4. "Collar Button" abscess refers to:
Answer: A). Hourglass shape.
Q5. Typical organism causing acute paronychia is:
Answer: A). Chronic paronychia is often Fungal (Candida).
Q6. Horseshoe abscess involves communication between:
Answer: A). Via the Space of Parona.
Q7. Incision for Felon drainage should spare:
Answer: A). Lateral incision is preferred to avoid painful scars on the fingertip.
Q8. Herpetic Whitlow is caused by:
Answer: A). Vesicles appear. Incision is CONTRAINDICATED (spreads virus).
Q9. Loss of palmar concavity suggests:
Answer: A). Infection deep to the flexor tendons.
Q10. Human bite injuries ("Fight Bite") typically infect the:
Answer: A). Hitting teeth punches the joint. Organism: Eikenella corrodens.
Q11. Chronic paronychia is often treated with:
Answer: A). "Dishwasher's hand".
Q12. Runaround infection involves:
Answer: A). Surrounds the nail base.
Q13. Untreated tenosynovitis can lead to:
Answer: A). Pressure kills the blood supply to the tendon.
Q14. Space of Parona is located:
Answer: A). Infection can track from the wrist here.
Q15. Pyogenic granuloma is:
Answer: A). Often seen after minor trauma. Silver nitrate treats it.
Q16. Floating nail sign indicates:
Answer: A). Nail plate is lifted off the bed.
Q17. Pasteurella multocida is associated with:
Answer: A). Rapid onset of infection.
Q18. Sporotrichosis ("Rose Gardener's Disease") spreads via:
Answer: A). Nodules appear along the arm lymphatics.
Q19. Splint position for infection is:
Answer: A). To prevent contractures while inflamed.
Q20. Why should you NOT incise a Herpetic Whitlow?
Answer: A). It is self-limiting.
Q21. Which fingers have separate flexor sheaths (do not communicate with bursae)?
Answer: A). Thumb connects to Radial Bursa, Little finger to Ulnar Bursa.
Q22. Septae in the fingertip pulp:
Answer: A). Must be broken down during I&D.
Q23. Osteomyelitis of the distal phalanx is a complication of:
Answer: A). Bone is right next to the pulp.
Q24. Abduction of fingers in Web Space Abscess is due to:
Answer: A). "V" sign.
Q25. Catheter irrigation is used for:
Answer: A). Flushing the tendon sheath with saline.
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