What is Hand Infection?
Various types of hand infections are commonly seen by hand specialists, general practitioners, and emergency doctors. Acute hand infections can differ greatly based on where they occur and what causes them. If these infections are incorrectly identified or left untreated, they can seriously hurt the patient or even be fatal.
Hand infections can generally be classified as either superficial or deep. Superficial infections affect the skin and the soft tissues just beneath it. Deep infections, on the other hand, affect the structures deeper within the hand. The type of infection typically determines the necessary treatment method and setting. However, because the hand is complex and performs delicate functions, a clear understanding of the specific structures involved is needed to properly diagnose and treat the infection.
Superficial infections are more common and often affect areas like the skin, the fold of the nail, the soft part of the fingertip, or the tissues just under the skin. These types of infections are often resolved with minor care rather than deep infections. Deep infections usually affect the tendons, the protective sheaths covering the tendons, the bones, joints, or deep areas of the hand. These infections often need surgical treatment and antimicrobial therapy – a treatment which stops the growth of microorganisms – to heal fully.
No matter what the specific diagnosis may be, it’s very important to quickly evaluate and treat the infection to heal it and get the best possible results for patients. This article discussed the wide range of infections that can affect the hand, their basic evaluation, and general principles of treatment. The goal of this article is to aid in recognizing these conditions and understanding the urgency of the treatment required.
What Causes Hand Infection?
Hand infections can happen in several ways, although they’re often caused by a wound or injury that allows nearby infectious matter to spread. Some hand infections could develop if a minor injury wasn’t treated properly or in time. Moreover, infections can also spread through the blood, though this is more common in children, people with weakened immune systems, or people who inject drugs.
Different types of bacteria and fungi have been found in hand infections. Staphylococcus aureus is the most commonly found bacteria in such infections, followed by the Streptococcus species. In recent times, there’s an increased number of cases caused by Methicillin-resistant Staphylococcus aureus, particularly in metropolitan areas. Some studies suggest it could be responsible for almost half of all hand infections.
Depending on the type of injury, some infections might be caused by specific microorganisms. For instance, human and animal bites frequently contain Eikenella corrodens and Pasteurella multocida, respectively. B-hemolytic Streptococcus group A is the most common bacterium found in life-threatening soft tissue infections. Chronic paronychia, an infection surrounding the fingernails, often arises in people who regularly have their hands in water, like dishwashers and bartenders. It’s commonly caused by Candida albicans fungus, particularly when the infection doesn’t respond to antibiotic treatment.
Infections caused by less common bacteria, such as Mycobacterium marinum or Vibrio spp, can occur following an injury in marine or water-based environments. Other bacteria, like Mycobacterium avium, can cause infections in both people with healthy and weakened immune systems. These types of infections progress slowly and diagnosis is often delayed. Understanding these associations can be useful in deciding the initial treatment.
Risk Factors and Frequency for Hand Infection
Superficial hand infections are common and often seen by hand surgeons, family doctors, and emergency room doctors. These infections mostly occur within the skin, nail edges, fingertips, or tissues just beneath the skin. They usually make up 70% to 85% of all hand infections. While they are typically treated in a clinic without hospitalization, it’s tough to pinpoint the exact number of such infections.
Deep infections of the hand are rarer, but they often need hospital admission, IV antibiotics, and surgery. Each year, hospitals see between 25 to 50 patients admitted due to deep hand infections. Some hospitals even have over 100 admissions related to hand infections annually.
Certain people are more likely to get hand infections. This includes manual laborers who are more prone to minor injuries that can lead to infection. People who use intravenous drugs, those with diabetes, and people with weakened immune systems are also at higher risk.
Compared to healthy individuals, diabetics are more likely to have deeper infections, infections caused by unusual organisms, and may need multiple surgeries to treat an infection. Transplant patients with hand infections stand a higher chance of needing finger amputation, and they tend to stay in the hospital longer than non-transplant patients.
- People taking certain medications for autoimmune conditions are particularly at risk of infection.
- Elderly individuals may also face higher risk due to additional health issues, a weaker skin barrier, and poor blood circulation in the hands and feet.
Signs and Symptoms of Hand Infection
When a doctor meets with a patient, they need to collect a lot of information to determine the right diagnosis and treatment. They need to know the patient’s age, which hand they use more (known as handedness), and what job they do. The patient’s job might make them more likely to get certain conditions or injuries. If the patient has any other health conditions or is on any medication, the doctor needs to know this too, as it might affect their treatment. If the patient has any symptoms like fever, fatigue, or weight loss, the doctor needs to ask about these as well, because they could point to a more serious underlying illness. The doctor will also ask about any previous injuries or surgeries the patient has had, especially to their hands.
If the patient knows, they should tell the doctor when their symptoms started and what caused them. For instance, if their hand was injured or bitten, it can help the doctor decide what kind of antibiotics to give them. It’s also helpful for the doctor to know if the patient has already tried any treatments and whether they’ve helped. If treatment hasn’t worked, it might mean the patient’s condition is more serious and needs a different approach, like surgery or stronger medication.
The doctor will ask the patient about their symptoms in detail to try to figure out what might be causing them. The location and type of pain, redness, swelling, and any discharge can all provide clues. If the patient shows signs of nerve compression, this would also be significant. The doctor will examine the hand and upper extremity closely for any changes in color, swelling, deformity or misalignment, and cuts or open wounds. Marking the outline of any red areas can help track the progress of an infection. The exact location of any tenderness or swelling also gives the doctor information about what parts of the anatomy might be affected.
Apart from typical symptoms like redness and swelling, the doctor will look for specific signs associated with various conditions. Pain and redness around the nail can suggest conditions known as paronychia or eponychia. Redness, swelling, and pain at the tip of the finger might mean the patient has a condition called a felon. A row of little blisters on the finger could signal a viral infection called a herpetic whitlow. Localized redness and swelling, along with a feeling of fluid under the skin, can suggest an abscess.
If redness and swelling don’t improve with antibiotics, it might mean the patient has an abscess, or pocket of pus. Abscesses need to be marked on the skin, as they can appear in different areas including on the surface, between the fingers, or in the palm. Feeling a crackling sensation under the skin might mean the patient has an infection with a type of bacteria that produces gas, and could be indicative of gas gangrene or a serious infection of the skin and tissues underneath. Swelling and pain along the inner part of the finger, combined with pain when the finger is extended, might suggest a condition called flexor tenosynovitis. Similarly, infections of the joints in the hand or wrist can cause pain, redness, and swelling, and these symptoms might worsen with movement.
If a patient is at risk for bone infection or osteomyelitis, they might present with localized redness, pain, and swelling, and possibly a discharging wound. A complete check for nerve and blood vessel functioning should always be conducted and recorded. The presence of symptoms like tingling or numbness might suggest that an infection is putting pressure on certain nerves, such as those in the wrist (also known as the carpal tunnel).
Testing for Hand Infection
Your doctor will check your vital signs like body temperature, heart rate, and more to look for signs of fever or other symptoms that could indicate a wider body illness. They may also run blood tests to count your white blood cells, which typically increase when your body is fighting an infection. They might also test for inflammation markers like the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These tests can help identify an inflammatory response in your body which usually happens when there is an infection. Your doctor may also repeat the CRP test over time to track if your body is responding well to treatment.
Occasionally, samples of blood, fluid, or tissue might also be taken to find out the type of bug causing the infection, and to check what kind of antibiotic would be effective against it. Ideally, these samples should be taken before starting antibiotics for the most accurate results, and this should be routine if there’s a need to remove damaged tissue (a procedure called debridement).
Your doctor might also get some images of the suspected infection site with X-rays or other more advanced imaging techniques if needed. X-rays can show if the infection has affected the bone (osteomyelitis). They can also reveal the presence of objects that don’t normally belong in the body, which can sometimes be the source of the infection. Ultrasounds, CT scans, or MRIs can be used to find and locate pockets of pus (abscesses). These imaging modalities can also help detect life-threatening conditions like gas gangrene or necrotizing fasciitis, which involve serious infections that spread rapidly, causing the affected tissue to die.
Treatment Options for Hand Infection
The treatment for hand infections can vary depending on the specific type of infection. Yet, there are some general guidelines used. Hand infections can often be treated conservatively by immobilizing the hand with a splint, soaking the hand, and keeping the hand elevated. The person is also given antibiotics which act against a broad spectrum of bacteria. Initially, antibiotics that can kill different types of bacteria, both oxygen-needing and non oxygen-needing, are used. This is while the doctors wait for results from the lab which will tell them what specific bacteria are causing the infection, to allow them to sharpen their antibiotic treatment.
While the doctor is waiting for these test results, antibiotics that are known as broad-spectrum antibiotics are used. These antibiotics can work against a variety of different bacteria. The choice of antibiotics can be influenced by the type of injury that led to the infection. MRSA, a type of bacteria, is frequently found in hand infections, so the antibiotic Vancomycin is often used. Piperacillin/tazobactam, another antibiotic, is also used because it works against other various types of bacteria. People with cat bites are usually treated with a combination of amoxicillin and clavulanic acid.
When treating hand infections, it may be necessary to use a minor surgical procedure to make a cut into the infected area to drain it. This could also be necessary if the infected person hasn’t responded to conservative methods, or if the infection has reached deeper structures in the hand.
Chronic paronychia, a long-term condition that causes swelling and redness around the nails, is usually treated by identifying and avoiding triggers, using topical antifungal creams and steroids, and occasionally oral antibiotics to treat any secondary bacterial infections.
In certain situations, even with these measures, the condition doesn’t improve. In these circumstances, small surgical procedures might be needed to drain the infected area or remove part or all of the nail. In extreme cases, a procedure called eponychial fold release might be needed.
Deeper infections that affect structures like the tendons or the spaces between the fingers often need intravenous antibiotics and prompt surgical treatment. Certain cases of flexor tenosynovitis, an infection of the tendon sheath in the fingers, might initially be managed with a course of intravenous antibiotics in a hospital setting. However, the usual treatment for this condition is a small surgical procedure to drain the infection from the sheath that wraps around the tendon.
If left untreated, some forms of flexor tenosynovitis can spread to other parts of the hand. Severe infections, like necrotizing soft tissue infections and gas gangrene, require urgent surgery and a broad-spectrum course of intravenous antibiotics to prevent the person from becoming dangerously unwell. Bone infections, known as osteomyelitis, usually need a long course of intravenous antibiotics and potentially surgery to remove the infected bone. Septic arthritis, a joint infection, requires urgent surgery to clean out the joint in order to prevent long-term problems with joint function.
What else can Hand Infection be?
Identifying an infection usually involves looking at a patient’s health history, conducting a physical exam, and undertaking lab tests. However, there are other non-infectious conditions that cause inflammation and could be mistaken for infections. These include:
- Intensified symptoms of osteoarthritis,
- Crystalline arthritis, a condition resulting from the buildup of crystal deposits in the joints,
- Inflammatory arthropathies, a group of conditions characterized by joint inflammation.
These can be mistaken for septic arthritis, an infection of the joints, but can be distinguished from it through synovial fluid analysis, gram stain, and culture.
There’s also a skin condition called Pyoderma gangrenosum, often linked to a systemic inflammatory disorder, that can make it look like there’s a localized skin and soft tissue infection.
Furthermore, trapped foreign objects or metastasis, the spread of cancer from the original tumor to other parts of the body, can create a local inflammatory response. This might make it appear as if there’s an infection present.
What to expect with Hand Infection
The outcome of hand infections can vary greatly, depending on the type of infection and how quickly it is spotted and treated by the doctor. If the infection is noticed right away, and immediate treatment with the right antibiotics begins, infections on the surface of the skin typically get better, allowing the hand to function normally again.
When infections spread to deeper parts of the hand, the outcome can depend on the duration of infection, the specific areas involved, and whether the treatment with surgery and antibiotics is adequate. With deeper infections, taking care of the hand after surgery and going through structured therapy sessions are key to avoiding problems like tenderness and stiffness in the fingers.
It’s also important to use correct splinting methods, which keep the capsular ligaments (the tissues that help keep your joints together) stretched and leave other healthy joints free to move, in order to retain hand function. Patients may need to see a specialist in hand therapy for supervised movement exercises and controlling swelling, which can greatly help in achieving good outcomes.
Possible Complications When Diagnosed with Hand Infection
Prompt action and proper treatment are crucial to cure the infection and obtain the best outcomes for the patient. If it goes unnoticed or isn’t adequately treated, the infection might spread to neighboring areas, causing more harm to the patient. Mismanagement could bring about physical limitations and problems with the nerves and blood vessels. Complications may include stiffness, tendon tears, joint damage, bone infections, nerve pressure, and wound problems that may need amputation or specialized wound coverings. If infections go untreated or are treated incorrectly, they could turn into severe diseases, blood poisoning (sepsis), and can even cause death.
Known complications:
- Functional limitations
- Neurovascular compromise
- Stiffness
- Tendon rupture
- Joint destruction
- Osteomyelitis (bone infection)
- Nerve compression
- Wound complications leading to amputation or flap coverage
- Severe systemic illness
- Sepsis (Blood poisoning)
- Possibility of death
Preventing Hand Infection
Because there’s a chance of complications, it’s essential that patients understand the warning signs of hand infections. These might include unusual redness, swelling, or pain. If they notice these symptoms, they should seek medical advice immediately. Recognizing and treating infections quickly can stop a small problem from becoming a big one, potentially avoiding the need for surgery. If the patient has a wound, they might get advice from their doctor on how to take care of it. This would cover things like how to clean it, how to keep it dry, and what sort of bandage to use.
