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Hand Infections

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Dr Jacqueline Tan

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Hand infections are common and can affect individuals of all ages. They occur when bacteria, viruses, or fungi invade tissues in the hand, causing inflammation and other symptoms. These infections can result in significant complications, including stiffness, weakness, and even the loss of tissues such as skin, nerves, or bone.

With various causes and types, such as paronychia and felon, prompt recognition and treatment are necessary to prevent long-term damage.

Symptoms of Hand Infections

Hand infections often present with symptoms such as redness, swelling, pain, warmth, or pus discharge. Fever or chills may accompany more severe infections. Specific symptoms vary according to the type of infection.

Causes and Risk Factors

Hand infections can arise from various sources and risk factors. Common causes include:

  • Injuries or Puncture Wounds: Cuts, scratches, or punctures provide a pathway for bacteria to enter, especially if the wound is not cleaned properly.
  • Bite Wounds: Animal or human bites can introduce harmful bacteria, especially from the biter’s saliva, increasing the risk of infection.
  • Diabetes: People with diabetes may be more susceptible to hand infections due to frequent finger pricks and reduced immune function.
  • Wet Environments: Prolonged exposure to water can weaken the skin’s natural barrier, increasing infection risk, especially in chronic paronychia.
  • Post-Surgical Infection: Rarely, infections may occur after surgery, requiring prompt medical intervention.

Types of Hand Infections

Hand infections are classified based on their location, severity, and the tissues they affect.Each type has distinct symptoms, causes, and treatment approaches.

Bite Wounds

Bite wounds result from human or animal bites and often lead to infections due to bacteria introduced during the bite. The biter’s saliva or the patient’s skin bacteria can enter deeper tissues through punctures, especially in smaller wounds that are difficult to clean thoroughly.

Symptoms
Bite wounds can cause redness, swelling, and warmth around the affected area. They may result in pus discharge and tenderness. In more severe cases, the bite can damage joints or tendons, leading to additional complications. Fever or chills may indicate a more widespread infection.

Causes
Infections are typically caused by bacteria such as Streptococcus and Staphylococcus. Bacteria from the biter’s mouth or teeth are introduced into the tissue. Small puncture wounds, such as those from cat bites, are particularly prone to infection.

Treatment
Treatment may involve irrigation of the wound, sometimes requiring enlargement for thorough cleaning. Antibiotics are often prescribed, either topically, orally, or intravenously for more severe cases. Debridement, or surgical trimming of infected tissue, is sometimes necessary. Wounds are often left open initially to allow proper drainage before being sutured later.

Paronychia

Paronychia is an infection of the skin fold around the fingernail, typically caused by bacteria or yeast. It is classified as acute or chronic, depending on how quickly it develops and its duration.

Symptoms
Symptoms include redness and tenderness around the nail, with pus-filled blisters often forming. The nail may detach, and its colour, shape, or texture may change. Chronic cases may have less noticeable symptoms but persist for extended periods.

Causes
Acute paronychia is commonly linked to trauma, such as nail-biting or hangnails. Chronic cases often result from repeated exposure to moisture, which creates an environment suitable for bacterial or yeast infections.

Treatment
Management includes antibiotics and drainage of abscesses or blisters. Chronic cases may require longer courses of treatment and lifestyle adjustments to minimise exposure to water. In severe cases, surgery may be needed to remove infected tissue.

Felon

A felon is a deep infection of the fingertip, usually affecting the pulp or pad. This infection leads to compartmentalised pus formation under the skin, causing significant discomfort and swelling.

Symptoms
Felons typically cause intense pain in the fingertip, especially when pressure is applied. The area may appear swollen, with visible or palpable pus accumulation. In advanced cases, the fingertip may become numb, and finger movement can be restricted, making everyday activities challenging.

Causes
Felons often result from injuries such as puncture wounds, gardening accidents, or improper nail-cutting. Patients with diabetes are at a higher risk due to frequent finger pricks for blood sugar monitoring.

Treatment
Treatment involves minor surgical drainage to release pus and alleviate pressure. Antibiotics are commonly prescribed, and adjustments may be necessary if the initial treatment does not resolve the infection.

Tendon Sheath Infection (Pyogenic Flexor Tenosynovitis)

This infection affects the protective sheath that surrounds the flexor tendons, which allow the fingers to bend and move smoothly. When bacteria enter the sheath, it can lead to inflammation and fluid accumulation, disrupting normal tendon function and causing pain.

Symptoms
Patients with tendon sheath infections often experience swelling along the length of the finger, particularly on the palm-facing side. The finger may be held in a slightly bent position due to pain and stiffness, as straightening it becomes uncomfortable. Redness, tenderness, and warmth are common, and severe cases may restrict hand movement.

Causes
This condition is typically caused by bacteria entering the tendon sheath through small cuts, puncture wounds, or bites, particularly those located near joints. Once inside, the bacteria can multiply rapidly, triggering infection and inflammation if untreated.

Treatment
Treatment involves immediate surgical drainage to relieve pressure and remove infected material from the sheath. Intravenous antibiotics are administered to eliminate the bacterial infection and prevent it from spreading to surrounding tissues.

Deep Space Infection

Deep space infections occur within the defined compartments of the hand, including the thumb, palm, or web spaces between the fingers. They can also spread to neighbouring areas, such as the wrist or forearm, causing complications that may require more extensive treatment.

Symptoms
Pain and swelling are the primary symptoms of deep space infections. The affected area may feel stiff, and hand function can be significantly reduced. Severe cases may result in redness and warmth spreading to nearby tissues.

Causes
Infections in deep spaces often result from puncture wounds or the spread of a nearby infection. The condition can escalate quickly, involving surrounding structures like the wrist or forearm.

Treatment
Treatment includes a combination of surgical drainage to clear the infection and antibiotics to address the bacterial cause. Diagnostic imaging may be used to determine the location of infection.

Herpetic Whitlow

Herpetic whitlow is a viral infection that affects the fingers, typically caused by the herpes simplex virus. This infection is commonly seen in individuals who have frequent contact with saliva or bodily fluids, such as healthcare workers or those caring for someone with oral herpes.

Symptoms
Patients typically notice small, fluid-filled blisters that are swollen and painful. The affected area may also feel numb or tingling, which can make activities involving hand use uncomfortable. In some cases, redness and mild swelling extend beyond the blistered area.

Causes
Herpetic whitlow occurs when the herpes simplex virus enters the skin through breaks such as small cuts, abrasions, or cracked skin. It is often transmitted via contact with infected saliva, mucous membranes, or open sores, making direct exposure a key risk factor.

Treatment
Herpetic whitlow often resolves on its own within a few weeks. Antiviral medications may be prescribed to shorten the duration. Wound care and cold compresses can provide symptomatic relief.

Septic Arthritis and Osteomyelitis

Septic arthritis is a joint infection caused by bacteria, fungi, or other microorganisms that invade the joint space, leading to inflammation and cartilage damage. Osteomyelitis is an infection of the bone, often affecting its marrow and structure. Both conditions require urgent treatment to prevent severe complications, including permanent tissue damage or systemic infection.

Symptoms
Patients may experience intense pain and swelling in the affected joint or bone. Movement becomes restricted, and redness and warmth are often present. Fever is a common accompanying symptom, indicating systemic involvement.

Causes
These infections can result from penetrating injuries, such as bites or trauma, or from bacteria travelling through the bloodstream. Infants and older adults are at greater risk.

Treatment
Treatment typically requires surgical removal of infected tissue. Patients often need weeks of intravenous antibiotics to address the infection. Delay in treatment may result in permanent joint or bone damage.

Diagnosis of Hand Infections

Physical Examination

A comprehensive evaluation involves assessing visible signs such as swelling, redness, warmth, and tenderness, along with testing the range of motion. This is often combined with a review of the patient’s medical history to identify potential causes or risk factors for infection.

Imaging Studies

Techniques like X-rays, ultrasound, or MRI scans are used to examine deeper tissues, detect fluid accumulation, or identify damage to bones and joints. These methods also help differentiate between soft tissue infections and more severe conditions like osteomyelitis.

Laboratory Tests

Blood tests are performed to check for systemic signs of infection, such as elevated white blood cell counts or inflammatory markers. Wound cultures are taken to identify the specific microorganism responsible for the infection, which helps determine the most effective antibiotic treatment.

Needle Aspiration

In cases where infections involve joints or deep abscesses, fluid is drawn using a needle and syringe. The sample is sent for analysis to confirm the presence of infection.

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Prevention and Management

Preventing hand infections involves regular hand hygiene, prompt wound care, and avoiding prolonged exposure to wet or contaminated environments. Individuals with underlying conditions like diabetes should take extra precautions, including careful wound monitoring and prompt medical attention for any signs of infection.

Frequently Asked Questions

Can hand infections cause permanent damage?

Yes, if left untreated, hand infections can lead to long-term complications, including joint stiffness, reduced mobility, or permanent loss of function in the affected hand.

Is it normal for a hand infection to cause swollen lymph nodes?

Yes, swollen lymph nodes near the affected area, such as in the armpit or elbow, may occur as the body’s immune system responds to the infection.

How can I differentiate between a fungal and bacterial hand infection?

Fungal infections often cause symptoms like itching, redness, and scaling of the skin, while bacterial infections are more likely to result in swelling, pus formation, and warmth around the affected area.

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Dr Jacqueline Tan

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

  • Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
  • Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
  • Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
  • Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

Widely Published
In hand surgery

Active In
Academic Teaching

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    Mt Elizabeth Novena Hospital

    38 Irrawaddy Road #07-42
    Singapore 329563

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