Hand Infections

Bite wounds

Causes

Infections from human or animal bites, are usually associated with several bacteria. In a bite, bacteria from the patients’ skin can be driven deeper under the skin by the tooth puncture, and the common bacteria found in these infections are usually Streptococcus and Staphylococcus. Other bacteria that cause infection come directly from the mouth or teeth of the biter. 

Small puncture wounds, for instance, cat bites, have a higher risk of infection, since only the surface of the skin can be cleansed.

Symptoms

A bite can be mild, moderate, or severe. Some bites may cause breaks in the skin, with or without bleeding. Bruising can also occur. Depending on the severity and location of the bite, you may sustain injury to a joint or tendon. Other symptoms of infection include: 

• Pus discharge from the wound
• Fever or chills
• Redness, swelling, and heat around the affected area
• Pain or tenderness on or around the affected area

Treatment

If you have sustained a small wound, your hand specialist may need to enlarge them for thorough irrigation. While a large open wound is easier to wash out, the fingertip infection treatment options available for patients is also determined by the location of the wound, the degree of contamination, and the tissues involved.

Whenever possible, the wounds should be closed by secondary sutures and mobilisation started as soon as possible. In some cases, secondary healing may be necessary, that is, open wounds are closed later or left to heal on their own.

Oral and topical antibiotics are also commonly used during the treatment of fingertip infections, however, if your condition is severe, your doctor may prescribe you intravenous antibiotics. Severe infections may also require debridement (surgical trimming of infected/crushed tissue). Wounds are usually not closed after initial treatment so that the infection can drain out.

Paronychia

Causes

Paronychia refers to an infection of the skin fold around the fingernail, also known as cuticle area. Paronychia is usually classified into two categories – acute and chronic. 

An acute infection often occurs around the fingernail and develops quickly. Nail-biting, picking, hangnails, manicures, and other physical trauma are some of the common risk factors for acute paronychia. 

Chronic paronychia has a slower onset as compared to acute cases. It usually lasts for several weeks, and is a recurring infection caused by more than one infecting agent – yeast and bacteria. Chronic paronychia is commonly observed in people who constantly work in water, as wet skin and excessive soaking disrupt the natural barrier of the cuticle. This creates an optimal environment for yeast and bacteria to grow and get under the skin, resulting in an infection. 

Symptoms

The symptoms of both acute and chronic paronychia are similar. The main differences between these two conditions are the speed of onset and duration of infection. Patients suffering from paronychia usually observe the following symptoms. 

• Detachment of your nail 
• Pus-filled blisters
• Tenderness of skin around your nail 
• Changes in nail shape, colour, or texture
• Redness of skin around your nail

Treatment 

Your hand specialist may prescribe you with an antibiotic and advise you to reduce or eliminate the exposure to moisture. Your hand specialist may also drain the fluids in your blisters or abscesses to relieve discomfort and speed up the healing process. Sometimes, surgery may be recommended to remove the infected tissue.

Prolonged treatment is common if you suffer from chronic paronychia.

Tendon Sheath Infection (Pyogenic Flexor Tenosynovitis)

Flexor tendons run from the wrist through the palm and to the fingertips to allow the fingers to bend inwards. At the base of the finger, the tendons will enter a pulley system or sheath. When a small cut or puncture wound occurs in the finger, especially if it is near a joint on the palmar side, the canal that the flexor tendon runs through has a risk of being infected. 

Symptoms

Some of the symptoms observed in patients with pyogenic flexor tenosynovitis include: 

• Swelling of the finger
• Redness and tenderness over the palmar side of the finger
• Difficulty or pain when straightening the finger, hence the finger is often in a slightly bent position. 

Treatment

This infection usually requires immediate medical attention and the patient may be admitted to the hospital for surgical drainage of the abscesses to relieve pressure. Intravenous antibiotics are also prescribed.

Felon

Causes

A felon refers to an infection in your fingertip. It typically affects the pulp or pad of your fingertip, causing the small compartments under your skin to fill with pus. This type of fingertip infection often occurs after gardening, nail-cutting or other activities that involve having sharp objects coming into contact with the fingertip. One of the known risk factors for felons is diabetes as these patients often have to undergo multiple finger pricks on a daily basis to check their blood sugar.

Symptoms 

Patients suffering from felon often experience extreme pain at the fingertip of the infected finger, especially when pressure is applied to the surface. Swelling may also be observed at the end of the finger. In some cases, there may be an accumulation of pus. If left untreated, the fingertip may become numb and certain finger movements may be restricted, e.g. pain may be experienced upon bending of infected finger. Hence, receiving fingertip infection treatment early is key to preventing your condition from worsening.

Treatment 

Fingertip infection treatment for felons is often done through minor surgery by hand specialists or surgeons to allow drainage. Your doctor will also prescribe antibiotics to treat the infection. Sometimes, the antibiotics may be changed if the infection does not clear up promptly.

Herpetic Whitlow

Causes

Herpetic whitlow is caused by herpes virus and often results in small blisters forming on the fingers, as well as the fleshy area around the fingertips. This condition is often seen in healthcare workers whose hands are frequently exposed to the saliva of patients carrying herpes. 

Symptoms 

Some of the symptoms associated with herpetic whitlow are: 

• Small, swollen and painful blisters
• Numbness of the affected area 

Treatment

Most herpetic whitlow do not require treatment and will heal on its own within a few weeks. However some hand specialists in Singapore may prescribe antiviral medication to shorten the duration of infection. Other conservative treatment include application of a cold compress to reduce swelling, as well as, thorough cleaning and covering of the wound with gauze.

Deep Space Infection

Causes

Our hand is divided into many separate compartments, also known as deep spaces. One or more of these deep spaces have a risk of becoming infected from a small puncture wound. These infections often affect the thumb area, palm, as well as, the web area between the bases of the fingers. Severe infections, if left untreated, can even spread to other areas, such as the wrist and forearm. 

Symptoms

Patients suffering from deep space infection often experience pain and swelling. 

Treatment 

Your hand specialist will often perform a physical examination and order diagnostic investigations to determine the location of the infection. As deep space infections have the potential to spread to other areas, the treatment will involve a combination of antibiotics, surgical drainage, as well as, proper wound care.

Septic Arthritis/Osteomyelitis

Causes

Septic arthritis is a painful and severe infection in the joint that can come from germs, bacteria or fungus travelling through your bloodstream from another part of your body. Septic arthritis can also be caused by a penetrating injury, such as from an animal bite or trauma delivering germs directly into the joint. 

Infants and older adults are more at risk of developing septic arthritis.

Symptoms 

Septic arthritis usually causes extreme discomfort and difficulty in using the affected joint. Other symptoms include swelling and redness of the affected area. Some patients may also develop a fever. As septic arthritis is severe, when left untreated, it may spread to the bones and cause infection of the bone (osteomyelitis) with rapid destruction of the cartilage.

Treatment

The treatment process typically requires one or more surgical procedures to remove the infected tissue and many patients may also require weeks of intravenous antibiotics.

Every case is different, hence it is best to consult a hand surgeon to determine the treatment method that is most suitable for you. Reach out to us today if you are suffering from a hand infection and let us help you.