Hand & Finger Infections

See Paronychia for acute and chronic paronychia (nail-fold infection) — this page covers the other, deeper hand and finger infections.

Condition

Although less common than in the past, serious suppurative infections of the deep fascial spaces of the hand and tendon sheath can still occur, especially with penetrating injuries and web-space infection.

Infections of the hand include:

• Infected wounds with superficial cellulitis or lymphangitis (Streptococcus pyogenes).
• Subcutaneous tissue infections — nail bed (paronychia), pulp (whitlow, e.g. herpes simplex).
• Erysipeloid — a specific infection of one finger in fishers or meat handlers, caused by Erysipelothrix insidiosa. Purplish erythema gradually extends over days; rapidly cured by penicillin.
• Tendon sheath infection (suppurative tenosynovitis) — a dangerous, painful infection that can cause synovial adhesions with severe residual finger stiffness. The affected finger is hot and swollen, and looks like a sausage.
• Aquarium”/“swimming pool” granuloma — a non-painful tendon-sheath infection due to Mycobacterium marinum following a minor cut of the finger; doxycycline or clarithromycin is usually effective, but refer to an infectious diseases physician.
• Deep palmar fascial space infection — infection from an infected tendon sheath or web space may spread to one of the two deep palmar spaces: the medial (midpalmar) space or lateral (thenar) space.
• Sporotrichosis (“gardener’s arm”) — a chronic fungal infection from contaminated spikes of wood or rose thorns, presenting as hard, non-tender nodules in the skin of the hand and extending along the lymphatics of the arm. Diagnosis confirmed by biopsy. Treat with itraconazole.

Management of serious infection

Early appropriate antibiotic treatment for infection, and early surgical referral where necessary.

Antibiotics (adult doses) for Streptococcus pyogenes (mild-moderate cellulitis, lymphangitis):

• Procaine penicillin 1.5g IM daily for 3–7 days, or
• Phenoxymethylpenicillin 500mg orally 6-hourly for 10 days.

If severe, to cover both S. pyogenes and Staphylococcus aureus (suspected or proven): flucloxacillin/dicloxacillin 2g IV 6-hourly until improved, then oral for 10 days.