Hand Infections-1

Hand Infections-1 - Hand Infections Overview Cellulitis...

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Hand Infections
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Overview Cellulitis Paronychia/eponychia Felon Herpetic Whitlow Flexor tenosynovitis
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Deep fascial space infections Septic arthritis Osteomyelitis Fight Bites
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Cellulitis of the hand Involves only the skin – erythema, edema, pain of localized area MUST document that deeper structures are not involved- beware the dorsal hand cellulitis! Full painless ROM of digits, hand, wrist No tenderness on palpation of deeper structures Strep pyogenes Occasionally S. aureus
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Cellulitis of the Hand Treatment Immobilize Elevate Antibiotics – Keflex, Augmentin, Diclox Disposition D/c home with 24 h follow up unless… Immunocompromised Systemically ill Rapidly spreading
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Paronychia Localized superficial infection or abcess of the lateral nail fold Most common infection in the hand Caused by frequent trauma to area Swelling and tenderness of the soft tissue next to the nail fold May have associated cellulitis
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Paronychia If extends to overlying proximal nail: eponychia S. aureus Thumb sucking/nail biting – anaerobes Chronic – candida Treatment Early Cellulitis Soaks, elevation, antibiotics (Keflex…)
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Paronychia Fluctuant – all of the above, plus… Drain May need anesthesia (digital block) Soften by soaking 11 blade If severe infection with purulent drainage beneath nail, requires removal of a portion of the nail Follow up 24-48 h. Most resolve in 5-10 days
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Paronychia Complication… Osteo of distal phalanx Refer to a hand surgeon. .
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Infection of the pulp of the distal finger or thumb Septa Facilitate infection
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Hand Infections-1 - Hand Infections Overview Cellulitis...

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