Soft Tissue and Bone Infections

  • Rainer R. SchmittEmail author
  • Georgios Christopoulos
Part of the Medical Radiology book series (MEDRAD)


Penetrating injuries and staphylococceal pathogens are the most frequent causes of infections at the hand, with the soft tissues involved in about 95%, and the bones and joints in 5%, only. In soft tissue infections, MRI is mostly necessary for depicting infections of the deep palmar spaces, whereas finger infections are prome to clinical examination. Typically, bone and joint infections are first visible in radiograms two weeks after clinical onset. MRI is powerful in early detection and in the assessment of spreading of both osteomyelitis and infectious arthritis, the adjacent soft tissues included. CT imaging is the modality of choice in the search of sequestra and cloaca when the superficial soft tissues and the skin are involved in chronic osteomyelitis. At the hands, rare infections are of tuberculous, syphilitic, leprous, viral, fungal, and parasitic orgin.


Carpal Tunnel Syndrome Necrotizing Fasciitis Flexor Tendon Tendon Sheath Chronic Osteomyelitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Amadio PC (1998) Fungal infections of the hand. Hand Clin 14:605–612PubMedGoogle Scholar
  2. Barbieri RA, Freeland AE (1998) Osteomyelitis of the hand. Hand Clin 14:589–603PubMedGoogle Scholar
  3. Beltran J (1995) MR imaging of soft tissue infection. MRI Clin North Am 3:743–751Google Scholar
  4. Benkeddache Y, Gottesman H (1982) Skeletal tuberculosis of the wrist and hand: a study of 27 cases. J Hand Surg 7:593–600Google Scholar
  5. Capitanio MA, Kirkpatrick JA (1970) Early roentgen observations in acute osteomyelitis. Am J Roentgenol 108:488–496CrossRefGoogle Scholar
  6. Comstock C, Wolson AM (1975) Roentgenology of sporotrichosis. Am J Roentgenol 125:651–655CrossRefGoogle Scholar
  7. Enna CD, Jacobson RB, Rausch RO (1971) Bone changes in leprosy: a correlation of clinical and radiologic features. Radiology 100:295–299PubMedGoogle Scholar
  8. Erdman WA, Tamburro F, Jayson HT, Weatherall PT, Ferry KB, Peshock RM (1991) Osteomyelitis: characteristics and pitfalls of diagnosis with MR imaging. Radiology 180:533–539PubMedGoogle Scholar
  9. Eustace SJ, Lan HH, Katz J et al (1996) HIV arthritis. Radiol Clin North Am 34:450–453PubMedGoogle Scholar
  10. Gold RH, Hawkins RA, Katz RD (1991) Bacterial osteomyelitis: findings on plain radiographs, CT, MR, and scintigraphy. Am J Roentgenol 157:365–370CrossRefGoogle Scholar
  11. Gonzales MH (1998) Necrotizing fasciitis and gangreane of the upper extremity. Hand Clin 14:635–645Google Scholar
  12. Gonzalez MH, Papierski P, Hall RF (1993) Osteomyelitis of the hand after a human bite. J Hand Surg 18A:520–522Google Scholar
  13. Graif M, Schweitzer ME, Deely D et al (1999) The septic versus nonseptic inflamed joint. MR characteristics. Skeletal Radiol 28:616–620PubMedCrossRefGoogle Scholar
  14. Grey AC, Davies AM, Mangham DC et al (1998) The “penumbra sign” on T1-weighted MR imaging in subacute osteomyelitis: frequency, cause and significance. Clin Radiol 53:587–592PubMedCrossRefGoogle Scholar
  15. Hausman MR, Lisser SP (1992) Hand infections. Orthop Clin North Am 23:171–185PubMedGoogle Scholar
  16. Hoffman KL, Bergman AG, Hoffman DK et al (1996) Tuberculous tenosynovitis of the flexor tendons of the wrist: MR imaging with pathologic correlation. Skeletal Radiol 25:186–188PubMedCrossRefGoogle Scholar
  17. Hopkins KL, Li KCP, Bergman G (1995) Gadolinium-DTPA-enhanced magnetic resonance imaging of musculoskeletal infectious processes. Skeletal Radiol 24:325–330PubMedCrossRefGoogle Scholar
  18. Hoyen HA, Lacey SH, Graham TJ (1998) Atypical hand infections. Hand Clin 14:613–634PubMedGoogle Scholar
  19. Hsu CY, Lu HC, Shih TT (2004) Tuberculous infection of the wrist: MRI features. Am J Roentgenol 183:623–628CrossRefGoogle Scholar
  20. Jaovisidha S, Chen C, Ryu KN et al (1996) Tuberculous tenosynovitis and bursitis: imaging findings in 21 cases. Radiology 201:507–513PubMedGoogle Scholar
  21. Jebson PJL (1998a) Infections of the fingertip. Hand Clin 14:547–555PubMedGoogle Scholar
  22. Jebson PJL (1998b) Deep subfascial space infections. Hand Clin 14:557–566PubMedGoogle Scholar
  23. Jeffrey RB Jr, Laing FC, Schechter WP et al (1997) Acute suppurative tendosynovitis of the hand: diagnosis with US. Radiology 162:471–472Google Scholar
  24. Jones WP (1972) Doigt en lorgnette and concentric bone atrophy associated with healed yaws osteitis. J Bone Joint Surg Br 54:341–345PubMedGoogle Scholar
  25. Kaim AH, Gross T, von Schulthess GK (2002) Imaging of chronic posttraumatic osteomyelitis. Eur Radiol 12:1193–1202PubMedCrossRefGoogle Scholar
  26. Kothari NA, Pelchovitz DJ, Meyer JS (2001) Imaging of musculoskeletal infections. Radiol Clin North Am 39:653–671PubMedCrossRefGoogle Scholar
  27. Langer MF (2009) Pyogenic flexor tendon sheath infection: a comprehensive review. Handchir Mikrocir Plast Chir 41:256–270CrossRefGoogle Scholar
  28. Martinoli C, Derchi LE, Bertolotto M et al (2000) US and MR imaging of peripheral nerves in leprosy. Skeletal Radiol 29:142–150PubMedCrossRefGoogle Scholar
  29. Miller WB, Murphy WA, Gilula LA (1979) Brodie abscess: reappraisal. Radiology 132:15–23PubMedGoogle Scholar
  30. Morrison WB, Schweitzer ME, Bock GW et al (1993) Diagnosis of osteomyelitis. Utility of fat-suppressed contrast-enhanced MR imaging. Radiology 189:251–257PubMedGoogle Scholar
  31. Murray PM (1998) Septic arthritis of the hand and wrist. Hand Clin 14:579–587PubMedGoogle Scholar
  32. Patriquin HB, Trias A, Jecquier S et al (1981) Late sequelae of infantile meningococcemia in growing bones of children. Radiology 141:77–82PubMedGoogle Scholar
  33. Peterson JJ, Bancroft LW, Kransdorf MJ (2002) Wooden foreign bodies: imaging appearance. Am J Roentgenol 178:557–562CrossRefGoogle Scholar
  34. Pineda C, Espinosa R, Pena A (2009) Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg 23:80–89PubMedCrossRefGoogle Scholar
  35. Reilly KE, Linz JC, Stern PJ, Giza E, Wyrick JD (1997) Osteomyelitis of the tubular bones of the hand. J Hand Surg Am 22:539–644CrossRefGoogle Scholar
  36. Resnick D (1976) Osteomyelitis and septic arthritis complicating hand injuries and infections: pathogenesis of roentgenographic abnormalities. J Can Assoc Radiol 27:21–28PubMedGoogle Scholar
  37. Sachdev M, Bery K, Chawla S (1982) Osseous manifestations in congenital syphilis: a study of 55 cases. Clin Radiol 33:319–323PubMedCrossRefGoogle Scholar
  38. Samuel E (1950) Roentgenology of parasitic calcification. Am J Roentgenol 63:512–522Google Scholar
  39. Santiago-Restrepo C, Giménez CR, McCarthy K (2003) Imaging of osteomyelitis and musculoskeletal soft tissue infections: current concepts. Rheum Dis Clin North Am 29:89–109PubMedCrossRefGoogle Scholar
  40. Schauwecker DS (1989) Osteomyelitis: diagnosis with In-111-labeled leukocytes. Radiology 171:141–146PubMedGoogle Scholar
  41. Towers JD (1997) The use of intravenous contrast in MRI of extremity infection. Semin Ultrasound CT MR 18:269–275PubMedCrossRefGoogle Scholar
  42. Tsai E, Failla JM (1999) Hand infections in the trauma patient. Hand Clin 15:373–386PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Institut für Diagnostische und Interventionelle RadiologieHerz- und Gefäss-Klinik GmbHBad Neustadt an der SaaleGermany

Personalised recommendations