Hand Infections

  • Anthony Barabas
  • Andrew N. M. FlemingEmail author


The hand is vulnerable to injury as mankind’s primary tactile interface and tool for manipulating the physical world. The hands unique, compartmentalised anatomy and complexity of structure results in an abundant variety of possible hand infections. Each infection has its own characteristic presentation and patho-physiology which must be recognised and understood for successful treatment.


Hand infection Paronychia Herpetic whitlow Felon Flexor Tenosynovitis Bursal infections Deep space infections Septic arthritis Osteomyelitis Necrotising fasciitis Bite injuries Mycobacterial infections Fungal infections 


  1. 1.
    Louis DS, Jebson PJ. Mimickers of hand infections. Hand Clin. 1998;14(4):519–29, vii.PubMedGoogle Scholar
  2. 2.
    Brown DM, Young VL. Hand infections. South Med J. 1993;86(1):56–66.PubMedCrossRefGoogle Scholar
  3. 3.
    Hausman MR, Lisser SP. Hand infections. Orthop Clin North Am. 1992;23(1):171–85.PubMedGoogle Scholar
  4. 4.
    Boles SD, Schmidt CC. Pyogenic flexor tenosynovitis. Hand Clin. 1998;14(4):567–78.PubMedGoogle Scholar
  5. 5.
    Connolly B, Johnstone F, Gerlinger T, Puttler E. Methicillin-resistant Staphylococcus aureus in a finger felon. J Hand Surg Am. 2000;25(1):173–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Karanas YL, Bogdan MA, Chang J. Community acquired methicillin-resistant Staphylococcus aureus hand infections: case reports and clinical implications. J Hand Surg Am. 2000;25(4):760–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Hochman LG. Paronychia: more than just an abscess. Int J Dermatol. 1995;34(6):385–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Canales FL, Newmeyer 3rd WL, Kilgore Jr ES. The treatment of felons and paronychias. Hand Clin. 1989;5(4):515–23.PubMedGoogle Scholar
  9. 9.
    Brook I. Aerobic and anaerobic microbiology of paronychia. Ann Emerg Med. 1990;19(9):994–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Rockwell PG. Acute and chronic paronychia. Am Fam Physician. 2001;63(6):1113–6.PubMedGoogle Scholar
  11. 11.
    Jebson PJ. Infections of the fingertip. Paronychias and felons. Hand Clin. 1998;14(4):547–55, viii.PubMedGoogle Scholar
  12. 12.
    McDonald LS, Bavaro MF, Hofmeister EP, Kroonen LT. Hand infections. J Hand Surg Am. 2011;36(8):1403–12.PubMedCrossRefGoogle Scholar
  13. 13.
    Wu IB, Schwartz RA. Herpetic whitlow. Cutis. 2007;79:193–6.PubMedGoogle Scholar
  14. 14.
    White WB, Grant-Kels JM. Transmission of herpes simplex virus type 1 infection in rugby players. JAMA. 1984;252(4):533–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Selling B, Kibrick S. An outbreak of herpes simplex among wrestlers (herpes gladiatorum). N Engl J Med. 1964;270:979–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Belongia EA, Goodman JL, Holland EJ, et al. An outbreak of herpes gladiatorum at a high-school wrestling camp. N Engl J Med. 1991;325(13):906–10.PubMedCrossRefGoogle Scholar
  17. 17.
    Fatahzadeh MSRA. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis and management. J Am Acad Dermatol. 2007;57(5):737–63.PubMedCrossRefGoogle Scholar
  18. 18.
    Clark DC. Common acute hand infections. Am Fam Physician. 2003;68(11):2167–76.PubMedGoogle Scholar
  19. 19.
    Gill MJ, Arlette J, Buchan K, Tyrrell DL. Therapy for recurrent herpetic whitlow. Ann Intern Med. 1986;105:631.PubMedCrossRefGoogle Scholar
  20. 20.
    Stern PJ. Selected acute infections. Instr Course Lect. 1990;39:539–46.PubMedGoogle Scholar
  21. 21.
    Watson PA, Jebson PJ. The natural history of the neglected felon. Iowa Orthop J. 1996;16:164–6.PubMedCentralPubMedGoogle Scholar
  22. 22.
    Moran GJ, Talan DA. Hand infections. Emerg Med Clin North Am. 1993;11(3):601–19.PubMedGoogle Scholar
  23. 23.
    Harrison BP, Hilliard MW. Emergency department evaluation and treatment of hand injuries. Emerg Med Clin North Am. 1999;17(4):793–822, v.PubMedCrossRefGoogle Scholar
  24. 24.
    Reid W, Draeger RW, Bynum Jr DK. Flexor tendon sheath infections of the hand. J Am Acad Orthop Surg. 2012;20(6):373–82.CrossRefGoogle Scholar
  25. 25.
    Abrams RA, Botte MJ. Hand infections: treatment recommendations for specific types. J Am Acad Orthop Surg. 1996;4(4):219–30.PubMedGoogle Scholar
  26. 26.
    Kanavel AB, editor. Infections of the hand. 7th ed. Philadelphia: Lea & Febiger; 1939.Google Scholar
  27. 27.
    Pang HN, Teoh LC, Yam AK, Lee JY, Puhaindran ME, Tan AB. Factors affecting the prognosis of pyogenic flexor tenosynovitis. J Bone Joint Surg Am. 2007;89(8):1742–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Neviaser RJ, Gunther SF. Tenosynovial infections in the hand: diagnosis and management. Instr Course Lect. 1980;29:108–28.Google Scholar
  29. 29.
    Gutowski KA, Ochoa O, Adams Jr WP. Closed-catheter irrigation is as effective as open drainage for treatment of pyogenic flexor tenosynovitis. Ann Plast Surg. 2002;49(4):350–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Lille S, Hayakawa T, Neumeister MW, Brown RE, Zook EG, Murray K. Continuous postoperative catheter irrigation is not necessary for the treatment of suppurative flexor tenosynovitis. J Hand Surg Br. 2000;25(3):304–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Henry M. Septic flexor tenosynovitis. J Hand Surg Am. 2011;36(2):322–3.PubMedCrossRefGoogle Scholar
  32. 32.
    Wain RAJ, Shah HA, Laitung JKG. Continous flexor sheath irrigation: a cautionary tale. J Hand Surg Eur Vol. 2012;37(E)(9):904–5.CrossRefGoogle Scholar
  33. 33.
    Pollen AG. Acute infection of the tendon sheaths. Hand. 1974;6(1):21–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Harris PA, Nanchahal J. Closed continuous irrigation in the treatment of hand infections. J Hand Surg Br. 1999;24(3):328–33.PubMedCrossRefGoogle Scholar
  35. 35.
    Plancher KD, editor. Masterclasses: hand and wrist surgery. Thieme, 2004.Google Scholar
  36. 36.
    Burkhalter WE. Deep space infections. Hand Clin. 1989;5(4):553–9.PubMedGoogle Scholar
  37. 37.
    Wolfe SW, editor. Green’s operative hand surgery. 6th ed. Churchill Livingstone, 2010.Google Scholar
  38. 38.
    Freeland AE, Senter BS. Septic arthritis and osteomyelitis. Hand Clin. 1989;5(4):533–52.PubMedGoogle Scholar
  39. 39.
    Sammer DM, Shin AY. Comparison of arthroscopic and open treatment of septic arthritis of the wrist. J Bone Joint Surg Am. 2009;91(6):1387–93.PubMedCrossRefGoogle Scholar
  40. 40.
    Sammer DM, Shin AY. Arthroscopic management of septic arthritis of the wrist. Hand Clin. 2011;27(3):331–4.PubMedCrossRefGoogle Scholar
  41. 41.
    Aydin N, Uraloglu M, Yilmaz Burhanoglu AD, Sensoz O. A prospective trial on the use of antibiotics in hand surgery. Plast Reconstr Surg. 2010;126(5):1617–23.PubMedCrossRefGoogle Scholar
  42. 42.
    Gaston RG, Kuremsky MA. Postoperative infections: prevention and management. Hand Clin. 2010;26(2):265–80.PubMedCrossRefGoogle Scholar
  43. 43.
    Rao N, Ziran BH, Lipsky BA. Treating osteomyelitis: antibiotics and surgery. Plast Reconstr Surg. 2011;127 Suppl 1:177S–87.PubMedCrossRefGoogle Scholar
  44. 44.
    Kleinert JM, Hoffmann J, Miller Crain G, Larsen CF, Goldsmith LJ, Firrell JC. Postoperative infection in a double-occupancy operating room. A prospective study of two thousand four hundred and fifty-eight procedures on the extremities. J Bone Joint Surg Am. 1997;79(4):503–13.PubMedGoogle Scholar
  45. 45.
    Reilly KE, Linz JC, Stern PJ, Giza E, Wyrick JD. Osteomyelitis of the tubular bones of the hand. J Hand Surg Am. 1997;22(4):644–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Cierny 3rd G. Surgical treatment of osteomyelitis. Plast Reconstr Surg. 2011;127 Suppl 1:190S–204.PubMedCrossRefGoogle Scholar
  47. 47.
    Cierny 3rd G, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res. 2003;414:7–24.PubMedCrossRefGoogle Scholar
  48. 48.
    Marr JS, Beck AM, Lugo Jr JA. An epidemiologic study of the human bite. Public Health Rep. 1979;94(6):514–21.PubMedCentralPubMedGoogle Scholar
  49. 49.
    Perron AD, Miller MD, Brady WJ. Orthopedic pitfalls in the ED: fight bite. Am J Emerg Med. 2002;20(2):114–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Wallace CG, Robertson CE. Prospective audit of 106 consecutive human bite injuries: the importance of history taking. Emerg Med J. 2005;22(12):883–4.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Mennen U, Howells CJ. Human fight-bite injuries of the hand. A study of 100 cases within 18 months. J Hand Surg Br. 1991;16(4):431–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Zubowicz VN, Gravier M. Management of early human bites of the hand: a prospective randomized study. Plast Reconstr Surg. 1991;88(1):111–4.PubMedCrossRefGoogle Scholar
  53. 53.
    Henry FP, Purcell EM, Eadie PA. The human bite injury: a clinical audit and discussion regarding the management of this alcohol fuelled phenomenon. Emerg Med J. 2007;24(7):455–8.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Goldstein EJ, Citron DM, Wield B, Blachman U, Sutter VL, Miller TA, et al. Bacteriology of human and animal bite wounds. J Clin Microbiol. 1978;8(6):667–72.PubMedCentralPubMedGoogle Scholar
  55. 55.
    Lacroix JM, Walker C. Characterization of a beta-lactamase found in Eikenella corrodens. Antimicrob Agents Chemother. 1991;35(5):886–91.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Hamilton JD, Larke B, Qizilbash A. Transmission of hepatitis B by a human bite: an occupational hazard. Can Med Assoc J. 1976;115(5):439–40.PubMedCentralPubMedGoogle Scholar
  57. 57.
    Figueiredo JF, Borges AS, Martinez R, Martinelli Ade L, Villanova MG, Covas DT, et al. Transmission of hepatitis C virus but not human immunodeficiency virus type 1 by a human bite. Clin Infect Dis. 1994;19(3):546–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Andreo SM, Barra LA, Costa LJ, Sucupira MC, Souza IE, Diaz RS. HIV type 1 transmission by human bite. AIDS Res Hum Retroviruses. 2004;20(4):349–50.PubMedCrossRefGoogle Scholar
  59. 59.
    Harrison M. A 4-year review of human bite injuries presenting to emergency medicine and proposed evidence-based guidelines. Injury. 2009;40(8):826–30.PubMedCrossRefGoogle Scholar
  60. 60.
    Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005;41(10):1373–406.PubMedCrossRefGoogle Scholar
  61. 61.
    Aghababian RV, Conte Jr JE. Mammalian bite wounds. Ann Emerg Med. 1980;9(2):79–83.PubMedCrossRefGoogle Scholar
  62. 62.
    Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995;33(6):1019–29.PubMedCrossRefGoogle Scholar
  63. 63.
    Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest. 1996;110(1):219–29.PubMedCrossRefGoogle Scholar
  64. 64.
    Andreasen TJ, Green SD, Childers BJ. Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans. Plast Reconstr Surg. 2001;107(4):1025–35.PubMedCrossRefGoogle Scholar
  65. 65.
    Schecter W, Meyer A, Schecter G, Giuliano A, Newmeyer W, Kilgore E. Necrotizing fasciitis of the upper extremity. J Hand Surg Am. 1982;7(1):15–20.PubMedCrossRefGoogle Scholar
  66. 66.
    Wilkerson R, Paull W, Coville FV. Necrotizing fasciitis. Review of the literature and case report. Clin Orthop Relat Res. 1987;216:187–92.PubMedGoogle Scholar
  67. 67.
    Giuliano A, Lewis Jr F, Hadley K, Blaisdell FW. Bacteriology of necrotizing fasciitis. Am J Surg. 1977;134(1):52–7.PubMedCrossRefGoogle Scholar
  68. 68.
    Huang KF, Hung MH, Lin YS, Lu CL, Liu C, Chen CC, et al. Independent predictors of mortality for necrotizing fasciitis: a retrospective analysis in a single institution. J Trauma. 2011;71(2):467–73; discussion 73.PubMedCrossRefGoogle Scholar
  69. 69.
    Schmid MR, Kossmann T, Duewell S. Differentiation of necrotizing fasciitis and cellulitis using MR imaging. AJR Am J Roentgenol. 1998;170(3):615–20.PubMedCrossRefGoogle Scholar
  70. 70.
    Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41.PubMedCrossRefGoogle Scholar
  71. 71.
    Golger A, Ching S, Goldsmith CH, Pennie RA, Bain JR. Mortality in patients with necrotizing fasciitis. Plast Reconstr Surg. 2007;119(6):1803–7.PubMedCrossRefGoogle Scholar
  72. 72.
    Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS. Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery. 1990;108(5):847–50.PubMedGoogle Scholar
  73. 73.
    Kishi K, Hirai K, Hiramatsu K, Yamasaki T, Nasu M. Clindamycin suppresses endotoxin released by ceftazidime-treated Escherichia coli O55:B5 and subsequent production of tumor necrosis factor alpha and interleukin-1 beta. Antimicrob Agents Chemother. 1999;43(3):616–22.PubMedCentralPubMedGoogle Scholar
  74. 74.
    van Langevelde P, van Dissel JT, Ravensbergen E, Appelmelk BJ, Schrijver IA, Groeneveld PH. Antibiotic-induced release of lipoteichoic acid and peptidoglycan from Staphylococcus aureus: quantitative measurements and biological reactivities. Antimicrob Agents Chemother. 1998;42(12):3073–8.PubMedCentralPubMedGoogle Scholar
  75. 75.
    Elhassan BT, Wynn SW, Gonzalez MH. Atypical infections of the hand. J Am Soc Surg Hand. 2004;4(1):42–9.CrossRefGoogle Scholar
  76. 76.
    Al-Qattan MM, Al-Namla A, Al-Thunayan A, Al-Omawi M. Tuberculosis of the hand. J Hand Surg Am. 2011;36(8):1413–21; quiz 22.PubMedCrossRefGoogle Scholar
  77. 77.
    Wynn SW, Elhassan BT, Gonzalez MH. Infections of the hand in the immunocompromised host. J Am Soc Surg Hand. 2004;4(2):121–7.CrossRefGoogle Scholar
  78. 78.
    Lakhanpal S, Linscheid RL, Ferguson RH, Ginsburg WW. Tuberculous fasciitis with tenosynovitis. J Rheumatol. 1987;14(3):621–4.PubMedGoogle Scholar
  79. 79.
    Evanchick CC, Davis DE, Harrington TM. Tuberculosis of peripheral joints: an often missed diagnosis. J Rheumatol. 1986;13(1):187–9.PubMedGoogle Scholar
  80. 80.
    Martini M, Benkeddache Y, Medjani Y, Gottesman H. Tuberculosis of the upper limb joints. Int Orthop. 1986;10(1):17–23.PubMedGoogle Scholar
  81. 81.
    al-Qattan MM, Bowen V, Manktelow RT. Tuberculosis of the hand. J Hand Surg Br. 1994;19(2):234–7.PubMedCrossRefGoogle Scholar
  82. 82.
    Subasi M, Bukte Y, Kapukaya A, Gurkan F. Tuberculosis of the metacarpals and phalanges of the hand. Ann Plast Surg. 2004;53(5):469–72.PubMedCrossRefGoogle Scholar
  83. 83.
    Hooker RP, Eberts TJ, Strickland JA. Primary inoculation tuberculosis. J Hand Surg Am. 1979;4(3):270–3.PubMedCrossRefGoogle Scholar
  84. 84.
    Andronikou S, Smith B. “Spina ventosa”-tuberculous dactylitis. Arch Dis Child. 2002;86(3):206.PubMedCentralPubMedCrossRefGoogle Scholar
  85. 85.
    Wang MN, Chen WM, Lee KS, Chin LS, Lo WH. Tuberculous osteomyelitis in young children. J Pediatr Orthop. 1999;19(2):151–5.PubMedCrossRefGoogle Scholar
  86. 86.
    Bhargava AD, Malaviya AN, Kumar A. Tuberculous rheumatism (Poncet’s disease): a case series. Indian J Tuberc. 1998;45:215–20.Google Scholar
  87. 87.
    Falkinham 3rd JO. Epidemiology of infection by nontuberculous mycobacteria. Clin Microbiol Rev. 1996;9(2):177–215.PubMedCentralPubMedGoogle Scholar
  88. 88.
    Hurst LC, Amadio PC, Badalamente MA, Ellstein JL, Dattwyler RJ. Mycobacterium marinum infections of the hand. J Hand Surg Am. 1987;12(3):428–35.PubMedCrossRefGoogle Scholar
  89. 89.
    Chow SP, Stroebel AB, Lau JH, Collins RJ. Mycobacterium marinum infection of the hand involving deep structures. J Hand Surg Am. 1983;8(5 Pt 1):568–73.PubMedCrossRefGoogle Scholar
  90. 90.
    Scollard DM, Adams LB, Gillis TP, Krahenbuhl JL, Truman RW, Williams DL. The continuing challenges of leprosy. Clin Microbiol Rev. 2006;19(2):338–81.PubMedCentralPubMedCrossRefGoogle Scholar
  91. 91.
    al-Qattan MM. Opportunistic mycotic infections of the upper limb. A review. J Hand Surg Br. 1996;21(2):148–50.PubMedCrossRefGoogle Scholar
  92. 92.
    Eo S, Jones NF. Fungal infections of the hand and upper extremity. J Am Soc Surg Hand. 2004;4(4):250–5.CrossRefGoogle Scholar
  93. 93.
    Amadio PC. Fungal infections of the hand. Hand Clin. 1998;14(4):605–12.PubMedGoogle Scholar
  94. 94.
    Rodgers P, Bassler M. Treating onychomycosis. Am Fam Physician. 2001;63(4):663–72, 77–8.PubMedGoogle Scholar
  95. 95.
    Hitchcock TF, Amadio PC. Fungal infections. Hand Clin. 1989;5(4):599–611.PubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Plastic SurgeryHinchingbrooke HospitalHuntingdonUK
  2. 2.Department of Plastic SurgerySt Georges HospitalLondonUK

Personalised recommendations