J Am Acad Orthop Surg 2014 Mar;22(3):165-74

Acute and chronic infections and inflammation adjacent to the fingernail, or paronychia, are common. Paronychia typically develops following a breakdown in the barrier between the nail plate and the adjacent nail fold and is often caused by bacterial or fungal pathogens; however, noninfectious etiologies, such as chemical irritants, excessive moisture, systemic conditions, and medications, can cause nail changes. Abscesses associated with acute infections may spontaneously decompress or may require drainage and local wound care along with a short course of appropriate antibiotics. Read More

J Hand Surg Am 2013 Jun 3;38(6):1189-93. Epub 2013 May 3.

Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA; and the Rothman Institute; Philadelphia, PA 15213, USA.

Purpose: To define the current epidemiology of adult acute hand infections in an urban setting, with the aim of helping to improve empiric treatment, as hand infections represent a major source of morbidity and can result in stiffness and, possibly, amputation.

Methods: We performed an electronic medical record search to identify all patients admitted to our urban academic medical center with diagnoses related to open wounds and infections in the hand and fingers over a 6-year period (2005-2010). We recorded demographic data, location of infection, medical comorbidities, and culture data. Read More

Int J Low Extrem Wounds 2012 Sep 2;11(3):174-6. Epub 2012 Aug 2.

Shanghai Jiao Tong University, Shanghai, Peoples' Republic of China.

This study reports the case of a 71-year-old woman with type 2 diabetes whose paronychia rapidly progressed to the right middle finger and then to the whole dorsal aspect necrosis of the right hand. After admission, the diagnosis of diabetic hand ulcer was established and Streptococcus agalactiae found as the pathogen. The authors controlled glucose, used 3% hydrogen peroxide and sulfadiazine silver in routine dressing, as well as surgical debridement, topical negative pressure, and skin grafting. Read More

J R Coll Physicians Edinb 2012 Mar;42(1):24-6

Department of Rheumatology, MES Medical College, Perinthalmanna, Kerala, India.

Digital gangrene is not usually associated with primary Raynaud's phenomenon (RP). Its presence should therefore alert the healthcare provider to look for an alternative explanation. A 19-year-old female patient with primary RP developed digital gangrene following surgical management of acute paronychia. Read More

J Hand Surg Am 2012 May 3;37(5):1068-70; quiz page 1070. Epub 2012 Feb 3.

Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.

Oper Orthop Traumatol 2011 Jul;23(3):204-12

Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48129, Münster, Deutschland.

Objective: The procedure is selected based on the stage of infection with careful removal of the focal infection in the area of the nail fold.

Indications: All infections of the periungual area.

Contraindications: Herpes infections [1, 12]. Read More

Tech Hand Up Extrem Surg 2011 Jun;15(2):75-7

Heatherwood and Wexham Park Hospital NHS Trust, Wexham, Berkshire, UK.

Management of paronychia should primarily be aimed at preventing any activity that results in impairment of the natural barrier function of the nail fold. Surgical treatments aim to cure paronychia by exposing the inflamed germinal matrix to permit unrestricted drainage. We describe a Swiss roll technique for treatment of chronic and severe acute paronychia. Read More

MMW Fortschr Med 2008 Oct;150(40):31-4

Zentrum Handchirurgie, Mikrochirurgie und Plastische Chirurgie, Orthopädische Klinik München-Harlaching, Schön Kliniken.

Clin Occup Environ Med 2006 ;5(2):369-80, viii

Department of Surgery, University of Louisville School of Medicine, 529 South Jackson Street, Louisville, KY 40202, USA.

Prompt diagnosis and treatment of hand and upper extremity infections is imperative because they have the potential to be life threatening and pose a risk of functional impairment. Serious infections may result in prolonged hospitalization and resultant loss of productivity. The mainstay of treatment continues to be antibiotic therapy, heat, elevation, adequate surgical drainage, and débridement. Read More

J Long Term Eff Med Implants 2005 ;15(5):499-510

University of Virginia Health System, Charlottesville, Virginia, USA.

When considering common bacterial diseases of the skin, rather distinct clinical responses to a variety of bacterial infections have been identified. In these cases, it is the specific site of infection and the attendant inflammatory responses that provide the characteristic clinical picture. When the pyoderma extends just below the stratum corneum, it is called impetigo. Read More

Tech Hand Up Extrem Surg 2005 Jun;9(2):120-1

State Specialist Hospital Ado-Ekiti, Formerly Department of Orthopaedics and Traumatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

The severe deformities of the fingers seen in poorly treated or late presenting cases of paronychia stimulated this prospective study. The aim was to make early diagnosis and to find a simple method of draining the pus in the paronychia. This was a prospective hospital based study at the Wesley Guild Hospital (WGH) Ilesa for 9 months. Read More

Am Fam Physician 2003 Dec;68(11):2167-76

Department of Family Practice, Naval Hospital Jacksonville, Jacksonville, Florida 32214, USA.

Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Host factors, location, and circumstances of the infection are important guides to initial treatment strategies. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Read More

Br J Plast Surg 2004 Jan;57(1):93-4

Am Fam Physician 2001 Mar;63(6):1113-6

University of Michigan Medical School, Ann Arbor, USA.

Paronychia is one of the most common infections of the hand. Clinically, paronychia presents as an acute or a chronic condition. It is a localized, superficial infection or abscess of the paronychial tissues of the hands or, less commonly, the feet. Read More

Hand Clin 1998 Nov;14(4):547-55, viii

Hand Surgery Service, University of Michigan, Ann Arbor, USA.

Paronychias and felons are the most commonly encountered hand infections. Successful management of an uncomplicated infection involves an accurate diagnosis and prompt initiation of treatment, consisting of the judicious use of an appropriate incision, wound drainage, local wound care, antistaphylococcal antibiotics, and early rehabilitation. Complicated infections occur in immunosuppressed patients or those whose infection has been neglected or mistreated. Read More

Dtsch Med Wochenschr 1996 Sep;121(36):1090-2

Klinik und Poliklinik für Unfall- und Handchirurgie, Universität Münste.

History And Clinical Findings: An 18-month-old infant was admitted for a suspected bacterial hand infection that had developed within 2 days. Examination demonstrated multiple vesicles with erythema involving the dorso-ulnar aspect of the thumb. The infant was in a good condition, had no constitutional symptoms and a history of gingivo-stomatitis 6 months ago. Read More

Acta Med Port 1995 Jul-Aug;8(7-8):409-13

Departamento de Cirurgia Pediátrica, Hospital de Dona Estefânia, Lisboa.

Hand and Foot anatomic and physiologic characteristics make the infections, located there, acquire specific aspects. Seventy seven in-patients admitted and/or with follow-up at the out-patient clinic of Dona Estefãnia Hospital with Hand (25) and Foot (52) infections, were reviewed during the period between January 1991 and January 1994. We treated, out-patients with paronychia (7 of the hand and 42 of the foot), one patient with hand pulpitis, and one with dorsum hand cellulitis. Read More

Ther Umsch 1995 Jan;52(1):75-81

Abteilung für Hand- und periphere Nervenchirurgie, Kantonsspital Basel.

The possibilities of hand injuries lead to the higher incidence of hand infections. The clinical signs of inflammation (pain, swelling, heat, loss of function and red colour) are found in near all cases. The start of pain and its localisation help to find quickly the layer of the inflammatory process. Read More

East Afr Med J 1992 Nov;69(11):616-8

Department of Surgery, Faculty of Medicine, University of Khartoum, Sudan.

One hundred and fifty patients with hand infection seen during 6 months period at Khartoum Teaching Hospital were studied. The disease is more common among young males manual and industrial workers (M:F = 2:1). Common types of hand infections were paronychia in (41%) of patients, volar infections in (30. Read More

J Hand Surg Am 1991 Mar;16(2):311-4

Department of Orthopaedic Surgery, SUNY-Stony Brook School of Medicine 11794.

The herpetic whitlow should be treated nonoperatively. However, a difficult therapeutic dilemma occurs when a whitlow is seen with an established bacterial abscess. We report a case of an adult whose first herpetic whitlow was complicated by secondary periungual abscesses that progressed despite intravenous antimicrobial therapy. Read More

J Ky Med Assoc 1990 Jul;88(7):337-41

Christine M. Kleinert Institute for Hand and Micro Surgery, Louisville, KY.

Many hand infections can produce permanent disability if not treated promptly and aggressively. Glass wounds and paint or grease gun injections can result in serious deep infections and often require immediate treatment in the operating room. The following common infections challenge the treating physician regarding their indications for surgical versus nonsurgical treatment. Read More

Hand Clin 1989 Nov;5(4):515-23

University of California, San Francisco.

Infections of the distal finger have a varied presentation, course, and treatment. As in other hand infections, initial treatment should always include elevation of the extremity and the avoidance of snug clothing or constricting jewelry. Immunosuppressive states and systemic diseases such as diabetes must be considered, for they will alter the action of the causative organisms as well as the intensity of treatment that a patient will require. Read More

J Hand Surg Am 1989 Nov;14(6):933-6

Orthopaedic Surgery Department, University of Oklahoma Health Sciences Center, Oklahoma City.

Digital sucking is common in children. Although orthodontic complications have been reported, hand complications of digital sucking are seldom described. Five patients are reported; two had digital deformities and three had infections. Read More

Khirurgiia (Mosk) 1989 Aug(8):109-13

Occup Med 1989 Jul-Sep;4(3):463-71

University of Louisville, Kentucky.

Following a few basic principles will help the industrial physician in managing hand infections. They are: (1) recognizing the infection early; (2) drainage and/or debridement; (3) identifying the organism; and (4) antibiotics. Following the course of a wound is extremely important. Read More

Klin Khir 1989 (1):3-6

On the basis of the experience with treatment of 632 patients with purulent diseases of the fingers and hand, it is shown that in local treatment of panaritium and hand phlegmons, the adequate drainage of an abscess and excision of the necrotized tissues, the use of laser- and roentgenotherapy, vacuum drainage, ultrasonic cavitation of wounds are of importance. The complex treatment permitted to achieve good results in most patients; exarticulation of the fingers III-IV in pandactylitis associated with diabetes mellitus was performed in 1 patient, amputation of the fingers II--III--also in 1. Read More

Prim Care 1988 Dec;15(4):751-66

Harvard Medical School, Boston, Massachusetts.

The local, systemic, and referred causes of finger pain are generally recognizable by historical features and physical examination findings, although radiographs and laboratory evaluation are often required to support the diagnostic impression. Most minor traumatic causes of finger pain require only conservative management, including immobilization followed by exercise. Infectious causes of finger pain include cellulitis, tendinitis, paronychia, felon, and infectious emboli, which generally require antibiotics with or without drainage. Read More

Vestn Khir Im I I Grek 1987 Aug;139(8):144-7

Examination and operations were made on 46 patients with bony panaritium. Early diagnosis of this disease along with X-ray examination were based on data of case histories of the patients and clinical symptoms. Surgical treatment included parsimonious dissection of necrotic tissues and suturing the wounds. Read More

Emerg Med Clin North Am 1985 May;3(2):263-74

The unique anatomic arrangements in the hand make possible rapid extension of infections through synovial-lined spaces if abscesses are not drained and pressure is allowed to build up. Adequate knowledge of these anatomic features and of routes for surgical drainage is mandatory if one is to give adequate management of hand infections. Localized processes, such as paronychia, felon, and human bite infections also require special insight for adequate treatment. Read More

J Hand Surg Am 1982 Jul;7(4):388-94

One hundred thirty-eight patients with acute hand infection (81% deep) treated from 1970 to 1980 in hospital were reviewed. Resolution time of infection was slow, 8 days or longer in 57% of 135 patients and 15 days or longer in 28%. Such slow resolution occurred in infection of closed anatomical spaces and included 50% of all pulp space and joint infections, 23% of tenosynovitis, and 24% of subcutaneous dorsal had infections. Read More

Vestn Khir Im I I Grek 1980 Sep;125(9):42-5

Med Klin 1980 Jun;75(12):459-64

Vestn Khir Im I I Grek 1979 Sep;123(9):55-9

Postgrad Med 1979 Aug;66(2):127-31

Nerve injuries in the forearm and hand are common, especially with concomitant tendon lacerations. The optimal time for repair of a clean sharp laceration is within the first 24 to 48 hours using magnification to achieve precise surgical reapproximation. Transfer to a facility equipped to perform replantation is indicated for multiple digit amputations, any thumb amputation, transmetacarpal amputation, wrist and arm amputation, and major amputations in children. Read More

Arch Ophthalmol 1979 Jun;97(6):1079-81

Two patients had herpes simplex infection of the fingertips (herpetic whitlow) associated with herpetic keratitis. Both patients were health-care professionals who probably acquired their disease from patients. Herpetic whitlow can be distinguished from a paronychia by the lack of a tense pulp space, formation of vesicles, and serous (rather than purulent) drainage. Read More

Am Fam Physician 1978 Sep;18(3):79-85

Superficial infections include paronychia, cellulitis and lymphangitis. Grave infections include felon, purulent tenosynovitis, thenar infections, septic arthritis and human bites. Treatment by incision and drainage, moist heat, elevation, splinting and specific antibiotics or other agents applies to most hand infections. Read More

P N G Med J 1975 Jun;18(2):113-8

In this paper the importance is stressed of the dangers associated with neglecting hand infections in Paua New Guinea, where, for understandable reasons, there is a tendency for people to be slow in seeking treatment. The prevention of hand infections is emphasised, and the principles in regard to rest, antibiotic therapy, and surgical decompression are discussed. The more common types of hand infection are described, with particular reference to surgical anatomy and surgical drainage. Read More

Ned Tijdschr Geneeskd 1974 Aug;118(33):1249-54

Orv Hetil 1972 Jun;113(26):1519-21

Orthop Clin North Am 1970 Nov;1(2):455-66

South Med J 1969 Feb;62(2):209-12

Khirurgiia (Mosk) 1963 May;39:98-104