Hand Infections

Hand infections can affect the skin, fingertip, nail fold, tendon sheath, joints, bones, and deeper spaces of the hand. Early evaluation is important because some infections can worsen quickly and may require antibiotics, wound care, or surgery.

Hand infections are common and can affect patients of all ages. There are multiple types and causes, so treatment varies. Long-term complications can occur even with proper and rapid treatment, including stiffness, pain, swelling, weakness, or loss of tissue.

Bite Wound Infection

In a bite, bacteria from the skin or from the mouth and teeth of the person or animal can be driven deep into the wound. Treatment may include thorough washing, soaking, surgical drainage, gauze packing, and antibiotics. More serious infections, including those involving bone or joints, may require IV antibiotics.

A fight bite can happen when a tooth penetrates the skin over the knuckle. These injuries can trap bacteria or foreign material in the finger joint and often require urgent surgical exploration and antibiotics. Rabies prevention must also be considered after animal bites, especially wild animal bites or bites from dogs with unknown vaccination status.

Cellulitis

Cellulitis is a skin infection that can cause redness, warmth, pain, fever, chills, or a general feeling of illness. It often starts around a break or cut in the skin. Prompt treatment is important because infection can spread through the limb or into the bloodstream.

Your doctor will determine whether the infection is limited to the skin or whether redness is a sign of a deeper infection such as fasciitis, tenosynovitis, myositis, osteomyelitis, septic joint, or an abscess.

Deep Space Infections

The hand is divided into separate compartments or deep spaces. An abscess can develop in the thenar space near the thumb, the deep palmar space, or the web spaces between the fingers. These infections may spread to the wrist or forearm and usually require urgent evaluation, antibiotics, surgical drainage, and wound care.

Felon infection of the fingertip pulp
Figure 1: Felon infection of the fingertip pulp.

Felon

A felon is a painful, throbbing infection of the pulp of the fingertip. It can occur after gardening, nail cutting, finger sticks, or other activities involving sharp objects near the fingertip. Some felons improve with soaks and oral antibiotics, while others need drainage.

If a felon is not treated early, soft tissue and even bone can be damaged, which may lead to poor wound healing, stiffness, and pain.

Acute paronychia infection around the fingernail
Figure 2: Acute paronychia around the fingernail.

Paronychia

Paronychia is an infection of the nail fold, the skin around the fingernail. In acute paronychia, bacteria can cause the skin around the nail to become red, swollen, and tender. Early infection may improve with soaks and oral antibiotics, but pus under the skin usually requires drainage. Sometimes part or all of the nail must be removed.

Chronic paronychia can be caused by fungus and is more common in people whose hands are frequently wet or whose immune systems are not working well. Keeping the area dry and using special medications may help, though surgery is sometimes needed to remove infected tissue.

Other Types of Hand Infections

Herpetic Whitlow

A viral infection usually affecting the fingers. It can cause small, swollen, painful, blood-tinged blisters and often heals over several weeks. Antiviral medication may be used in some cases.

MRSA

Methicillin Resistant Staphylococcus Aureus is resistant to certain antibiotics. Skin infections may look like boils or collections of pus and should be treated promptly to prevent spread.

Necrotizing Fasciitis

A rare but severe deep infection that can spread rapidly and become life-threatening. It often causes severe pain and swelling out of proportion to skin appearance and usually requires urgent IV antibiotics and surgery.

Mycobacterial Infections

These slower-growing infections may follow puncture wounds from fish spines or contaminated water. Diagnosis may take time, and treatment may include surgery plus months of medication.

Septic Arthritis and Osteomyelitis

A wound in or near a joint can cause septic arthritis, a severe infection inside the joint. Urgent surgical drainage and antibiotics are needed. Delayed treatment can lead to bone infection, called osteomyelitis, or rapid destruction of cartilage. Some painful, chronically damaged small joints may eventually need surgical fusion for pain relief.

Flexor tendon sheath infection illustration
Figure 3: Flexor tendon sheath infection.

Tendon Sheath Infection

Tendon sheath infection, also called infectious flexor tenosynovitis, can occur after a small cut or puncture wound on the palm side of the finger. The infected finger is often swollen, red, tender on the palm side, slightly bent to relieve pressure, and very painful to straighten.

This infection can cause severe stiffness or damage the tendon. It often requires hospital admission for IV antibiotics and surgical drainage.

Treatment

Early and aggressive treatment is essential. Some infections can be treated with antibiotics, local wound care, and nonsurgical treatment. Others require surgery to open the infected area, improve drainage, or remove infected, devitalized, or dead tissue so antibiotics can work.

Important: Hand infections can worsen quickly. Seek prompt medical care for increasing redness, swelling, severe pain, fever, drainage, numbness, spreading symptoms, or difficulty moving the fingers or hand.

During surgery, a sample of infected tissue may be sent for laboratory testing to identify the organism and determine which antibiotics are effective.