Clinical Assessment and Management of Common Hand Infections Urgent message: Common superficial hand infections may be man- aged easily by the urgent care physician. Left untreated or under- treated, however, simple hand infections may progress to disabling conditions requiring urgent sub-specialty management. Arthur R. Smolensky, MD, Samuel M. Keim, MD, MS, and Peter Rosen, MD he hand is an intricate and crucial feature of the human body. Yet, with the exception of superfi- cial cellulitis, common hand infections require rela- tively simple surgical proce- dures—many of which can be performed in the urgent care setting. Proper diagnosis and man- agement is essential in pre- venting significant morbidity related to these infections. Many hand infections do well with early splinting, antibi- otics, and pain control, whereas more advanced in- fections require incision and drainage. This article will focus on and distinguish among types of hand infections seen commonly in urgent care. T FELON Pathophysiology A felon is an infection of the pulp of the distal finger or thumb. It differs from other subcutaneous abscesses be- cause of the presence of 15 to 20 septa that run along w w w. j u c m . c o m the long axis of the finger that divide the pulp into small superficial compart- ments. Abscesses in these small noncompliant spaces can be extremely painful, and swelling in this area can lead to necrosis before any fluctu- ance can be observed. Additionally, because the septa attach to the perios- teum, spread of the infection can lead to osteomyelitis of the distal phalanx. 1 The septa do, however, provide a barrier that pro- tects the joint space and ten- don sheath by limiting the proximal spread of the infec- tion. The usual cause is pen- etrating trauma with secondary bacterial invasion. © Colin Anderson/Brand X/Corbis; Clinical Images: PhotoResearchers Inc.; Digital Composite: Tom DePrenda Introduction Clinical Features The most commonly affected digits are the thumb and index finger. Common predisposing causes include wood splinters, bits of glass, abrasions, and minor punc- ture wounds. Staphylococcus aureus is the most common organism, JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | N o v e m b e r 2 0 0 7 11