Infection

What is an Infection?

An infection occurs when harmful microorganisms (such as bacteria, fungi, or viruses) enter the body and multiply
Causes tissue damage and illness

How Infection Ties Into Hand Therapy

Hand therapists play a key role in monitoring for signs of infection
- Especially when seeing patients post-surgery
Infections can lead to decreased range of motion due to swelling, pain, tissue damage, or scarring
Can also lead to loss of strength, coordination, or sensory deficits
Dressing changes may be needed
Orthoses can be fabricated to protect a healing infection

Signs of Infection

Pain - particularly if around the nail
Redness - particularly if around the nail
Swelling
Warmth - area feels hotter than the surrounding skin
Pus
Loss of range of motion

Common Types of Infection

Paronychia

Infection of the nail fold (skin around the fingernail)
May be bacterial (acute) or fungal (chronic)

Bacterial/acute infections:

More common after minor trauma (such as hangnails or injury from cutting a nail)
Causes redness, swelling, and tenderness of the skin around the nail
Treatment involves soaking and oral antibiotics
If pus is present, surgical drainage is required
May require partial or full removal of the nail to treat infection

Fungal/chronic infections:

Is caused by fungus
More common in people whose hands are frequently wet or who have impaired immune systems
Cuticle becomes mildly red, swollen, and tender
No drainage present
Treatment involves medication and keeping area dry
Surgery may be required to remove infected tissue

Image by James Heilman, MD via Wikimedia Commons, CC BY-SA 3.0. Source: https://commons.wikimedia.org/wiki/File:Panaritium_RH_(1).jpg

Tendon sheath infection

Infection inside the flexor tendon sheath
Usually from a small puncture near a joint
Causes fusiform swelling, where the finger is thicker in the middle and narrower at the ends
Also causes tenderness along the tendon sheath, a flexed finger position, and pain with finger extension
Requires urgent IV antibiotics and surgical drainage
Delay in treatment can cause the tendon to rupture, long-term stiffness from scar tissue adhesions

Image by IEM Student via Flickr, CC BY 2.0. Source: https://www.flickr.com/photos/iem-student/49817101016

Cellulitis

Superficial skin infection that causes redness, warmth, swelling, and pain
Fever, chills, and feeling ill may be additional symptoms
Rapidly spreads if untreated and can lead to bloodstream infection
Treatment involves antiobiotics as soon as possible and possibly surgical drainage if abscess is present

Image by Wellcome Collection via Wikimedia Commons, CC BY 4.0. Source: https://commons.wikimedia.org/wiki/File:Hand_with_cellulitis_following_upon_a_poisoned_wound_Wellcome_L0062186.jpg

Bite wound

Caused by bacteria from the mouth or from the patient's skin that gets driven deep into the tissue
Smaller punctures (such as cat bites) have a higher risk of infection as the smaller wounds are more difficult to clean
Often requires washing, soaking, surgical drainage, and antibiotics to get rid of the infection

Image from Reddit user via r/popping. Source: https://www.reddit.com/r/popping/comments/lksts5/infected_cat_bite_will_post_an_update_when_its/

MRSA

Is a type of bacteria that is resistant to a lot of antibiotics
Presents as boils or collections of pus on the skin
Requires immediate treatment to prevent spread
Highly contagious
- Healthcare workers should wear gloves and gowns when treating
Treatment involves special antibiotics and often surgery

Image from CDC via Picryl, public domain. Source: https://picryl.com/media/cutaneous-abscess-mrsa-staphylococcus-aureus-7826-lores-744fb2

Septic arthritis/osteomyelitis

Infection inside a joint is called septic arthritis
Infection inside a bone is called osteomyelitis
Often is a result following a wound near a joint
Can cause rapid joint destruction if untreated
- Damage to cartilage is irreversible
Requires urgent surgical drainage and antibiotics
Can result in chronic joint stiffness, pain, or need for joint fusion

"Septic Arthritis: Infection of a Joint." Fife Virtual Hand Clinic, https://fifevirtualhandclinic.co.uk/septic-arthritis-infection-of-a-joint/.

Quiz Questions

1. Which symptom is most suggestive of a developing infection around the nail fold (paronychia)?

A. Joint instability

B. Redness, swelling, and tenderness near the nail

C. Cracking of the fingernail

D. Excessive nail growth

2. What is the most appropriate response if pus is observed during hand therapy after surgery?

A. Apply cold pack and continue session if pain is not present

B. Perform modified edema massage to remove pus

C. Refer patient to a physician

D. Refer patient to a chiropractor

3. Which infection is characterized by fusiform swelling and pain with finger extension?

A. Cellulitis

B. MRSA

C. Chronic paronychia

D. Tendon sheath infection

4. What is the biggest concern if a tendon sheath infection is not treated urgently?

A. Tendon rupture and scar adhesions

B. Muscle atrophy

C. Nerve degeneration

D. Loss of pigmentation of surrounding skin

5. Why are cat bites particularly high risk for infection?

A. Cats carry viruses in their saliva

B. The bites are generally more forceful

C. The small punctures are harder to clean thoroughly

D. They affect bones more than soft tissue

6. Which of the following is TRUE about MRSA?

A. It is a fungal infection

B. It is resistant to many antibiotics and highly contagious

C. It usually clears without intervention

D. It cannot spread to others through skin contact

Quiz Answers

References

American Society for Surgery of the Hand. (2020). Hand infection: Types and treatment. https://www.assh.org/handcare/condition/hand-infection

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