Hand Infections in Emergency Medicine Workup

  • Author: Rohini J Haar, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jan 13, 2011
 

Laboratory Studies

Paronychia and felons

These often require no laboratory tests because the diagnosis is made clinically.

Herpetic whitlow

The diagnosis can be confirmed by a Tzanck test, which demonstrates the presence of multinucleated giant cells in a scraping taken from the base of an unroofed vesicle.

Infectious tenosynovitis and/or deep fascial space infections

As the infected spaces are drained and debrided in the operating room, preoperative laboratory tests (CBC count with differential; prothrombin time/activated partial thromboplastin time; electrolytes; ECG, if age appropriate) may be requested by the hand surgeons and/or the anesthesiologist, but the diagnosis is made clinically.

Cultures are obtained in the operating room.

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Imaging Studies

Radiography

Because trauma is often a contributing factor in most hand infections, plain radiographs are useful in excluding fractures and retained foreign bodies if they are radiopaque.

Radiographs help identify subcutaneous or subfascial gas formation, if present.

Radiographs may indicate osteomyelitis.

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Other Tests

In cases of severe infection causing vascular insufficiency, Doppler ultrasonography may assist in evaluation.

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Contributor Information and Disclosures
Author

Rohini J Haar, MD  Staff Physician, Department of Emergency Medicine, New York University/Bellevue Hospital Center

Rohini J Haar, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Gregory S Johnston, MD  Attending Physician, Beth Israel Medical Center

Gregory S Johnston, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Dan Danzl, MD  Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eric L Weiss, MD, DTM&H  Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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  16. Wolanyk DE. 17. Infections. In: Hart RG, Uehara DT, Wagner MJ, eds. Emergency and Primary Care of the Hand. Irving,Tx: The American College of Emergency Physicians; 2001:219-246.

 
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A paronychia can progress to a felon if left untreated.
A herpetic whitlow. Image courtesy of Glen Vaughn, MD.
Paronychia incision and drainage.
 
 
 
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