Orthopedic Surgery for Hand Infections Clinical Presentation

Updated: Oct 22, 2019
  • Author: Matthew B Klein, MD; Chief Editor: Harris Gellman, MD  more...
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Presentation

History

A thorough history of a hand infection includes determination of the onset, duration, any recent trauma, and any systemic symptoms (eg, fever, chills, diaphoresis). [3] Most patients present with a 2- to 3-day history of cellulitis, swelling, and, occasionally, drainage.

Review of the patient's past medical history is important, because individuals with diabetes or an immunocompromised status require more aggressive treatment and closer observation. [2, 3] Obtaining the patient's immunization history is also important. If the patient's tetanus status is unknown or out of date, administer tetanus prophylaxis.

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Physical Examination

The physical examination should include a thorough examination of the hand, with particular attention to the following:

  • Lymphangitis
  • Areas of fluctuance
  • Range of motion
  • Foreign bodies
  • Presence or absence of Kanavel signs - (1) Flexed position of the digit, (2) fusiform swelling of the digit, (3) pain with passive extension, and (4) excruciating tenderness over the course of the flexor tendon sheath

The four Kanavel signs are used to differentiate between infectious tenosynovitis and a superficial or localized abscess. [12, 20, 21]

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