Hand Infections Workup

Updated: Jun 06, 2018
  • Author: Eden Kim, DO; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Workup

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; 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 reveal osteomyelitis.

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Other Tests

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

Bedside ultrasonography may also assist in differentiating among the various etiologies of hand infections by identifying fluid collections along tendon sheaths consistent with flexor tenosynovitis or "cobble-stone" patterns consistent with cellulitis. [6] Bedside ultrasonography is ideally performed using a water bath technique, which obviates the need for direct pressure of the ultrasound probe on the affected area while enhancing resolution. [7]

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