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Palm Abscess

By David R. Steinberg, MD, Associate Professor, Department of Orthopaedic Surgery, and Director, Hand and Upper Extremity Fellowship, Perelman School of Medicine at the University of Pennsylvania

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A palm abscess is a purulent infection of deep spaces in the palm, typically with staphylococci or streptococci.

Palm abscesses can include collar-button abscesses (arising in the web space between two fingers), thenar space abscesses, and midpalmar space abscesses. An abscess can occur in any of the deep palmar compartments and spread between the metacarpals, from the midpalmar space to the dorsum, manifesting as an infection on the dorsum of the hand. Intense throbbing pain occurs with swelling and severe tenderness on palpation. X-rays should be taken to detect occult foreign bodies.

Incision and drainage in the operating room (with cultures), with care to avoid the many important anatomic structures, and antibiotics (eg, a cephalosporin) are required. In areas where methicillin-resistant Staphylococcus aureus (MRSA) is prevalent, trimethoprim/sulfamethoxazole, clindamycin, doxycycline, or linezolid should be used instead of a cephalosporin.