Overview and Evaluation of Hand Disorders

Deformities of the hand can result from generalized disorders (eg, arthritis) or dislocations Finger Dislocations Most finger dislocations occur at the proximal interphalangeal (PIP) joint; they are usually caused by hyperextension and thus are usually dorsal. Finger dislocations can be dorsal, lateral... read more , fractures Fingertip Fractures Fingertip (tuft) fractures occur in the distal phalanx. The usual mechanism is a crush injury (eg, in a door jamb). (See also Overview of Fractures.) Fingertip fractures are common. They range... read more , and other localized disorders. Most nontraumatic localized disorders can be diagnosed by physical examination. Once a hand deformity becomes firmly established, it cannot be significantly altered by splinting, exercise, or other nonsurgical treatment.

Common bacterial hand infections include paronychia Acute Paronychia Paronychia is infection of the periungual tissues. Acute paronychia causes redness, warmth, and pain along the nail margin. Diagnosis is by inspection. Treatment is with antistaphylococcal antibiotics... read more , infected bite wounds Infected Bite Wounds of the Hand A small puncture wound, particularly from a human or cat bite, may involve significant injury to the tendon, joint capsule, or articular cartilage. The most common cause of human bites is a... read more , felon Felon A felon is an infection of the pulp space of the fingertip, usually with staphylococci and streptococci. (See also Overview and Evaluation of Hand Disorders.) The most common site is the distal... read more , palm abscess Palm Abscess A palm abscess is a purulent infection of deep spaces in the palm, typically with staphylococci or streptococci. (See also Overview and Evaluation of Hand Disorders.) Palm abscesses can include... read more , and infectious flexor tenosynovitis Infectious Flexor Tenosynovitis Infectious flexor tenosynovitis is an acute infection within the flexor tendon sheath. Diagnosis is suggested by Kanavel signs and confirmed with x-rays. Treatment is surgical drainage and antibiotics... read more . Herpetic whitlow Herpetic Whitlow Herpetic whitlow is a cutaneous infection of the distal aspect of the finger caused by herpes simplex virus. (See also Overview and Evaluation of Hand Disorders.) Herpetic whitlow may cause... read more is a viral hand infection. Infections often begin with constant, intense, throbbing pain and are usually diagnosed by physical examination. X-rays are taken in some infections (eg, bite wounds, infectious flexor tenosynovitis) to detect occult foreign bodies but may not detect small or radiolucent objects.

Treatment of most hand infections involves surgical measures and antibiotics. The increased incidence of community-acquired and nosocomial methicillin-resistant Staphylococcus aureus (MRSA) should be taken into consideration (1 General references Common hand disorders include a variety of deformities, ganglia, infections, Kienböck disease, nerve compression syndromes, noninfectious tenosynovitis, and osteoarthritis. (See also complex... read more ). Uncomplicated MRSA infections are best treated with incision and drainage (2 General references Common hand disorders include a variety of deformities, ganglia, infections, Kienböck disease, nerve compression syndromes, noninfectious tenosynovitis, and osteoarthritis. (See also complex... read more ). If there is a high incidence of MRSA and the infection is severe, hospitalization and vancomycin or daptomycin (for IV therapy) are recommended, as is consultation with an infectious disease specialist. For outpatients, trimethoprim/sulfamethoxazole, clindamycin, doxycycline, or linezolid (for oral therapy) can be given. Once culture and sensitivity results rule out MRSA, nafcillin, cloxacillin, dicloxacillin, or a 1st- or 2nd-generation cephalosporin can be given. Nontuberculous mycobacterial infections should be considered in patients with more subacute inflammation, especially in those who are immunosuppressed.

Common nerve compression syndromes include carpal tunnel syndrome Carpal Tunnel Syndrome Carpal tunnel syndrome is compression of the median nerve as it passes through the carpal tunnel in the wrist. Symptoms include pain and paresthesias in the median nerve distribution. Diagnosis... read more , cubital tunnel syndrome Cubital Tunnel Syndrome Cubital tunnel syndrome is compression or traction of the ulnar nerve at the elbow. Symptoms include elbow pain and paresthesias in the ulnar nerve distribution. Diagnosis is suggested by symptoms... read more , and radial tunnel syndrome Radial Tunnel Syndrome Radial tunnel syndrome is compression of the radial nerve in the proximal forearm. Symptoms include forearm and elbow pain. Diagnosis is clinical. Treatments include splinting and sometimes... read more . Compression of nerves often causes paresthesias; these paresthesias can often be reproduced by tapping the compressed nerve, usually with the examiner’s fingertip (Tinel sign). Suspected nerve compression can be confirmed by testing nerve conduction velocity Nerve conduction studies When determining whether weakness is due to a nerve, muscle, or neuromuscular junction disorder is clinically difficult, these studies can identify the affected nerves and muscles. In electromyography... read more and distal latencies, which accurately measure motor and sensory nerve conduction. Initial treatment is usually conservative (eg, rest, modified work environment, splinting, corticosteroid injection), but surgical decompression may be necessary if conservative measures fail or if there are significant motor or sensory deficits.

( See also Tendinitis and Tenosynovitis Tendinitis and Tenosynovitis Tendinitis is inflammation of a tendon, often developing after degeneration (tendinopathy). Tenosynovitis is tendinitis with inflammation of the tendon sheath lining. Symptoms usually include... read more .)

Tenosynovitis may involve any of the tendons in or around the hand. Common conditions include digital flexor tendinitis and tenosynovitis Digital Flexor Tendinitis and Tenosynovitis (Trigger Finger) Digital flexor tendinitis and tenosynovitis are inflammation, sometimes with subsequent fibrosis, of tendons and tendon sheaths of the digits. (See also Overview and Evaluation of Hand Disorders... read more (trigger finger) and De Quervain syndrome De Quervain Syndrome De Quervain syndrome is stenosing tenosynovitis of the short extensor tendon (extensor pollicis brevis) and long abductor tendon (abductor pollicis longus) of the thumb within the first extensor... read more .