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Hand Infection, Emergency Medicine

Chester D. Shermer Reviewed 06/2017



  • Hand infections are commonly seen in the ED.

  • The range of pathology is broad and may include acute and chronic conditions.

  • Serious hand infections are potential liability issues and mu...


Signs and Symptoms

  • Paronychia:

    • Localized edema, erythema, and pain in proximal portion of lateral nail fold

    • Fluctuance may be present and may extend beneath the nail margin.

    • Systemic signs and s...



Hand immobilization as appropriate 

Ed Treatment/Procedures

  • Paronychia:

    • Early paronychia/simple cellulitis without purulence present may be managed with oral antibiotics and rest:

      • Ce...



Admission Criteria

  • Flexor tenosynovitis, web space abscess, palmar space infections:

    • All these infections require admission for IV antibiotics and drainage.

  • Clenched fist injury with...

Pearls and Pitfalls

  • Missed or delay in diagnosis

  • Failure to obtain history of clenched fist injury

  • Failure to consult surgeon promptly

Additional Reading

  • Antosia  RE, Lyn  E. The hand. In: Rosen  P, et al., eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, MO: Mosby, 1997;1998:625–668.

  • Bach  HG, Steffin  B,...



  • 112.3 Candidiasis of skin and nails

  • 681.02 Onychia and paronychia of finger

  • 914.9 Other and unspecified superficial injury of hand(s) except finger(s) alone, infected

  • 054.6 Herpetic whitlow

  • 681....

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