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Common Acute Hand Infections - Article
ABSTRACT: Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Host factors, location, and circumstances of the infection are important guides to initial treatment strategies. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Tetanus prophylaxis is indicated in patients who have at-risk infections. Paronychia, an infection of the epidermis bordering the nail, commonly is precipitated by localized trauma. Treatment consists of incision and drainage, warm-water soaks and, sometimes, oral antibiotics. A felon is an abscess of the distal pulp of the fingertip. An early felon may be amenable to elevation, oral antibiotics, and warm water or saline soaks. A more advanced felon requires incision and drainage. Herpetic whitlow is a painful infection caused by the herpes simplex virus. Early treatment with oral antiviral agents may hasten healing. Pyogenic flexor tenosynovitis and clenched-fist injuries are more serious infections that often require surgical intervention. Pyogenic flexor tenosynovitis is an acute synovial space infection involving a flexor tendon sheath. Treatment consists of parenteral antibiotics and sheath irrigation. A clenched-fist injury usually is the result of an altercation and often involves injury to the extensor tendon, joint capsule, and bone. Wound exploration, copious irrigation, and appropriate antibiotics can prevent undesired outcomes.
ABSTRACT: Excessive sweating from the palms and soles, known as palmoplantar hyperhidrosis, affects both children and adults. Diagnosis of this potentially embarrassing and socially disabling condition is based on the patient's history and visible signs of sweating. The condition usually is idiopathic. Treatment remains a challenge: options include topical and systemic agents, iontophoresis, and botulinum toxin type A injections, with surgical sympathectomy as a last resort. None of the treatments is without limitations or associated complications. Topical aluminum chloride hexahydrate therapy and iontophoresis are simple, safe, and inexpensive therapies; however, continuous application is required because results are often short-lived, and they may be insufficient. Systemic agents such as anticholinergic drugs are tolerated poorly at the dosages required for efficacy and usually are not an option because of their associated toxicity. While botulinum toxin can be used in treatment-resistant cases, numerous painful injections are required, and effects are limited to a few months. Surgical sympathectomy should be reserved for the most severe cases and should be performed only after all other treatments have failed. Although the safety and reliability of treatments for palmoplantar hyperhidrosis have improved dramatically, side effects and compensatory sweating are still common, potentially severe problems.
ABSTRACT: Diagnosis of upper extremity injuries depends on knowledge of basic anatomy and biomechanics of the hand and wrist. The wrist is composed of two rows of carpal bones. Flexor and extensor tendons cross the wrist to allow function of the hand and digits. The ulnar, median, and radial nerves provide innervation of the hand and wrist. A systematic primary and secondary examination of the hand and wrist includes assessment of active and passive range of motion of the wrist and digits, and dynamic stability testing. The most commonly fractured bone of the wrist is the scaphoid, and the most common ligamentous instability involves the scaphoid and lunate.
ABSTRACT: Osteoarthritis is a common rheumatologic disorder. It is estimated that 40 million Americans and 70 to 90 percent of persons older than 75 years are affected by osteoarthritis. Although symptoms of osteoarthritis occur earlier in women, the prevalence among men and women is equal. In addition to age, risk factors include joint injury, obesity, and mechanical stress. The diagnosis is largely clinical because radiographic findings do not always correlate with symptoms. Knowledge of the etiology and pathogenesis of the disease process aids in prevention and management. Acetaminophen and nonsteroidal anti-inflammatory medications remain first-line drugs. Agents such as cyclooxygenase-2 inhibitors and sodium hyaluronate joint injections offer new treatment alternatives. Complementary medication use has also increased. Therapeutic goals include minimizing symptoms and improving function.
Necrotic Wound on the Hand - Photo Quiz
Rash in an Eight-Year-Old Boy - Photo Quiz