Patient presenting with left middle finger infection with abscess formation, requiring Rays amputation

Hand infections are common and, if not treated properly early in their course, can lead to devastating outcomes. Bacterial sources are the most frequent cause, but viral and fungal pathogens also can prompt emergency department (ED) visits. Occult foreign bodies always should be in the diagnosis for hand infection, since healing only will be achieved after removal of the nidus of infection. Several anatomic features of the hand lend it to rapid and deep spread of infection compared to other body parts.

Infection can spread rapidly from the distal finger along the flex-or tendon sheath to the palm. The fibrous connections of the fingertips and palm leave little room for swelling and can aid in proximal spread, or force the infection to the dorsal surface of the hand. Often, the exam of the palm will be benign enough that it can be overlooked as the source of the infection. Further, as dorsal infections generally are better tolerated than palm infections, this presentation can mislead the ED physician as to the true nature of the problem. Even if accurately diagnosed and treated, any hand infection has the potential to result in loss of hand function from tendon scarring, nerve, and tissue damage.

This is the case of a diabetic patient with an infection of the left middle finger with abscess formation that will require amputation.

Patients with diabetes mellitus have a high risk of infections resulting from neuropathy, vascular disease and immunosuppression.

Infections of the hands and upper limbs in these patients are attributable to an important rate of morbidity and mortality.