Огляд та оцінка захворювань кистей

Deformities of the hand can result from generalized disorders (eg, arthritis) or dislocations, fractures, 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.

Hand infections are typically classified as superficial or deep. Superficial infections involve the skin and subcutaneous tissues. Deep infections can involve the tendon sheaths, tendons, deep fascial planes, joint spaces, and bones. Untreated superficial hand infections can progress to deep infections. Prompt evaluation and treatment of a suspected hand infection is imperative to avoid severe infection and disability.

Common bacterial hand infections include paronychia, infected bite wounds, felon, palm abscess, and infectious flexor tenosynovitis. Herpetic whitlow is a viral hand infection. Infections often begin with constant, intense, throbbing pain and are usually diagnosed by physical examination. Radiographs are taken in some infections (eg, bite wounds, infectious flexor tenosynovitis) to detect occult foreign bodies but may not detect small or radiolucent objects. Blood cultures should be taken if a hematogenous source is suspected, and joint aspiration should be performed if septic arthritis is suspected.

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). Uncomplicated MRSA infections are best treated with incision and drainage (2). If there is a high incidence of MRSA and the infection is severe, hospitalization for IV antibiotic therapy is 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 first- or second-generation cephalosporin can be given. Nontuberculous mycobacterial infections should be considered in patients with more subacute inflammation, especially in those who are immunosuppressed.

Additional treatment measures include elevating the hand to help reduce edema and sometimes splinting.

Common nerve compression syndromes include carpal tunnel syndrome, cubital tunnel syndrome, and radial tunnel syndrome. 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 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.)

Tenosynovitis may involve any of the tendons in or around the hand. Common conditions include digital flexor tendinitis and tenosynovitis (trigger finger) and De Quervain syndrome.

1. 1. O'Malley M, Fowler J, Ilyas AM: Community-acquired methicillin-resistant Staphylococcus aureus infections of the hand: Prevalence and timeliness of treatment. J Hand Surg Am 34(3):504–508, 2009. doi: 10.1016/j.jhsa.2008.11.021.

2. 2. Chen WA, Plate JF, Li Z: Effect of setting of initial surgical drainage on outcome of finger infections. J Surg Orthop Adv 24(1):36–41, 2015. PMID: 25830261.