Deep Space Hand infections
HPI: Teenage RHD healthy male presented initially to PCP with blister to left hand from playing baseball. Small blister incised and culture sent which eventually grew out MRSA and he was started on bactrim. On follow up 4 days later swelling worsened with worsening surrounding erythema. Denied fevers ,chills or other symptoms. Denied insect, spider or other exposures. Admitted for IV antibiotics and ortho hand consultation.
afebrile, vitals normal
2+ radial pulse, cap refill < 2 sec
SILT throughout hand and digits
Flexion/Extension/adduction/abduction intact and notable only for mild pain with flexion of thumb, area of fluctuance to radial aspect of palm extending from mid palm around to dosal aspect of 1st and 2nd digits; see picture
Orthopedic hand consultation
Admission for IV antibiotics
3 main deep spaces: potential spaces separated by fascial septum
By: Dr Bryon Callahan
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CMC ER Residents
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