A Potential Major Problem

By Dr. Jeff Daniels EBS Medical Columnist

As we know, the hand is a key part of the body and is one feature of our anatomy that helps define us as humans. But being an extremity, the hand is also vulnerable to serious infections.

These infections are fairly common, so people often don’t seem too concerned when they suffer minor hand trauma. But beware, these inconsequential injuries can blossom into a major problem.

In the Medical Clinic of Big Sky during the second week of January, we treated a number of broken bones and torn ligaments, as well as two interesting hand infections. One was somewhat benign and was treated with an antibiotic shot. But the other injury was bad and needed emergency surgery.

The first minor infection came from a stab wound. Not from a knife, but the tip of a sharp pencil in the middle of the patient’s palm. Three days after the injury, the palm around the puncture wound was beet-red, and pain was moving up into the finger directly inline with the wound.

The injured man could make a fist and the swelling was minimal, so we decided to try a shot of a potent antibiotic. By the next morning, the pain was relieved significantly, and the redness was almost gone.

The second, more serious infection resulted from a dog bite. A young man came into the clinic holding his red and swollen hand in the air. A dog’s tooth had punctured the inside of his ring finger and he couldn’t move his fingers or bend his wrist without pain.

We immediately sent the patient to the hand surgeon in Bozeman, and upon arrival, was taken to the operating room to open up the channels through which the infection was spreading. The doctors washed out the infection then started massive doses of antibiotics.

I saw this fellow at his workplace a couple days later, with his hand in a cast, holding his arm up in the air to help reduce the swelling. The pain was under control and he was smiling.

Animal bites to the hand are almost guaranteed to cause a serious infection – nearly 100 percent of the time from a cat bite or scratch, and approximately 50 percent of the time from a dog bite.

Both animals transmit a bacteria called Pasteurella multocida, carried in their mouths – and cats lick it onto their claws – so that any break of the skin is susceptible to infection. It responds well to an antibiotic, but most people wait too long to get it looked at, and by that time it’s too late for an easy fix.

When a bite to the hand becomes infected, your anatomy makes it likely the infection will spread rapidly. The tendons in the hand, and sheathes around those tendons, serve as conduits for the bacteria and the inflammatory response the body makes as a defense. It’s the inflammation that really hurts.

The presenting symptoms are usually the inability to make a fist, pain resulting from moving of the fingers or wrist, and swelling of the entire hand. Nerves in the hand and fingers are some of the most sensitive in the body, so when there is inflammation and infection, the pain can be excruciating.

If you suffer a puncture wound to your hand, get it checked out before it becomes a major problem.

Dr. Jeff Daniels has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.