Hand infections range from minor nail fold irritation to surgical emergencies that can permanently destroy tendon function within hours. Knowing the difference — and acting on it — is everything. Dr. Graham treats every infection of the upper extremity, from paronychia to necrotizing fasciitis, urgently when needed.
For urgent infections on clinic days (Tue · Wed · Fri), JOI Now walk-in may be appropriate. When in doubt, call first.
Upper Extremity Infection Care
The hand has very little tissue between the skin and the structures that matter — tendons, nerves, joints, and bone are all within millimeters of the surface. An infection that might be a nuisance in the thigh or back can destroy a flexor tendon sheath in 24–48 hours. The same anatomy that makes the hand a marvel of precision makes it acutely vulnerable to infection spreading along fascial planes and tendon sheaths.
Dr. Graham treats every infection of the upper extremity — finger, hand, wrist, forearm, elbow, and shoulder. Most common infections are straightforward: drain the abscess, culture the organism, target the antibiotic. The ones that require judgment are the ones that look worse than they are, or — more dangerously — the ones that look better than they are. A fight bite with a 5mm laceration. A puncture wound from a palm frond that "didn't go that deep." A finger that's a little swollen with a line of tenderness along the flexor sheath.
Jacksonville's outdoor lifestyle means Dr. Graham also sees a steady volume of foreign body infections — palm frond punctures, cactus spines, fishing hooks, wood splinters, and plant material that tracked deep into tissue. These require surgical removal and targeted antibiotic coverage that generic urgent care management often misses.
Four Kanavel signs: finger in flexion, fusiform swelling, sheath tenderness, pain with passive extension. Surgical washout within hours — tendon function is at stake.
Always a same-day hand surgery evaluation regardless of wound size. The joint is likely inoculated. Do not wait.
Spreading redness, fever, firmness out of proportion to skin findings, dark discoloration or blistering — ED immediately for necrotizing infections.
Throbbing fingertip pulp pain with tense swelling — abscess that needs drainage. Prompt but not necessarily midnight ED visit.
Early nail fold infections, retained plant material or spines, nail fungus — evaluated and managed at a scheduled or walk-in clinic visit.
All four present = flexor tenosynovitis until proven otherwise. Go to the emergency department immediately. Do not wait for a clinic appointment.
Conditions Treated
Every infection of the hand, finger, wrist, forearm, elbow, and shoulder — from superficial nail fold infections to deep space emergencies.
Vibrio vulnificus is a naturally occurring bacterium in Gulf Coast and Atlantic saltwater — present in oysters, fish, and seawater year-round in Northeast Florida. A laceration from an oyster shell, a puncture from a fish spine, or even contact between saltwater and an open wound can introduce Vibrio into tissue.
In healthy individuals, Vibrio causes a painful, rapidly progressing wound infection that requires aggressive surgical debridement and specific antibiotic coverage — doxycycline plus a third-generation cephalosporin or fluoroquinolone. Standard wound infection antibiotics are not adequate.
In patients who are immunocompromised — liver disease, diabetes, cancer, HIV, chronic kidney disease, or taking immunosuppressants — Vibrio vulnificus can cause necrotizing fasciitis and sepsis within 24–48 hours. Mortality in high-risk patients exceeds 50%. Any saltwater wound in an immunocompromised patient is a medical emergency. Go to the ED immediately — do not wait and watch.
Upper Extremity Infection Expertise
Hand infections treated by surgeons who understand the anatomy produce better outcomes than those managed by general practitioners alone. Here's what that means in this practice.
Every infection of the upper extremity is within scope — paronychia, felon, flexor tenosynovitis, deep space infections, fight bites, animal bites, foreign body infections, marine infections, septic joint, osteomyelitis, necrotizing fasciitis, and periprosthetic infections. Referrals from the ED, urgent care, and other physicians are accepted urgently when needed.
Palm fronds, cactus spines, fishhooks, and plant material are a routine part of this practice — not unusual presentations. Retained plant material introduces organisms and stimulates an inflammatory response that does not resolve with antibiotics alone. Surgical removal under direct visualization is the only reliable treatment, and Dr. Graham performs this regularly.
A 5mm laceration over the knuckle after a fight is a potential joint infection. Dr. Graham evaluates and manages these same-day. Surgical exploration of the joint, thorough irrigation, and targeted antibiotic coverage — not a prescription for oral antibiotics and a follow-up appointment in a week.
Early paronychia, cellulitis without abscess, and minor soft tissue infections often respond to antibiotics and local wound care. Dr. Graham evaluates each infection for what it actually requires — avoiding unnecessary surgery and unnecessary delay in equal measure. The standard is appropriate treatment, not reflexive escalation.
Referred periprosthetic and hardware infection cases are accepted — whether the original surgery was done here or elsewhere. Management requires understanding the implant, the organism, the host, and the staging options. These are complex cases that benefit from a surgeon who performs the full range of upper extremity reconstruction.
Flexor tenosynovitis and fight bites do not wait for a standard appointment slot. Dr. Graham's office accommodates urgent infection referrals on clinic days, and coordinates with the emergency department for cases requiring same-day surgical intervention. JOI Now walk-in is available for infections that don't need the ED.
"Roy Williams said if there were 10 stars available he would give Dr. Graham 10. The outcome exceeded every expectation."
Roy Williams · Complex Upper Extremity Surgery Patient · Verified Google Review ★ 5/5
Common Questions