SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences

View all Images (2)

Emergency: requires immediate attention
Deep space and collar button infections
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Deep space and collar button infections

Contributors: Keith Sweitzer MD, Danielle Wilbur MD
Other Resources UpToDate PubMed


Emergent Care / Stabilization:
  • Start (IV) intravenous therapy
  • IV antibiotics
  • Nothing by mouth
Causes / typical injury mechanism: Collar button infections are often caused by puncture wounds to palmar, thenar, or Parona space.

Classic history and presentation:

Deep space infection 
  • The patient sustained a puncture wound (eg, gardening, animal bite, IV drug use) 24-72 hours prior to presentation.
  • Presents with pain, tense fluctuance, increased pain with range of motion (ROM), and erythema surrounding the site.
Collar button abscess
  • Deep space infection between 2 digits.
  • Leads to an abducted position of the digits with associated swelling, erythema, and puckering of the adjacent skin.
  • 5%-15% of hand infections.
Risk factors:
  • Puncture wound to the hand
  • Immunosuppression; diabetes, HIV, autoimmune diseases
Pathophysiology: Compartmentalized by thick fascial septae, infections in the hand are trapped in expected areas. For example, an abscess in the hypothenar region cannot move radially toward the thumb due to the midpalmar septum. Rather, it travels along the flexor digiti minimi into the wrist where it travels through the Parona space, then to the flexor pollicis longus sheath and into the thenar space. This creates the classic "horseshoe abscess."

A collar button abscess originates in the volar webspace and is confined distally by the palmar aponeurosis. This causes the infection to spread dorsally into the subcutaneous tissues.

The most commonly isolated pathogens are Staphylococcus aureus and group A Streptococcus.


B99.9 – Unspecified infectious disease
L08.9 – Local infection of the skin and subcutaneous tissue, unspecified

200635001 – Finger web space infection
240043009 – Infection of palmar space

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required


Subscription Required

Last Reviewed:02/19/2023
Last Updated:04/03/2023
Copyright © 2024 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Deep space and collar button infections
Copyright © 2024 VisualDx®. All rights reserved.