Upper Limb Cellulitis

What is cellulitis?

Cellulitis is a common but potentially serious bacterial skin infection; mainly to the deep layers of the skin. It can affect any part of the body but mainly occurs in the legs.  

The main signs and symptoms include heat, redness and swelling to a specific area which can increase in size over a short period of time.

Why am I at risk of getting cellulitis?

You may have skin injuries including:

• skin cut for surgery
• insect and animal bites 
• puncture to your skin from an object, for example a screw. 

Some medical conditions can increase your risk, including but not limited to: 

• diabetes 
• peripheral artery disease 
• lymphedema  
• more common in middle ages and above 
• weakened immune system
• obesity 
• other skin conditions including eczema 

How might cellulitis affect me?

The movement to your affected joint can be limited in the early stages because of the swelling and pain but it is important to move regularly as comfort allows to reduce any potential for stiffness.

How is cellulitis treated?

The treatment for cellulitis can be a mix of Intra-venous antibiotics (administered into the veins so it can get into the bloodstream immediately) and/or oral antibiotics (taken by the mouth) and this will be determined by the consultant or doctors on the ward. 

Will I have to wear a sling?

If you’ve been given a sling, it is usually for comfort only.This can be discarded after 1-2 weeks.  

How can I manage pain, swelling, and recovery? 

• Pain: Continue to take your pain relief as advised. If you feel that this is not adequate, please speak to the ward staff or your GP if you are already home. 
• Swelling: You may have wrist pain and swelling for 3-6 months after your injury. Swelling is often worse at the end of the day. 
• Elevation: You will also find it helpful to elevate (have your limb raised) your affected area frequently in the day to help reduce the swelling. This will reduce the swelling around the wrist and fingers.  
• Physiotherapy: When the cellulitis settles, you should regain your movement of the affected area. Please complete the exercises in the booklet to help. 
• Hand Hygiene: If you have any breaks to the skin, it is important to keep them clean and dry. Your nurse will help you to manage this whilst you’re on the ward. Wash your hands regularly to help keep the area clean.  
• Follow-up: We do not routinely refer for Physiotherapy but please speak to the Physiotherapist on the ward if you have questions or concerns.  

Exercise Programme

Early movement of the fingers, thumb, elbow and shoulder is important to prevent stiffness.

Start these exercises day 1 after your injury.

1. Finger and thumb movements

• Keep your fingers and thumb moving regularly.

• Try and get your thumb to touch each fingers within your comfort levels.

Repetitions___ Frequency___   

2. Make a fist

• Open and close your hand as shown in the picture below.
• After a few days, hold a soft ball or a ball of socks. Squeeze the ball as hard as possible without pain.  

Repetitions___     Frequency___  Hold for ___

3. Wrist exercises

• Bend your wrist up and down as shown in the picture below.
• As your pain or stiffness gets less, you should be able to move you wrist more. 

Repetitions__             Frequency__

4. Bend and straighten your elbow

• Bend and straighten your elbow as far as you can.
• You should not feel more than a mild to moderate stretch. You can use your other arm to assist if necessary.

Repetitions___           Frequency___

5. Twist your forearm

• Begin this exercise with your elbow at your side and bent to 90 as shown in the picture below. 
• Slowly turn your palm up to the ceiling and down towards the floor as far as you can without pain.

Repetitions___           Frequency___ 

6. Shoulder movements

• Sit with your arms resting at your sides.
• Pull your shoulder blades down and in towards your spine.

Repetitions___           Frequency___ 

How do I know if the cellulitis is worsening?

You may have an increase in your temperature and feel generally unwell. The redness and swelling may spread further around the arm. You may find your pain in that area gets worse.

Will I have further (follow up) appointments?

Once you have completed your course of antibiotics, the cellulitis should settle and you should regain your movement to the affected area. The GP will sometimes follow you up once you’ve left the hospital. You will be advised in hospital if you need anything specific.

Will smoking or vaping slow down my healing?

Smoking will slow down your healing. We would advise that you stop smoking while your fracture heals. Talk to your GP or go to SmokeFree for more information.

How can I get a certificate to say that I am fit to work?

You can get a fitness for work statement from the ward doctors or your GP if you are home.

When can I start driving?

When you can grip the steering wheel comfortably and can perform an emergency stop pain free. Always test your ability to drive in a safe environment first.