Hand infections account for a significant number of attendances to the emergency department, with the NHS reporting an incidence of hand cellulitis alone as 16.4/1000 person years (Office of Population Censuses and Surveys, 1992; Masson, 2002). Prompt treatment allows a rapid return of function; however, delayed diagnosis risks significant disability and suboptimal outcomes for patients. The spectrum of clinical presentation and pathophysiology varies immensely and can be diagnostically challenging.