The surgeon is rarely the first physician to examine the hand with a chronic infection. In most cases, simple treatment has been tried and has failed. The surgeon must think of atypical mycobacteria and fungi and then systematically make a diagnosis by biopsy and culture and by excluding other diseases and conditions. Because these infections can be very damaging to the hand or wrist, treatment should be rendered promptly and adequately. These general principles are no different from those followed in treating acute hand infections or actually for any disease.