Background Infections of the hand are relatively common, and can result in devastating complications such as long term stiffness and loss of function. Rates of significant stiffness up to 30% have been reported in flexor tenosynovitis. Treatment algorithms often include immobilization, however immobilization has been shown to increase the risk of stiffness. Method We performed a literature review to answer the question “Is splinting beneficial or harmful in the acute management of hand infections?”. The PubMed database was searched for articles discussing the management of flexor tenosynovitis and other hand infections, and articles assessing the impact of immobilization on long term hand function. Results No articles were identified directly comparing splinting vs free mobilization. A majority of articles describing management of flexor tenosynovitis and other hand infections utilise splinting and immobilization in their treatment but no studies have shown this to improve the early or long term outcomes. Numerous studies have shown immobilization to increase the risk of long term stiffness and delay return to work in injuries such as fractures or nerve repairs. A survey of 91 hand surgeons showed that more than 50% would advocate for active mobilization in flexor tenosynovitis regardless of the severity. Conclusion Immobilization in the acute management of hand infections is often advocated, however there is no evidence to suggest that it improves recovery or reduces spread. The role of immobilization in flexor tenosynovitis remains controversial, however the risks associated with immobilization outweigh the benefits. Immobilization of hand infections should be avoided where possible to reduce the risk of long term stiffness.