Health care workers exposed to oral secretions (e.g., dental hygienists, respiratory therapists) can be affected if they are not using universal precautions. Felon A felon is a deep space infection or abscess of the distal pulp of the finger or thumb. Early treatment with oral antiviral agents may hasten healing. If a single digit is infected, a finger splint supporting the interphalangeal joints in extension is usually adequate. Infections of the fingertip. Diagnosis of Systemic Lupus Erythematossus. An infection involving the distal finger pad is called a felon. A felon is an infection occurring within the compartments of the fingertip pulp. HIV = human immunodeficiency virus; AIDS = acquired immunodeficiency syndrome. Bogdan MA, In the early stages, this is not actually a full-blown abscess, but a soft tissue infection that may fail to yield copious pus. Perionychial infections associated with sculptured nails. Coyle MB. Diabetic hand infections. An infection that develops along the edge of the fingernail or toenail is called a Tyrrell DL. Young VL. (A) The incision starts 3 to 5 mm from the distal interphalangeal (DIP) joint flexor crease and extends to the end of the distal phalanx. Photographs and diagrams of the hand may be helpful in assessing the success of therapy. A tetanus booster should be administered if necessary. In case you fail to treat the infection you may end up losing the entire finger due to […] Emerg Med Clin North Am. Kelleher AT, Let’s start with some anatomy (hurrah!) Occupational rehabilitation can be considered once the infection has cleared. A felon is an infection in the fleshy part of the fingertip. Splint immobilization and elevation can protect the affected area, minimize edema, and decrease pain. The pulp of your finger pad is made up of lots of septations (small compartments made of very strong tissue) that forms strong connections between the skin and the underlying soft tissue to resist shear stress. It is important to assess the patient's underlying medical status as well as the circumstances of the infection (Table 1).1–10  Antibiotic selection is guided by a knowledge of the organisms encountered in common hand infections (Table 2). However, in rare cases, it may also be caused by the herpes simplex virus. A felon is a fingertip abscess deep in the palm side of the finger. The recommended length of treatment varies from five to 14 days and depends on the clinical response and severity of infection.3,12 Methicillin-resistant S. aureus has been reported in felons and other hand infections; clinical response, as well as bacterial cultures, should be followed closely.17,18. Louis DS, The position of function, a safe splint position for the hand. All patients were hospitalized. Medeiros I, It's easily treated but can come back. Orengo IF, Extensor tendon function should be documented. 36. Emergency department evaluation and treatment of hand injuries. Watson PA, Laskin OL. Most organisms enter into the body through open wounds. Enzenauer RJ, The hand should be splinted in a position of function and elevated. 1996;16:164–6. Cellulitis of unspecified finger. Selected acute infections. New York: McGraw-Hill, 1999:2414–26. It can be acute (< 6 weeks) or chronic (persisting > 6 weeks). Gravier M. Treatment of a Paronychia . Miller SD, Radiol Clin North Am. 1985;102:494–5. They require the use of broader spectrum antibiotics.1–4, The culprit organism is more likely to be Mycobacterium marinum. Incision and drainage of the lesion may cause viremia or bacterial infection.2–4 Patients should be advised that the infection recurs in 30 to 50 percent of cases, but the initial infection is typically the most severe. Finger infections ranging from mild to moderate may also produce itching. Zubowicz VN, Laskin OL. Moran GJ, Krieger LE, Empiric therapy should include parenteral penicillin plus either an antistaphylococcal penicillin or a first-generation cephalosporin.1,3,4,24 Alternatively, a parenteral beta-lactamase inhibitor may be used as monotherapy. Cardinal E, (E) In both techniques, the wound may be packed with sterile gauze. S. aureus and streptococci also are commonly isolated. In patients who are allergic to penicillin, clindamycin plus either a fluoroquinolone or trimethoprim-sulfamethoxazole (Bactrim, Septra) should provide adequate coverage. It is caused by the same bacteria that cause paronychia, and the bacteria may take advantage of a punctured wound. Rehabilitation of the hand: surgery and therapy. Amore advanced felon requires incision and drainage. Stage 1, cellulitis, can often be treated with hot soaks (5 times a day, for 20 minutes). 22. Herpetic whitlow is a painful infection caused by the herpes simplex virus. Herpetic whitlow (whitlow finger) is a painful infection of the finger caused by the herpes virus. An infection inside the tip of the finger can form an enclosed pocket of 1997;64:137–41. Aubin B, The term is from Greek: παρωνυχία from para, "around", onyx, "nail" and the abstract noun suffix -ia.. 5th ed. It differs from the superficial apical infection involving the distal portion of the pulp skin, which often responds to a small, deroofing incision The organism most frequently cultured from a pulp space infection is S. Aureus 12. Iowa Orthop J. None of the patients treated with antibiotics developed a subsequent infection. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Treatment is guided by whether or not there is an associated abscess. Symptoms of herpetic whitlow … Lisser SP. Turner DP, Potential complications of a felon and felon drainage include an anesthetic fingertip, a neuroma, and an unstable finger pad. Felons have been reported following multiple finger-stick blood tests.12. A felon is an infection of the pulp of the distal finger or thumb. Role of ultrasound in musculoskeletal infections. Early recognition and proper treatment of the following main finger infections will help prevent most of the serious outcomes. Clin Orthop. Infected finger is a common problem. 37. 14. Felon •Deep infection of the soft pad, or pulp of the fingertip. The incision location should avoid injury to the flexor tendon sheath, digital neurovascular structures, and nail matrix. For severe infections, an antistaphylococcal penicillin or a first-generation cephalosporin should be given.3,12,14 Clindamycin (Cleocin) or amoxicillin-clavulanate potassium (Augmentin) may be considered if anaerobes and Escherichia coli are suspected organisms.4,11 A tetanus booster should be administered when appropriate. However, this is often a rapidly spreading infection and therefore unless presenting very early, strong consideration should be made to incision and drainage. Fever, lymphadenitis, and epitrochlear and axillary lymphadenopathy may be present. Griego RD, Gunther SF, Human bite infections are often more virulent than animal bite injuries and are polymicrobial in nature.30,31,34 Cultures grow an average of five different organisms, three of which are usually anaerobes.30 Isolated anaerobes are commonly beta-lactamase producers. Methicillin-resistant Staphylococcus aureus in a finger felon. 35. Management of bite wounds and infection in primary care. Incision and drainage are contraindicated. Wertz MJ, The aim of the study was an assessment of the early stage of felon - non exceeded 72 hours from the first symptoms - with 99mTc-MPD (metylendiphosphonien marked by Technetium) in relation to patient physical investigation and radiological hand investigation.Material and methods. The first stage of the infection: Infected fingers start out with the bacterial invading your tissues, and causing the generalized tenderness, swelling, and redness. Matsui T. Address correspondence to CDR Dwayne C. Clark, Department of Family Practice, Naval Hospital Jacksonville, 2080 Child St., Jacksonville, FL 32214 (e-mail:[email protected]). Schwandt NW, Lille S, The hand's compartmentalized anatomy may contribute to the development of an infection. Physical and occupational therapy should be initiated to reduce long-term disability from scarring and contractures. Townsend DJ, J Bone Joint Surg [Br]. The pain caused by a felon is usually more intense than that caused by paronychia. How does it happen? It most commonly occurs after a small penetrating injury (a cut, splinter, scratch, spike, bite or snip) to the fingertip. Jebson PJ. A history of localized trauma to the nail cuticle may be helpful in distinguishing herpetic whitlow from paronychia. Aguide to the surgical treatment of acute and chronic suppurative processes in the fingers, hand, and forearm.7th ed. Cochrane Database Syst Rev. Turner DP, Copyright © 2003 by the American Academy of Family Physicians. 1986;105:631. Schwandt NW, An abscess in these noncompliant compartments is called a felon. A case report and literature review. Oral antibiotic therapy usually is adequate. 1993;86:56–66. Usually, due to the septae, the infection is usually contained to the pulp of the fingertip. Your finger may become infected with the HSV virus when broken skin on the fingers, such as a minor cut, comes in contact with HSV-infected bodily fluids. Wolf JE. Harrison BP, Puncture wounds should be extended proximally and distally while the physician is looking for extensor tendon disruption or injury. Physical findings success of therapy compartments by fibrous septa that connect to and!, issue, or osteomyelitis felon also may aid in the hand as soon as possible recent article acute. High lateral incision ( Figure 5 ) abscess in these noncompliant compartments causes significant pain, significant. Is found around it in rare cases, it may be packed with sterile gauze fingertip pad cause... Involving a flexor tendon sheath within the compartments of the finger is made up of several areas... Pus from an infection of the fingertip is termed as felon •Deep infection of fingertips! Bites: a review krieger LE, Schnall SB, Holtom PD, Costigan W. acute gonococcal flexor in! 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