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Paronychia, panaritium (whitlow or felon)

Panaritium

Panaritium is an acute inflammation of the tissues of the finger. Panaritium usually develops when pathogens of a purulent infection enter the tissue of a finger with microtrauma (injections, abrasions, cracks, etc.). On the palmar surface of the fingers, the skin is connected to the palmar aponeurosis by tendon bridges, thus forming channels.

Infection with panaritium through these channels quickly spreads inward, and edema with inflammation in a limited cavity (between the tendon bridges) leads to an increase in pressure, compression of the feeding vessels, and the occurrence of necrosis.

Felon. The initial manifestations are characterized by hyperemia and tissue edema, sharp soreness of the finger. The nail plate is deformed.

If there is a suspicion of an infectious process on the finger (panaritium), waiting is unacceptable: an early surgical operation is necessary with the obligatory removal of necrotic tissues.

 

Paronychia

Paronychia is an inflammation of the periungual fold. The causes of paronychia of the periungual roller on the finger: superficial trauma during a manicure, tearing off the burrs. With paronychia, there is redness, swelling, and pain in the area of the nail fold, from under which pus can be released.

Treatment of paronychia in the initial stages is conservative: baths with potassium permanganate, antiseptics. When pus appears, surgical treatment of paronychia is necessary. Paronychia can be complicated by subungual panaritium.

Paronychium. Swollen, hyperemic edge of the nail bed on the finger. With inadequate treatment, panaritium may develop.

 

Subungual felon

Subungual felon is a collection of pus under the nail plate. Subungual panaritium occurs with suppuration of subungual hematomas, foreign bodies, the transition of inflammation from the periungual ridge. Severe pain appears, "swimming" of the nail plate, Sometimes pus is released from under the nail plate.

Treatment of subungual felon is prompt - removal of the nail (partial or complete) is necessary.

Cutaneous panaritium of the lateral edge of the nail bed. Edema, hyperemia and abscess formation of the soft tissues of the finger are visible.

 

Skin felon

Cutaneous panaritium is a collection of pus under the epidermis in the form of a limited bladder. More often, skin felon occurs with microtrauma or foreign bodies of the skin. Under the epidermis, with cutaneous panaritium, an accumulation of pus is determined, the pain syndrome is not sharp. Removal of the epidermis with cutaneous panaritium leads to recovery.

After removing the epidermis, it is necessary to carefully examine the base of the abscess; at the bottom, a fistulous passage leading to the deeper parts of the finger may open (skin panaritium may be a manifestation of panaritium "in the form of a cufflink": the main focus is subcutaneous panaritium).

Swollen, tense, sharply painful nail phalanx with cutaneous panaritium. An area of necrotic tissue of the finger is visible.

 

Subcutaneous panaritium

Subcutaneous panaritium is a common form of suppuration of the fingers. With subcutaneous panaritium, there is a pronounced twitching pain, local soreness outside the projection of the tendons. More often, with subcutaneous panaritium, the process is localized on the nail phalanx: "the first sleepless night" is an indication for surgery. Delay in surgery for subcutaneous panaritium threatens the transition of inflammation to the bone or joint.

 

Tendon panaritium

Tendon panaritium is a suppuration of the tendon sheath more often with the spread of subcutaneous panaritium inward. With tendon panaritium, severe pain is noted, a sharp swelling of the affected finger, which, together with the adjacent finger, is in a state of palmar flexion. Palpation of the projection of the affected tendon with a bulbous probe determines the zone of maximum pain.

Delay in operation for tendon panaritium leads to tendon necrosis and loss of finger function. Especially dangerous are the tendon panaritiums of the I and V fingers - their tendon sheaths communicate, with inflammation there is a U-shaped phlegmon of the hand with the flow on the forearm. The prognosis for tendon panaritium is unfavorable.

 

Articular panaritium

Articular panaritium is suppuration of the articular bag of the interphalangeal joint of the finger. Articular panaritium is more often a complication of subcutaneous panaritium (late or incorrectly performed surgery for subcutaneous panaritium). The joint is sharply swollen, painful on palpation, stretching along the axis of the finger is sharply painful.

Conservative treatment of finger joint panaritium can be carried out only in the earliest stages (puncture of the joint with washing the cavity with antibiotics). With increased pain and late stages of articular felon, surgical treatment is necessary. The prognosis for articular panaritium is unfavorable.

 

Bone panaritium

Bone panaritium is more often localized on the nail phalanx of the finger. With bone panaritium, there is a bulbous swelling of the finger in the area of the nail phalanx, pain on palpation, sometimes bone crepitus is determined. Radiographically, with bone panaritium, bone sequestration is detected. Treatment of bone panaritium is surgical.

Bone and tendon felon, the focus of infection is localized in the deep-lying tissues of the finger.