felon vs paronychia

https://www.uptodate.com/contents/paronychia-and-ingrown-toenails, http://emedicine.medscape.com/article/1106062-overview, http://www.aafp.org/afp/2001/0315/p1113.html, http://emedicine.medscape.com/article/782537-treatment#showall, https://www.uptodate.com/contents/overview-of-hand-infections?source=search_result&search=Felon&selectedTitle=1~4, https://www.uptodate.com/contents/overview-of-nail-disorders, http://emedicine.medscape.com/article/1948841-overview, Most common hand infection in the United States, Multifactorial: chronic exposure to moist environments or, Systemic infection with hematogenous extension, Commonly involves the thumb and index finger, Culture wound fluid: to identify the causative pathogen. New York: McGraw-Hill, 1999:2414–26. Role of ultrasound in musculoskeletal infections. Emergency department evaluation and treatment of hand injuries. Management of early human bites of the hand: a prospective randomized study. 31. For recurrent herpetic whitlow, suppressive therapy with an antiviral agent may be helpful. Because of the innocent appearance of this injury, patients may not seek medical attention and commonly present with advanced infection. In a study of 191 patients with clenched-fist injuries, 75 percent had an injury to tendon, bone, joint, or cartilage.33. Potential complications of a felon and felon drainage include an anesthetic fingertip, a neuroma, and an unstable finger pad. Johnstone F,

Doyle JR.

1986;105:631. Schaefer RA, Candida tenosynovitis in an AIDS patient: a case report.
i have tense swelling in the finger pad, with some tenderness, but i have prior chronic numbness due to previous hand surgeries. Bassett RL. Arch Surg. Pyogenic flexor tenosynovitis is an acute synovial space infection involving a flexor tendon sheath. Dry dressing changes with twice-daily saline soaks, range-of-motion activities and, eventually, scar massage may accelerate return to normal activity.12, Gram stain should guide initial antibiotic therapy. Roberge RJ,

Occasionally, the high pressure in the fingertip pad will cause a felon to spontaneously drain, resulting in a visible sinus. Get Permissions, Access the latest issue of American Family Physician. Costigan W. You must be seen by federal law regardless of your ability to p ... Make sure you follow up as directed. Neumeister MW,

Lisser SP.

Complications include fingertip soft tissue necrosis and osteomyelitis. 14. Mohler A. For example, the radial bursa can communicate with the ulnar bursa at the wrist (an infection of this area is called a “horseshoe abscess”). Connolly B, Recognition of the potential severity of the injury is important in the management of a clenched-fist injury. Holtom PD, Human bite injuries to the hand usually result from a direct bite or a “fight bite” (also known as a “clenched-fist” injury).30–32 Direct human bite injuries are often visually evident. Relhan V, Goel K, Bansal S, Garg VK.

Rings should be removed from the affected finger and other fingers of the hand as soon as possible. Mjos DP,

Candida tenosynovitis in an AIDS patient: a case report. The sweat glands provide a potential portal of entry for bacteria.

This article is one in a series coordinated by the Department of Family Medicine at Naval Hospital Jacksonville, Jacksonville, Fla. paronychia or felon. Instr Course Lect.

In: Hunter JM, Mackin E, Callahan AD, eds. This infection is usually the result of dishwashing, a manicure, an ingrown nail, or a hangnail, and usually becomes evident two to five days posttrauma.12,13 Paronychia in children is usually the result of thumb sucking. Tetanus prophylaxis should be administered when necessary. This is not often seen, but when it is, you know the paronychia has progressed to the second stage, an abscess. 4th ed. Thimons MM. Tissue pressures in pyogenic flexor tenosynovitis of the finger: compartment syndrome and its management.

The family physician's comfort level and the availability of a surgeon may determine whether this procedure is performed in the family physician's office, or the patient is referred. Treatment of acute paronychia usually involves antibiotics, while chronic paronychia is treated with topical steroids and antifungal therapy. Lille S,

7. Amore advanced felon requires incision and drainage. Early surgical treatment should be considered if the patient is immunocompromised or has diabetes.24 Surgical treatment involves proximal and distal tendon exposure, and careful insertion of a catheter or feeding tube into the tendon sheath with copious intraoperative irrigation.1,4,15,24,25 Postoperatively, the catheter may be left in place for 24 hours to allow for further low-flow irrigation. Doyle B, In: Hunter JM, Mackin E, Callahan AD, eds. Rockwell PG.

Gomperts BN, The subcutaneous tissue is sharply dissected just volar to the volar cortex of the distal phalanx. 1990;39:539–46. what do i do? Emerg Med Clin North Am. Susceptible to more severe infections and more likely to require surgical intervention.

Harrison BP, Material for Gram stain and aerobic/anaerobic cultures should be obtained from deep within all suppurative wounds before therapy is instituted. Physical and occupational therapy should be initiated to reduce long-term disability from scarring and contractures. using that product could be problematic on human skin. Acute and Chronic Paronychia. Do not stress. The gauze should be removed in approximately 24 to 48 hours, and the wound allowed to close by secondary intention. what do i do. Felon is an infection of the distal pulp space of the fingertip. Don't miss a single issue. The thumb flexor sheath begins at the terminal phalanx and extends to the volar wrist crease, where it communicates with the radial bursa. Herpetic whitlow usually is self-limited and resolves in two to three weeks. Perron AD, 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. Many hand infections improve with early splinting, elevation, appropriate antibiotics and, if an abscess is present, incision and drainage. Perionychial infections associated with sculptured nails. Please enable JavaScript in your browser settings and reload this page to access AMBOSS. Paronychia and ingrown toenails. Mjos DP, 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. These may eventually coalesce and, as the fluid becomes cloudier, mimic a pyogenic bacterial infection.

As long as you do not have redness extending beyond the digit i would give the antibiotics another day or two. 25. (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. Chronic paronychia often is caused by a candidal infection that may respond to treatment with a topical antifungal/steroid agent.11,12, A felon is an abscess of the distal pulp or phalanx pad of the fingertip.1,2,12,14,15 The pulp of the fingertip is divided into small compartments by 15 to 20 fibrous septa that run from the periosteum to the skin (Figure 3). New York: Churchill Livingstone, 1994:62. 34. J Hand Surg [Am]. | STEP 2 CK 12 View/Print Figure Kelleher AT, Because the septa attach to the periosteum of the distal phalanx, spread of infection to the underlying bone can result in osteomyelitis.16, A felon usually is caused by inoculation of bacteria into the fingertip through a penetrating trauma. Often, the pain is out of proportion to the physical findings. slightly pink in color. Complications include nail dystrophy or felon. A thorough neurovascular and musculoskeletal examination should be performed. Surgical findings in clenched-fist injuries.

15. Gill MJ, Rockwell PG.

While the cause is often unknown, minor trauma most commonly precedes infection. Herpetic whitlow of the toe. 1996;16:164–6. This organism is quite fastidious and often responsible for chronic, indolent hand infections.9, Possible sexually transmitted disease exposure, Flexor tenosynovitis as well as cutaneous abscesses are known potential sequelae of disseminated N. gonorrhoeae infection.1,3,5,6,10.

The depth of the incision is to the dermis.

Necrotic skin edges are excised, and the abscess is decompressed and irrigated. 1989;5:525–31.

Matsui T. In: Freedberg IM, Fitzpatrick TB, eds. Moran GJ,

Management of chronic paronychia.

The trauma often is at a flexor crease; this is where the tendon sheath is most superficial.

Continuous postoperative catheter irrigation is not necessary for the treatment of suppurative flexor tenosynovitis. Plast Reconstr Surg.

The metacarpophalangeal joint should be moderately flexed to 60 degrees, and the interphalangeal joints should be slightly flexed (10 degrees for the proximal interphalangeal joint and 5 degrees for the distal interphalangeal joint). Treatment involves warm soaks, topical antibiotics, and abscess drainage, if indicated. Chang J.

Gonococcal hand abscess. Treatment consists of parenteral antibiotics and sheath irrigation.

Hand infections. Puttler E. Guest editor of the series is Anthony J. Viera, LCDR, MC, USNR. Arlette J, 1993;11:601–19. Chronic paronychia infections have a multifactorial etiology, often related to repeated exposure to moist environments and/or skin irritants, and may be accompanied by secondary fungal infection. 8.

2002;20:114–7. On keflex x2 days not responding (neither is my doctor) it is on mastectomy side and i also take hydroxyurea. Mimickers of hand infections.

Gunther SF, 1998;14:647–56. Acute gonococcal flexor tenosynovitis in an adolescent male with pharyngitis.

Talan DA. The patient presented with three days of increased swelling, redness, and severe pain of the fingertip.
Felon is an infection of the distal pulp space of the fingertip.

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