28. Surgical inflammation of the skeletal and muscular system – surgical infections of the fingers

Overview: What is Panaritium?

Panaritium refers to an acute purulent inflammation of the soft tissues of the fingers or hand, affecting structures like:

• Skin
• Subcutaneous tissue
• Nail folds
• Tendon sheaths
• Bones and joints

Infections may be superficial or deep.

Etiology

• Bacteria: Staphylococcus aureus (most common), Streptococcus, anaerobes
• Fungi: Rarely, in chronic or immunosuppressed patients
• Routes of infection:
• Direct inoculation (e.g., puncture wound, hangnail)
• Spread from adjacent structures (e.g., arthritis, osteomyelitis)

Types of Surgical Finger Infections

1. Paronychia

Infection around the nail fold (from torn hangnail or cuticle)

Signs:

• Redness, pain, swelling around the nail
• Pus accumulation

Complication: May form subungual abscess

Treatment:

• Warm soaks, antibiotics
• Incision and drainage if pus is present

2. Subungual Abscess

Pus collects under the nail

Often secondary to paronychia

Signs:

• Severe throbbing pain under nail
• Visible swelling, pressure

Treatment:

• Nail puncture or partial removal to drain abscess
• Antiseptics and antibiotics

3. Cutaneous Panaritium

Also called infectious bulla

Superficial infection of skin

Signs:

• Redness, blistering, mild swelling

Usually treated conservatively

4. Subcutaneous Panaritium

Most common form of purulent finger infection

Infection spreads into subcutaneous tissue

Signs:

• Red, swollen, hot finger
• Sharp pain during flexion
• Risk of spreading to tendons, joints, bones

Treatment:

• Incision and drainage
• Antibiotics
• Immobilization

5. Felon

Infection or abscess in the pulp (bulbous tip) of the finger

Two forms:

• Cellulitis (non- pus forming)
• Abscess (pus- filled cavity)

Etiology:

• Puncture wounds, splinters, or spread from surrounding sites

Clinical signs:

• Severe pain, redness, swelling
• Pressure buildup can cause tissue necrosis

Treatment:

• Surgical drainage (longitudinal incision)
• Antibiotics

“Felon = cellulitis or abscess of fingertip pulp” — can lead to osteomyelitis if untreated.

6. Arthritis of Finger Joints

Septic arthritis may follow deep panaritium

Leads to joint destruction if untreated

Signs:

• Swelling, redness, severe tenderness over joint

Treatment:

• Joint puncture
• Antibiotics
• Surgical drainage if needed

7. Tenosynovitis

Infection of the flexor tendon sheath

Extremely painful

Kanavel’s signs:

1. Finger held in slight flexion
2. Fusiform swelling
3. Tenderness over the tendon sheath
4. Pain on passive extension

Treatment:

1. Early: IV antibiotics + immobilization
2. Later: surgical drainage

8. Osteomyelitis

May result from untreated felon or deep panaritium

Chronic infection of phalangeal bones

Signs:

• Persistent pain, swelling
• Draining sinus (chronic cases)

Diagnosis:

• X- ray, bone scan, biopsy

Treatment:

• Surgical debridement
• Long- term antibiotics

Complications of Untreated Panaritium

Spread to:

• Joint → Arthritis
• Tendon sheath → Tenosynovitis
• Bone → Osteomyelitis

Fistula formation

• Loss of function or amputation in severe cases

General Treatment Principles

Early:

• Antibiotics (empirical → culture- based)
• Warm soaks, rest

Abscess present: