Purulent diseases of the fingers. Panaritiums.

The thumb is the shortest of the human fingers. Unlike other fingers, which consist of three phalanges, it consists of only two. Because of the other possibilities of movement, the thumb plays a special role in allowing pressure to be applied against the other fingers, which is the basis of the hand's grasping function.

How to find the cause of the disease

To help the doctor make a diagnosis, it is important to correctly describe what is happening.
Pain in the fingers is almost always accompanied by other unpleasant sensations. For example, with Raynaud's phenomenon, they are accompanied by numbness, and symptoms appear after hypothermia of the hand. Polycythemia at the initial stage is accompanied by a burning sensation in the hands and their redness. Ligamenitis bothers you at rest, more often at night. If the spine is to blame, the unpleasant sensations will not be limited to the fingers; they will arise in the back or along the arm. Does your fingertip hurt when you press it? This may be associated with injury, or may occur due to the appearance of microthrombi. In such cases, sometimes black dots appear on the skin, in place of which scars form, reminiscent of rat bite marks. If this happens once, there is nothing to worry about, but if it occurs regularly, this symptom indicates the need for medical attention.

Purulent diseases of the fingers. Panaritiums.

Among purulent diseases, the most common are purulent processes located on the hands and fingers. Over the past 50 years, the incidence of these diseases has not decreased, despite the fact that we are still seeing changes in their treatment: the number of deaths has decreased several times, mutilating operations are practically not performed, and the complex treatment used leads to very effective results.

Purulent diseases of the fingers are called felons. They can appear as a result of minor damage to the skin. In most cases, the disease occurs due to puncture wounds, bruises, and abrasions. A purulent disease of the fingers and hand proceeds like any other inflammation: at the beginning there is swelling, then redness, pain, the temperature rises, and the function of the organ is impaired.

Cutaneous panaritium

This type of panaritium is diagnosed quite simply. Inflammation occurs on the three phalanges of the fingers on the back or palm side. The source of inflammation can sometimes migrate and, actively spreading, in turn involves the entire finger in the inflammatory process. The spread of exudate in skin panaritium occurs under the epidermis, which exfoliates to form a bubble, inside of which there is serous, purulent or hemorrhagic content. With cutaneous panaritium, mild pain is noted. Sometimes during the course of the disease the body temperature may rise significantly. Due to the outflow of lymph to the hand, regional lymphadenitis and lymphangitis may develop. If the epidermis, exfoliated with exudate, is not completely removed, then there is a possibility that the infection will spread further. There are cases when the inflammatory process spreads to the young, still fragile, epidermis, which turns the disease into a chronic form.

Subcutaneous panaritium

The most common purulent inflammation of the hand is subcutaneous panaritium. The disease occurs in two phases: in the phase of serous exudate and in the phase of purulent melting. Among the clinical signs of subcutaneous felon, first of all, is the presence of gradually increasing, twitching, throbbing pain in the place where the inflammatory focus has arisen. At the onset of the disease, sometimes for several days, patients are able to carry out their normal work. However, later the pain in the small area of ​​inflammation that appears on the finger begins to intensify, which causes discomfort in the patient and deprives him of sleep. During examination of the finger, tissue tension is detected; if the source of inflammation is located next to the interphalangeal flexion groove, then in some cases its smoothness may be observed. The skin is slightly hyperemic. Those who are sick begin to spare the inflamed finger. To detect the location of the purulent focus, sequential palpation is used using a button probe, which easily determines the area of ​​​​the highest pain. The body temperature becomes slightly higher than normal, but patients suffer from constant pain of varying degrees of intensity. With this disease, the pus spreads deeper. This is explained by the fact that the spread of the process of spreading pus along the periphery is limited by connective tissue bridges running perpendicular to the axis of the finger, which act as natural barriers and prevent the infection from spreading to the bones, tendons and joints of the phalanx of the finger.

Paronychia

Paronychia is characterized by painful swelling in the area of ​​the periungual fold and hyperemia of the tissues surrounding it. A distinctive feature of paronychia is the periungual fold, affected by the inflammatory process, hanging over the nail plate. The inflammatory process is located on the back side of the nail phalanx. During palpation, severe pain is felt at the site of inflammation. In some cases, pus can penetrate under the nail plate, as a result of which it begins to peel off either in the lateral or proximal part. Exudate is visible through the edge of the nail, which has peeled off. The connection of the nail plate with the nail bed is lost due to the fact that its edge is raised by pus. If pus continues to accumulate under the nail and peel it off, then subungual felon develops.

Subungual panaritium

The disease is diagnosed quite simply. An accumulation of inflammatory exudate occurs under the nail, as a result of which the plate peels off either from the entire nail bed or from a separate section of it. The nail plate rises due to the purulent exudate that has accumulated underneath it. During palpation, the nail plate “sways”. It loses its fixation to the bed; the plate remains attached to the bed only at the matrix in the proximal section. The pus that has accumulated underneath is visible through the nail plate. There is practically no swelling or hyperemia at the site of inflammation. The patient complains of throbbing, bursting pain felt in the nail phalanx. As the inflammatory process develops, the pain intensifies. Palpation and percussion of the nail plate indicate pain in this area. For treatment, it is recommended to remove the nail plate, which will lead to recovery. After the wound heals, complete regeneration of the nail plate will occur in 4 months.

Articular felon

In case of injury to the dorsal surface of the interphalangeal or metacarpophalangeal region of the finger, where they are covered with soft tissue, articular panaritium may occur. Through the wound channel, the infection ends up in the joint space, where conditions are created for the infection to develop further and the pathological process to progress. The shape of the inflamed joint becomes fusiform, and smoothing of the dorsal interphalangeal grooves is observed. Flexion and extension of the finger is accompanied by a sharp increase in pain in the affected joint. Local temperatures are rising. There is swelling and redness on the back of the finger. If you puncture the joint, you can take a little cloudy liquid. Against the background of primary inflammation of the joints, in some cases, secondary, or metastatic, articular panaritium may appear. Its clinical signs are similar to those listed above. Treatment of articular felon should be timely and radical. It must be carried out while the inflammation is at the serous stage and the inflammatory process has not yet reached the cartilaginous surface and bones of the phalanges. If treatment is not carried out on time, and as a result of advanced disease, the articular ends begin to collapse, this can lead to ankylosis.

Bone panaritium

Bone panaritium most often develops at a time when the pathological process from soft tissues moves to the finger bone. Thus, this process is secondary. The inflammatory process develops on the bones of the fingers quite rarely. Bone panaritium can occur if the infection is transferred by blood flow from existing foci of inflammation during a sharp decrease in protective forces as a result of a severe somatic illness. In most cases, the development of bone felon is the result of an advanced form or incompletely cured subcutaneous felon. If during surgery small “economical” incisions were made, as a result of which sufficient outflow of pus was not ensured, then the infection may begin to spread right up to the bony phalanx of the finger. In this case, after the subcutaneous panaritium has been opened, a short period begins, during which the patient’s condition improves, and swelling and pain decrease. However, this does not lead to complete recovery. Instead, the developed granulation tissue takes on a gray, dull color. There is a constant dull pain in the finger. Scanty pus is constantly discharged from the wound, sometimes containing small bone sequesters. The phalanx thickens and takes on the appearance of a club. Pain is felt on palpation. The brush practically does not function. The operation should be carried out before obvious destructive changes begin, which can be determined using x-rays. It is imperative to monitor how the process develops. First, the amount of pus discharged should decrease and then stop completely. Then the swelling subsides and the pain in the finger stops. Healthy granulation tissue appears at the surgical site. General body temperature returns to normal. The results of blood tests show positive dynamics. Control radiographs show that there are no progressive destructive changes. All these indicators indicate that the course of bone panaritium is favorable.

Tendon panaritium (tenosynovitis)

Tenosynovitis may occur due to subcutaneous panaritium. This is possible if, during therapy, conditions under which inflammation would be successfully eliminated were not created. The infection begins to spread into tissues that are located deeper than the source of inflammation, most often the flexor tendons of the finger are affected. The extensor tendons are less likely to become inflamed because they are more resistant to infection. With tendon panaritium, the patient’s general condition worsens, twitching, throbbing pain appears throughout the finger, the tissues swell evenly, and the interphalangeal grooves smooth out. The finger becomes like a sausage. If the projection line of the flexor tendons is palpated using a button probe, this will cause very sharp pain. The sore finger is slightly bent. If the finger is placed in a position close to the physiological one, then the degree of tension on the flexor tendons is relieved, which leads to a decrease in pain. When the finger is extended, the pain increases sharply, and when it is bent, it decreases significantly. This symptom can be defined as a cardinal sign of tenosynovitis. You cannot delay surgical intervention for tendon panaritium. Due to the compression of the mesotenone vessels by the exudate, the tendon is deprived of blood supply and soon dies. If the operation is performed late, the inflammatory focus will be eliminated, but the finger will no longer bend. Preservation of the finger depends on how early the diagnosis is made and the correct treatment path is chosen.

Pandactylitis

With pandactylitis, purulent inflammation affects all tissues of the finger. In this disease, any of the types of inflammatory processes listed earlier does not predominate. In this case, you can observe all types of purulent finger lesions at the same time. The course of pandactylitis is quite severe. Severe intoxication, regional lymphangitis, cubital and axillary lymphadenitis are observed. The development of the disease is gradual. The prerequisites for the occurrence of pandactylitis is the introduction of a virulent infection into the damaged tissue of the finger. Most often, the inflammatory process occurs and progresses if the wound channel is long and narrow, for example, after an injury from a thin, sharp piercing object. With such an injury, the skin located above the wound channel “sticks together” quite quickly, which creates favorable conditions for the development of an infection that has already penetrated into the tissue. Clinical observations show that if the wound on the finger is sufficiently extensive, then pandactylitis, as a rule, does not develop. Most likely, this can be explained by the fact that the wound compartment has a good outflow, which allows drainage of an open infected wound and its treatment with antibacterial drugs. Pandactylitis can arise from subcutaneous felon, which is one of the simpler forms of purulent inflammation of the finger. Some time after infection, pain occurs, which gradually intensifies and becomes intense, painful and bursting. The finger begins to swell and its color turns blue-purple. The development of the inflammatory process follows the type of dry or wet necrosis. On palpation, all parts of the finger are painful. When you try to move your fingers, a sharp, severe pain occurs. The development of the purulent-inflammatory process can be stopped with the help of surgery and further active complex therapy aimed at eliminating the disease.

What research needs to be done

Because pain in the fingertips is a symptom of diseases that may pose a risk to the patient, a complete baseline examination is necessary. General and biochemical blood tests are prescribed, and an ECG is performed. Even if there is no suspicion that the pain is related to the heart, but problems with the spine cannot be ruled out, the results of the research will be needed to decide on admission to physiotherapy.

Further research depends on what diagnosis the doctor suspects after receiving the results of basic research.

What will the therapy be like?

How to treat a patient whose fingertips hurt depends on the cause that caused the disease. If the problem is osteochondrosis, anti-inflammatory treatment is aimed at relieving inflammation in the spinal area. The surgeon opens the panaritium. Polycythemia - a pathological increase in the number of red blood cells - is a serious reason to consult a hematologist. Diabetic neuropathy is treated jointly by an endocrinologist and a neurologist. Ligamenitis is a reason to consult a surgeon.

Due to the abundance of causes of discomfort in the fingertips, their treatment is also varied. In case of a bruise, the traumatologist, having ruled out serious injuries, will prescribe rest and anti-inflammatory ointment for several days, and in other cases the matter may end with surgery or long-term regular treatment.

Inflammation of the fingers, or felon

25.09.2019

Inflammation of the fingers is medically called felon . Usually the disease manifests itself as a purulent abscess on the fingers or toes , as a rule, the abscess is localized near the nail plate. The affected area swells, turns red, and an inflammatory process begins to form inside.

Most often, pathology develops by introducing infection into the wound through cracks and microtraumas of the skin. As a rule, these are injuries, cuts, bruises, splinters. Sometimes the cause of the development of a purulent abscess is banal hangnails, torn to the point of bleeding . If not treated in time, an ordinary abscess can turn into a serious wound.

Types of panaritium by location

Depending on the location of the suppuration, doctors divide felon into several categories:

1. cutaneous - develops on the surface or inside in the subcutaneous layer of the palm or finger. The tissues swell, filling with purulent contents, sometimes with admixtures of blood , a swelling forms externally, which is very painful;
2. subungual – occurs as a complication or as a result of infection under the nail plate. In this case, the tissues located under the nail become soft and inflamed. Often the cause of the development of subungual suppuration is a blow to the finger with a heavy object;
3. articular - spreads to all phalanges of the finger, causing swelling and immobility. It begins with an infection that accompanies cuts and bruises and small wounds. Due to swelling, the finger may stop straightening;
4. bone - a severe form of panaritium , which is formed due to lack of treatment and damages the entire finger. Edema fills the periarticular tissues with serous fluid, which leads to serious consequences and hospitalization;
5. tendon – the last stage of the disease, when all tissues of the joints and tendons are affected. It can act as a complication or after serious injuries to the phalanges of the fingers. With the tendinous form of panaritium, surgical treatment cannot be avoided.

Symptoms

Symptoms may vary depending on how deep the infection has penetrated into the tissue. The disease begins in several stages. At the beginning, tissue infection occurs, with the introduction of a microbial infection.

At this stage, felon sometimes occurs unnoticed, without causing any pain. After a few days, the affected area turns red, swells, and becomes hot to the touch. Characteristic pains appear that accompany the wound. At the last stage, a purulent boil , the joints of the phalanx are affected. Protracted forms of panaritium are treated surgically .

Some characteristic symptoms:

• severe swelling , redness at the site of the abscess;
• increase in temperature in the wound area;
• formation of pus around the nail, under the nail;
• constant throbbing pain;
• trauma to the cuticle under the nail plate;
• transfer of swelling to the remaining phalanges of the finger, difficulty in flexion.

Methods of treating felon

At first, it is best to resort to conservative methods of treatment, as they can quickly stop the penetration of pus into the deep layers of the finger. Treatment methods must be discussed with the surgeon.

In the later stages, panaritium is treated with antibacterial drugs that suppress the purulent process. In some situations, you have to resort to surgical opening of the wound. The formation of a persistent abscess requires immediate medical ; in this case, you should not self-medicate, as this can be dangerous.

Published in Surgery Premium Clinic