What are the common causes of finger infections. How can you identify symptoms of infected fingers. When should you seek medical care for swollen fingers. What are effective treatments for finger infections. How can you prevent finger infections at home.

Understanding the 6 Main Types of Finger Infections

Finger infections are a common ailment that can range from mild to potentially serious. Early recognition and proper treatment are crucial to prevent complications or permanent disability. Let’s explore the six primary types of finger infections:

1. Paronychia
2. Felon
3. Herpetic whitlow
4. Cellulitis
5. Infectious flexor tenosynovitis
6. Deep space infection

Paronychia: The Most Common Bacterial Finger Infection

Paronychia is an infection that affects the tissue surrounding the fingernail. It’s typically superficial and localized to the soft tissue and skin around the nail. This condition is the most prevalent bacterial infection observed in the hand.

How does paronychia develop? Often, it begins with a hangnail or attempts to bite off a piece of nail at the corner. This creates an open wound, allowing bacteria from the skin and mouth to enter and cause infection.

Felon: An Infection of the Fingertip Pad

A felon is a bacterial infection that occurs in the fingertip pad and associated soft tissue. It’s usually the result of a puncture wound that introduces bacteria deep into the fingertip pad. The unique structure of the fingertip, with its multiple compartments, contains the infection within this area.

Herpetic Whitlow: The Most Common Viral Hand Infection

Herpetic whitlow is a viral infection of the fingertip area caused by the herpes simplex virus type I or II. It’s the most common viral infection of the hand and is often misdiagnosed as paronychia or felon.

Who is at risk for herpetic whitlow? People in certain occupations, such as dentists, hygienists, physicians, nurses, or anyone who may have contact with saliva or body fluids containing the virus, are at higher risk. Additionally, individuals with oral or genital herpes may inadvertently infect their own fingers.

Recognizing Symptoms of Finger Infections

Identifying the symptoms of finger infections is crucial for timely treatment. Here are some common signs to watch for:

• Redness and swelling around the affected area
• Pain or tenderness
• Warmth in the infected region
• Pus or discharge
• Difficulty moving the finger
• Fever (in severe cases)

Can symptoms vary depending on the type of infection? Yes, different infections may present unique symptoms. For instance, herpetic whitlow often causes small blisters to form around the fleshy part of the fingertips, while paronychia typically begins with redness and swelling at the nail edge.

When to Seek Medical Care for Finger Infections

While some minor finger infections can be treated at home, certain situations require prompt medical attention. Seek medical care if you experience:

• Severe pain or swelling
• Signs of spreading infection (red streaks up the arm)
• Fever or chills
• Inability to move the affected finger
• Symptoms that worsen or don’t improve with home treatment

Is it necessary to see a doctor for all finger infections? Not always, but it’s better to err on the side of caution. Early medical intervention can prevent complications and ensure proper treatment, especially for more serious infections like felons or deep space infections.

Diagnostic Exams and Tests for Finger Infections

When you visit a healthcare provider for a suspected finger infection, they may perform several exams and tests to determine the cause and severity of the infection. These may include:

1. Physical examination of the affected finger
2. Medical history review
3. Culture of any drainage or pus
4. Blood tests to check for signs of systemic infection
5. X-rays or other imaging studies in severe cases

How do doctors differentiate between various types of finger infections? They consider factors such as the location of the infection, its appearance, and the patient’s history. For example, a history of cold sores might suggest herpetic whitlow, while a recent puncture wound could point to a felon.

Home Care Treatments for Finger Infections

For mild finger infections, several home care treatments can be effective:

• Warm water soaks: Soak the affected finger in warm water for 10-15 minutes, 3-4 times a day
• Over-the-counter pain relievers: Acetaminophen or ibuprofen can help manage pain and reduce inflammation
• Topical antibiotic ointments: For superficial infections, apply as directed
• Elevation: Keep the hand elevated to reduce swelling
• Avoid irritants: Keep the affected area clean and dry, avoiding harsh soaps or chemicals

Are home treatments always sufficient for finger infections? While they can be effective for mild cases, it’s important to monitor the infection closely. If symptoms worsen or don’t improve within a few days, seek medical attention.

Medical Treatments for Severe Finger Infections

When finger infections are severe or don’t respond to home care, medical treatments may be necessary. These can include:

1. Oral antibiotics for bacterial infections
2. Antiviral medications for herpetic whitlow
3. Incision and drainage procedures for abscesses
4. Surgical intervention for deep space infections or severe cases
5. Intravenous antibiotics for systemic infections

How long does it take for medical treatments to show results? The timeline can vary depending on the severity and type of infection. Some patients may see improvement within a few days, while others might require weeks of treatment. It’s crucial to follow your healthcare provider’s instructions and complete the full course of any prescribed medications.

Preventing Finger Infections: Tips and Best Practices

Prevention is always better than cure when it comes to finger infections. Here are some tips to help you avoid these painful conditions:

• Practice good hand hygiene: Wash your hands regularly with soap and water
• Avoid biting nails or cuticles
• Use protective gloves when working with harsh chemicals or in dirty environments
• Moisturize your hands to prevent dry, cracked skin
• Promptly clean and care for any cuts or injuries to the fingers
• Avoid sharing personal items like nail clippers or towels

Can proper nail care help prevent finger infections? Absolutely. Keeping your nails trimmed and avoiding aggressive manicure techniques can significantly reduce the risk of paronychia and other nail-related infections.

Long-term Outlook and Potential Complications of Finger Infections

While most finger infections resolve completely with proper treatment, some can lead to complications if left untreated or improperly managed. Potential long-term issues include:

1. Chronic or recurrent infections
2. Nail deformities or loss
3. Scarring or tissue damage
4. Joint stiffness or reduced range of motion
5. In severe cases, loss of finger function or amputation

Do all finger infections carry the same risk of complications? No, the risk varies depending on the type and severity of the infection. Deep space infections and infectious flexor tenosynovitis generally carry higher risks of serious complications compared to more superficial infections like paronychia.

Understanding Cellulitis: A Superficial Skin Infection

Cellulitis is a superficial infection of the skin and underlying tissue, usually occurring on the surface without involving deeper structures of the hand or finger. This condition is typically caused by staphylococcal and streptococcal organisms.

How does cellulitis develop? It’s often the result of an open wound that allows bacteria to infect the local skin and tissue. The infection can also spread to the hand and fingers through the bloodstream, carrying the bacteria to these areas.

Infectious Flexor Tenosynovitis: A Deep Tendon Infection

Infectious flexor tenosynovitis is a serious infection involving the tendon sheaths responsible for flexing or closing the hand. It’s considered a type of deep space infection and can have severe consequences if not treated promptly.

What causes infectious flexor tenosynovitis? This bacterial infection is usually the result of penetrating trauma that introduces bacteria into the deep structures and tendon sheaths. Once inside, the infection can spread along the tendon and associated sheath.

Deep Space Infections: Understanding the Risks

Deep space infections involve one or several deep structures of the hand or fingers, including tendons, blood vessels, and muscles. These infections can be particularly serious due to their location and potential for rapid spread.

What is a collar button abscess? This is a specific type of deep space infection located in the web space between the fingers. It’s named for its characteristic shape, resembling a collar button.

The Role of Trauma in Finger Infections

Most finger infections begin with some form of trauma to the area. Common causes include:

• Cuts or scrapes
• Animal bites
• Puncture wounds
• Splinters or foreign objects
• Harsh chemicals or irritants

Why does trauma increase the risk of infection? Trauma creates openings in the skin, allowing bacteria to enter and colonize the area. Additionally, injured tissue may have reduced blood flow, making it harder for the body’s immune system to fight off invading pathogens.

Occupational Risks for Finger Infections

Certain occupations carry a higher risk of finger infections due to increased exposure to pathogens or potential for hand injuries. These include:

1. Healthcare workers (doctors, nurses, dentists)
2. Food service workers
3. Construction workers
4. Mechanics
5. Gardeners and landscapers
6. Nail technicians and beauticians

How can workers in high-risk occupations protect themselves? Regular hand washing, proper use of personal protective equipment (like gloves), and prompt treatment of any cuts or injuries are crucial. Additionally, maintaining good overall hand health through moisturizing and proper nail care can help prevent infections.

The Impact of Underlying Health Conditions on Finger Infections

Certain health conditions can increase a person’s susceptibility to finger infections or complicate their treatment. These include:

• Diabetes
• Immunocompromising conditions (like HIV/AIDS)
• Peripheral vascular disease
• Chronic skin conditions (like eczema)
• Autoimmune disorders

Why do these conditions increase infection risk? Many of these conditions affect the body’s immune response or circulation, making it harder to fight off infections. For example, diabetes can lead to reduced sensation in the hands, making it easier to overlook small injuries that could become infected.

Antibiotic Resistance and Finger Infections

The rise of antibiotic-resistant bacteria has implications for the treatment of finger infections. Some key points to consider:

1. Methicillin-resistant Staphylococcus aureus (MRSA) can cause difficult-to-treat finger infections
2. Overuse of antibiotics contributes to resistance
3. Proper wound care and hygiene are crucial in preventing resistant infections
4. Culture and sensitivity testing may be necessary to guide antibiotic selection
5. Alternative treatments may be needed for resistant infections

How does antibiotic resistance affect treatment choices? Healthcare providers must carefully consider the most appropriate antibiotic for each case, often starting with broader-spectrum antibiotics until culture results are available. In some cases, combination therapy or non-antibiotic treatments may be necessary.

Rehabilitation and Recovery After Finger Infections

After treatment for a finger infection, rehabilitation may be necessary to restore full function. This process can involve:

• Physical therapy exercises to improve range of motion
• Occupational therapy to regain fine motor skills
• Scar management techniques
• Gradual return to normal activities
• Ongoing monitoring for signs of recurrence

How long does rehabilitation typically take? The duration of rehabilitation can vary widely depending on the severity of the infection and any complications. Some patients may recover fully within a few weeks, while others might require months of therapy to regain optimal function.

Psychological Impact of Severe Finger Infections

Severe finger infections can have psychological effects beyond the physical symptoms. These may include:

1. Anxiety about potential loss of function or disfigurement
2. Depression related to chronic pain or disability
3. Frustration with the recovery process
4. Social isolation due to visible symptoms or inability to perform usual activities
5. Fear of recurrence or developing new infections

How can patients cope with the psychological impact of finger infections? Support from healthcare providers, family, and friends is crucial. In some cases, counseling or support groups may be helpful. Additionally, focusing on rehabilitation goals and celebrating progress can help maintain a positive outlook during recovery.

Emerging Treatments and Research in Finger Infections

While traditional treatments remain the mainstay for finger infections, research continues to explore new options. Some areas of interest include:

• Novel antibiotic delivery methods for deep tissue infections
• Bacteriophage therapy as an alternative to antibiotics
• Advanced wound healing technologies
• Immunomodulatory treatments to enhance the body’s natural defenses
• Improved diagnostic techniques for faster, more accurate identification of pathogens

What potential benefits could these emerging treatments offer? These new approaches could lead to more effective treatments, particularly for antibiotic-resistant infections. They may also reduce treatment times, minimize side effects, and improve overall outcomes for patients with finger infections.

Finger Infections & Swollen Fingers: 6 Possible Causes

Written by WebMD Editorial Contributors

• Finger Infection Overview
• Finger Infection Causes
• Finger Infection Symptoms
• When to Seek Medical Care
• Exams and Tests
• Finger Infection Treatment – Self-Care at Home
• Medical Treatment
• Next Steps – Follow-up
• Prevention
• Outlook
• For More Information
• Multimedia
• Synonyms and Keywords
• More

Injury or infection to a finger or fingers is a common problem. Infection can range from mild to potentially serious. Often, these infections start out small and are relatively easy to treat. Failure to properly treat these infections can result in permanent disability or loss of the finger.

Early recognition and proper treatment of the following main finger infections will help prevent most of the serious outcomes.

• Paronychia: A paronychia is an infection of the finger that involves the tissue at the edges of the fingernail. This infection is usually superficial and localized to the soft tissue and skin around the fingernail. This is the most common bacterial infection seen in the hand.
• Felon: A felon is an infection of the fingertip. This infection is located in the fingertip pad and soft tissue associated with it.
• Herpetic whitlow: A herpetic whitlow is an infection of the fingertip area caused by a virus. This is the most common viral infection of the hand. This infection is often misdiagnosed as a paronychia or felon.

  Herpetic whitlow is a painful infection of the fingertip area caused by the herpes virus. Small blisters form around the fleshy part of the fingertips. The condition is contagious and very common. It can be treated with antiviral medications but may come back.

• Cellulitis: This is a superficial infection of the skin and underlying tissue. It is usually on the surface and does not involve deeper structures of the hand or finger.
• Infectious flexor tenosynovitis: This infection involves the tendon sheaths responsible for flexing or closing the hand. This is also a type of deep space infection.
• Deep space infection: This is an infection of one or several deep structures of the hand or fingers, including the tendons, blood vessels, and muscles. Infection may involve one or more of these structures. A collar button abscess is such an infection when it is located in the web space of the fingers.

Bacteria cause most of these finger infections. The exception to this is the herpetic whitlow, which is caused by a virus. How the infection starts and is found in a particular location is what makes each specific type of infection unique. Usually some form of trauma is the initial event. This may be a cut, animal bite, or puncture wound.

• Paronychia: The offending bacteria are usually staphylococcal and streptococcal organisms. Rarely, a fungus causes this infection, which usually begins as a hangnail. Often a person will attempt to bite off the piece of nail that is at the corner. This results in an open wound that allows the bacteria found on the skin and the bacteria found in the mouth to infect the wound. The infection can then spread to the surrounding tissue next to the nail and cuticle.
• Felon: This bacterial infection of the finger pad, caused by the same organisms that cause paronychia, is usually the result of a puncture wound. The wound allows the introduction of bacteria deep into the fingertip pad. Because the fingertip has multiple compartments, the infection is contained in this area.
• Herpetic whitlow: The offending viral organism is the herpes simplex virus type I or II. This is the same virus that causes oral or genital herpes infections. People in certain occupations are more at risk for this infection. These include dentists, hygienists, physicians, nurses, or any other person who may have contact with saliva or body fluids that contain the virus. People with oral or genital herpes may also infect their own fingers.
• Cellulitis: The most common causes of this bacterial infection are staphylococcal and streptococcal organisms. This infection is usually the result of an open wound that allows the bacteria to infect the local skin and tissue. The infection can also spread to the hand and fingers by blood carrying the organisms.
• Infectious flexor tenosynovitis: This bacterial infection is usually the result of penetrating trauma that introduces bacteria into the deep structures and tendon sheaths, which allows the spread along the tendon and associated sheath.
• Deep space infection: This bacterial infection is usually the result of a puncture wound or deep cut that introduces the bacteria to the deep tissue. The collar button abscess is associated with the web space between the fingers. The deep structures of the hand create many potential compartments for an infection to invade.

Each of the main finger infections has specific signs and symptoms that make identification unique and can sometimes cause confusion if not properly evaluated.

• Paronychia: The area next to the fingernail will appear red and swollen. A visible collection of pus may be seen under the skin and nail. This fluid may be actually leaking out of the wound. The area will be tender and painful to the touch. The drainage from the area is usually a cloudy white-yellow color.
• Felon: The fingertip is swollen and painful. The swelling usually develops over several days and is located in the pad area of the fingertip. The area will have a throbbing pain and be painful to the touch. The area is usually red, and a visible collection of pus may be seen under the skin. The swollen area may have a portion that feels soft as if it contains fluid. As the swelling continues, the area may become tense or hard to the touch.
• Herpetic whitlow: The fingertip area will be red and tender. A burning or itching sensation may be present in the area. There may be mild swelling, but not as extensive as in the felon. There may be a single or many open wounds in the area affected. These open wounds often occur in clusters after the formation of a small blister-like lesion. The fluid in these lesions is usually clear in appearance but may be slightly cloudy. You may also have a low-grade fever and have swollen and tender lymph nodes in the area.
• Cellulitis: The area will be red and warm to the touch. The area may be slightly swollen and tender. This is usually a superficial infection, so the deep structures should not be involved. The motion of the fingers and hand should not be difficult or painful. If painful or difficult, this may indicate a deep space infection of some type.
• Infectious flexor tenosynovitis: Four major signs often are found with this condition. First is tenderness over the flexor or palm side of the finger. This pain is found over the tendons in the finger. Second is uniform swelling of the finger. Third is pain on extending or straightening of the finger. Fourth, the finger will be held in a slightly flexed or partially bent position. These signs are called Kanavel cardinal signs. All 4 signs may not be present at first or all at once.
• Deep space infections: The deep space infection that arises in the web space of the fingers is also called a collar button abscess. The space between the fingers will be painful and swollen. The area may also be red and warm to the touch. As the abscess becomes larger, the fingers will be slightly spread apart by the increasing pressure. The central area may have a soft spot that represents a collection of pus under the skin.

The key to preventing disability and possible loss of the finger is early and appropriate treatment. If any signs and symptoms are present, you should contact your doctor at once.

If you have signs or symptoms of a felon, cellulitis, infectious flexor tenosynovitis, or deep space infection, you should seek emergency care at once.

The correct diagnosis will start with a detailed history and physical exam. People who have a localized infection will be treated differently than someone with a severe infection. Coexisting problems such as diabetes or blood vessel disorders of the arms and legs will complicate the infection and may change the degree of treatment. 

• Important information that your doctor will need to know will include the following:
  • How did the injury or infection start?
  • When did this first occur or begin?
  • Where did it occur? Home? Work? In water? In dirt? From an animal or human bite?
  • Is it possible that a foreign body is in the wound?
  • What have you done to care for this before seeing your doctor?
  • When was your last tetanus shot?
  • Any previous injuries to the area?
  • Any other medical problems that you may have not mentioned?

• Specific information may help pinpoint the type of finger infection:
  • Paronychia: A history of nail biting may aid the diagnosis.
  • Felon: A history of a puncture wound or cut will aid the diagnosis. This would include a plant thorn. The doctor may obtain an x-ray to look for involvement of the bone or possible foreign body.
  • Herpetic whitlow: A history of contact with body fluids that may contain the herpes virus will aid the diagnosis. The diagnosis can often be made from the history and the appearance of the lesions. The presence of a clear fluid from the wounds may indicate a viral infection rather than a bacterial infection. A sample of the fluid may be analyzed by a Tzank smear, which will identify certain cells, indicating a viral cause.
  • Cellulitis: The doctor will need to consider other causes that may look similar such as gout, various rashes, insect sting, burns, or blood clot before the final diagnosis is made. An X-ray may be obtained to look for a foreign body or gas formation that would indicate a type of serious cellulitis.
  • Infectious flexor tenosynovitis: A history of a puncture wound or cut will aid the diagnosis. The presence of the 4 Kanavel cardinal signs is a strong diagnostic aid. A recent sexually transmitted disease may indicate a type of gonorrhea-related infection, which may resemble infectious flexor tenosynovitis.
  • Deep space infections: A history of puncture wound or other wound may aid the diagnosis. The finding of swelling between the fingers with a slow spreading of the involved fingers will help identify a collar button abscess.

Because finger infections have the potential to become severe, home care is limited. A very minor paronychia may be managed at home if you have no other complicating medical illness, such as diabetes. All of the other infections require urgent evaluation and treatment by a doctor. Because delay in treatment may result in disability or loss of the finger, you should not hesitate to obtain medical care.

A small, simple paronychia may respond to frequent warm water soaks and elevation of the hand. However, if no improvement is noticed in 1–2 days, you should see your doctor at once.

The mainstay of treatment for finger infections is antibiotics and proper wound care. This can range from a simple incision and drainage of the wound to an extensive surgical exploration of the wound to remove as much infected material as possible.

Some of the infections can be treated in a doctor’s office or clinic, but several will require inpatient treatment and IV antibiotics. Because the organisms that cause these infections are similar, many of the same types of antibiotics may be used.

• Paronychia: Often the wound may be treated with wound care alone. If a collection of pus is present, it will need to be drained. This may be done in several different ways. Commonly a scalpel is used to make a simple incision over the collection of pus to allow drainage. Or the scalpel may be inserted along the edge of the nail to allow drainage. If the infection is large, a part of the nail may be removed. If this procedure is required, the doctor will inject a local anesthetic at the base of the finger that will provide for a pain-free procedure. Most often, you will be placed on an oral antibiotic. You will then be instructed how to take care of the wound at home. (See paronychia.)
• Felon: Often, incision and drainage is required because the infection develops within the multiple compartments of the fingertip pad. Usually an incision will be made on one or both sides of the fingertip. The doctor will then insert an instrument into the wound and break up the compartments to aid in the drainage. Sometimes, a piece of rubber tubing or gauze will be placed into the wound to aid the initial drainage. The wound may also be flushed out with a sterile solution to remove as much debris as possible. These infections will require antibiotics. The wound will then require specific home care as prescribed by your doctor.
• Herpetic whitlow: Antiviral drugs such as acyclovir (Zovirax) may shorten the duration of illness. Pain medication is often needed. The wound must be properly protected to prevent a secondary bacterial infection and to prevent you from infecting other sites on your body or other people. Incision and drainage is not proper and, if done, may actually delay healing.
• Cellulitis: This infection is superficial, and oral antibiotics are usually sufficient. If the area is extensive or your immune system is weakened, then you may be treated in the hospital with IV antibiotics.
• Infectious flexor tenosynovitis: This is a surgical emergency and will require rapid treatment, hospital admission, and early treatment with IV antibiotics. Usually, the area will need to be surgically opened and all debris and infected material removed. Because of the intricate nature of the fingers and hands, a hand surgeon will usually perform this procedure. After surgery, several days of IV antibiotics will be required followed by a course of oral antibiotics.

• Deep space infections: Much like flexor infectious tenosynovitis, this can require emergency care. If the infection is mild, then only oral antibiotics may be needed. If more severe, a hand surgeon should evaluate the wound and IV antibiotics begun. Often these wounds will require incision and drainage followed by a course of antibiotics.

You need to understand the doctor’s instructions completely and ask any questions you have in order to thoroughly understand your care at home.

• If you have been prescribed antibiotics for a finger infection, you must follow the directions and take them for the prescribed time period.
• Often, your doctor will instruct you to keep your hand elevated to prevent swelling. This is important and needs to be done both during the day and night. By placing pillows next to you while sleeping, your hand can remain elevated.
• Wound care will often need to be continued at home. This may include daily warm water soaks, dressing changes, and application of antibiotic ointment. The different types of wound care are extensive. Your doctor should explain in detail.
• The finger or hand may be placed in a splint. This provides both immobilization and protection. It will be important to follow the instructions regarding the care of the splint. You will need to protect and properly care for the splint. You should closely monitor the finger or hand to watch for complications such as swelling or infection under the splint.
• Often, you will be asked to return to the doctor’s office in 24-48 hours. This may be necessary to remove packing or change a dressing. It is very important that you have close follow-up care to monitor the progress or identify any further problems.

Common sense safety practices will help prevent many of the finger wounds that become a problem. Simple things such as wearing protective work gloves may prevent injury. Wearing latex or vinyl gloves is mandatory if possible exposure to bodily fluids is expected. Avoid chewing on your nails, and wash your hands as needed. Seek early medical attention as soon as you think an infection is present.

If the infections are treated early and properly, the prognosis for full recovery is good. However, if treatment is delayed, or if the infection is severe, the prognosis is not as good.

• With the infections that involve deep structures such as infectious flexor tenosynovitis, even with the best care, the outcome may be less than desirable. Loss of function, loss of sensation, disfigurement, or even loss of the finger is possible.
• Your doctor will need to evaluate each case individually and present the likely outcome based on the findings.

See the following for related finger injuries:

• Broken finger
• Nail injuries
• Subungual hematoma (smashed fingernail, blood under the nail)
• Skier’s thumb (jammed thumb usually in a fall, fall on an outstretched hand)
• Dislocated finger
• Mallet finger (jammed finger, painful tendon injury, common sports injury)
• Onychomycosis (fungal infection of the fingernail or toenail)

Media file 1: Flexor tendon sheaths and radial and ulnar bursae. Image courtesy of Randle L Likes, DO.
 

Media type: Illustration

Media file 2: A herpetic whitlow. Image courtesy of Glen Vaughn, MD.

Media type: Photo

Media file 3: A moderate paronychia. Swelling and redness around the edge of the nail is caused by a large pus collection under the skin. Image courtesy of Christina L Kukula, DO.

Media type: Photo

Media file 4: Drainage of pus from a paronychia. Image courtesy of Glen Vaughn, MD.

Media type: Photo

Media file 5: A paronychia can progress to a felon if left untreated. Image courtesy of A paronychia can progress to a felon if left untreated. Image courtesy of Glen Vaughn, MD.

Media type: Photo

Media file 6: Anatomy of the fingernail. Top – The normal fingernail. Bottom – Nail bed laceration with subungual hematoma.

Media type: Image
 

paronychia, hangnail, onychia lateralis, onychia periungualis, felon, whitlow, herpetic whitlow, cellulitis, infectious flexor tenosynovitis, pyogenic flexor tenosynovitis, flexor tendosynovitis, tendosynovitis, deep space infections, collar button abscess, finger injury, finger infection, onychomycosis

Top Picks

Finger Infections & Swollen Fingers: 6 Possible Causes

Written by WebMD Editorial Contributors

• Finger Infection Overview
• Finger Infection Causes
• Finger Infection Symptoms
• When to Seek Medical Care
• Exams and Tests
• Finger Infection Treatment – Self-Care at Home
• Medical Treatment
• Next Steps – Follow-up
• Prevention
• Outlook
• For More Information
• Multimedia
• Synonyms and Keywords
• More

Injury or infection to a finger or fingers is a common problem. Infection can range from mild to potentially serious. Often, these infections start out small and are relatively easy to treat. Failure to properly treat these infections can result in permanent disability or loss of the finger.

Early recognition and proper treatment of the following main finger infections will help prevent most of the serious outcomes.

• Paronychia: A paronychia is an infection of the finger that involves the tissue at the edges of the fingernail. This infection is usually superficial and localized to the soft tissue and skin around the fingernail. This is the most common bacterial infection seen in the hand.
• Felon: A felon is an infection of the fingertip. This infection is located in the fingertip pad and soft tissue associated with it.
• Herpetic whitlow: A herpetic whitlow is an infection of the fingertip area caused by a virus. This is the most common viral infection of the hand. This infection is often misdiagnosed as a paronychia or felon.

  Herpetic whitlow is a painful infection of the fingertip area caused by the herpes virus. Small blisters form around the fleshy part of the fingertips. The condition is contagious and very common. It can be treated with antiviral medications but may come back.

• Cellulitis: This is a superficial infection of the skin and underlying tissue. It is usually on the surface and does not involve deeper structures of the hand or finger.
• Infectious flexor tenosynovitis: This infection involves the tendon sheaths responsible for flexing or closing the hand. This is also a type of deep space infection.
• Deep space infection: This is an infection of one or several deep structures of the hand or fingers, including the tendons, blood vessels, and muscles. Infection may involve one or more of these structures. A collar button abscess is such an infection when it is located in the web space of the fingers.

Bacteria cause most of these finger infections. The exception to this is the herpetic whitlow, which is caused by a virus. How the infection starts and is found in a particular location is what makes each specific type of infection unique. Usually some form of trauma is the initial event. This may be a cut, animal bite, or puncture wound.

• Paronychia: The offending bacteria are usually staphylococcal and streptococcal organisms. Rarely, a fungus causes this infection, which usually begins as a hangnail. Often a person will attempt to bite off the piece of nail that is at the corner. This results in an open wound that allows the bacteria found on the skin and the bacteria found in the mouth to infect the wound. The infection can then spread to the surrounding tissue next to the nail and cuticle.
• Felon: This bacterial infection of the finger pad, caused by the same organisms that cause paronychia, is usually the result of a puncture wound. The wound allows the introduction of bacteria deep into the fingertip pad. Because the fingertip has multiple compartments, the infection is contained in this area.
• Herpetic whitlow: The offending viral organism is the herpes simplex virus type I or II. This is the same virus that causes oral or genital herpes infections. People in certain occupations are more at risk for this infection. These include dentists, hygienists, physicians, nurses, or any other person who may have contact with saliva or body fluids that contain the virus. People with oral or genital herpes may also infect their own fingers.
• Cellulitis: The most common causes of this bacterial infection are staphylococcal and streptococcal organisms. This infection is usually the result of an open wound that allows the bacteria to infect the local skin and tissue. The infection can also spread to the hand and fingers by blood carrying the organisms.
• Infectious flexor tenosynovitis: This bacterial infection is usually the result of penetrating trauma that introduces bacteria into the deep structures and tendon sheaths, which allows the spread along the tendon and associated sheath.
• Deep space infection: This bacterial infection is usually the result of a puncture wound or deep cut that introduces the bacteria to the deep tissue. The collar button abscess is associated with the web space between the fingers. The deep structures of the hand create many potential compartments for an infection to invade.

Each of the main finger infections has specific signs and symptoms that make identification unique and can sometimes cause confusion if not properly evaluated.

• Paronychia: The area next to the fingernail will appear red and swollen. A visible collection of pus may be seen under the skin and nail. This fluid may be actually leaking out of the wound. The area will be tender and painful to the touch. The drainage from the area is usually a cloudy white-yellow color.
• Felon: The fingertip is swollen and painful. The swelling usually develops over several days and is located in the pad area of the fingertip. The area will have a throbbing pain and be painful to the touch. The area is usually red, and a visible collection of pus may be seen under the skin. The swollen area may have a portion that feels soft as if it contains fluid. As the swelling continues, the area may become tense or hard to the touch.
• Herpetic whitlow: The fingertip area will be red and tender. A burning or itching sensation may be present in the area. There may be mild swelling, but not as extensive as in the felon. There may be a single or many open wounds in the area affected. These open wounds often occur in clusters after the formation of a small blister-like lesion. The fluid in these lesions is usually clear in appearance but may be slightly cloudy. You may also have a low-grade fever and have swollen and tender lymph nodes in the area.
• Cellulitis: The area will be red and warm to the touch. The area may be slightly swollen and tender. This is usually a superficial infection, so the deep structures should not be involved. The motion of the fingers and hand should not be difficult or painful. If painful or difficult, this may indicate a deep space infection of some type.
• Infectious flexor tenosynovitis: Four major signs often are found with this condition. First is tenderness over the flexor or palm side of the finger. This pain is found over the tendons in the finger. Second is uniform swelling of the finger. Third is pain on extending or straightening of the finger. Fourth, the finger will be held in a slightly flexed or partially bent position. These signs are called Kanavel cardinal signs. All 4 signs may not be present at first or all at once.
• Deep space infections: The deep space infection that arises in the web space of the fingers is also called a collar button abscess. The space between the fingers will be painful and swollen. The area may also be red and warm to the touch. As the abscess becomes larger, the fingers will be slightly spread apart by the increasing pressure. The central area may have a soft spot that represents a collection of pus under the skin.

The key to preventing disability and possible loss of the finger is early and appropriate treatment. If any signs and symptoms are present, you should contact your doctor at once.

If you have signs or symptoms of a felon, cellulitis, infectious flexor tenosynovitis, or deep space infection, you should seek emergency care at once.

The correct diagnosis will start with a detailed history and physical exam. People who have a localized infection will be treated differently than someone with a severe infection. Coexisting problems such as diabetes or blood vessel disorders of the arms and legs will complicate the infection and may change the degree of treatment. 

• Important information that your doctor will need to know will include the following:
  • How did the injury or infection start?
  • When did this first occur or begin?
  • Where did it occur? Home? Work? In water? In dirt? From an animal or human bite?
  • Is it possible that a foreign body is in the wound?
  • What have you done to care for this before seeing your doctor?
  • When was your last tetanus shot?
  • Any previous injuries to the area?
  • Any other medical problems that you may have not mentioned?

• Specific information may help pinpoint the type of finger infection:
  • Paronychia: A history of nail biting may aid the diagnosis.
  • Felon: A history of a puncture wound or cut will aid the diagnosis. This would include a plant thorn. The doctor may obtain an x-ray to look for involvement of the bone or possible foreign body.
  • Herpetic whitlow: A history of contact with body fluids that may contain the herpes virus will aid the diagnosis. The diagnosis can often be made from the history and the appearance of the lesions. The presence of a clear fluid from the wounds may indicate a viral infection rather than a bacterial infection. A sample of the fluid may be analyzed by a Tzank smear, which will identify certain cells, indicating a viral cause.
  • Cellulitis: The doctor will need to consider other causes that may look similar such as gout, various rashes, insect sting, burns, or blood clot before the final diagnosis is made. An X-ray may be obtained to look for a foreign body or gas formation that would indicate a type of serious cellulitis.
  • Infectious flexor tenosynovitis: A history of a puncture wound or cut will aid the diagnosis. The presence of the 4 Kanavel cardinal signs is a strong diagnostic aid. A recent sexually transmitted disease may indicate a type of gonorrhea-related infection, which may resemble infectious flexor tenosynovitis.
  • Deep space infections: A history of puncture wound or other wound may aid the diagnosis. The finding of swelling between the fingers with a slow spreading of the involved fingers will help identify a collar button abscess.

Because finger infections have the potential to become severe, home care is limited. A very minor paronychia may be managed at home if you have no other complicating medical illness, such as diabetes. All of the other infections require urgent evaluation and treatment by a doctor. Because delay in treatment may result in disability or loss of the finger, you should not hesitate to obtain medical care.

A small, simple paronychia may respond to frequent warm water soaks and elevation of the hand. However, if no improvement is noticed in 1–2 days, you should see your doctor at once.

The mainstay of treatment for finger infections is antibiotics and proper wound care. This can range from a simple incision and drainage of the wound to an extensive surgical exploration of the wound to remove as much infected material as possible.

Some of the infections can be treated in a doctor’s office or clinic, but several will require inpatient treatment and IV antibiotics. Because the organisms that cause these infections are similar, many of the same types of antibiotics may be used.

• Paronychia: Often the wound may be treated with wound care alone. If a collection of pus is present, it will need to be drained. This may be done in several different ways. Commonly a scalpel is used to make a simple incision over the collection of pus to allow drainage. Or the scalpel may be inserted along the edge of the nail to allow drainage. If the infection is large, a part of the nail may be removed. If this procedure is required, the doctor will inject a local anesthetic at the base of the finger that will provide for a pain-free procedure. Most often, you will be placed on an oral antibiotic. You will then be instructed how to take care of the wound at home. (See paronychia.)
• Felon: Often, incision and drainage is required because the infection develops within the multiple compartments of the fingertip pad. Usually an incision will be made on one or both sides of the fingertip. The doctor will then insert an instrument into the wound and break up the compartments to aid in the drainage. Sometimes, a piece of rubber tubing or gauze will be placed into the wound to aid the initial drainage. The wound may also be flushed out with a sterile solution to remove as much debris as possible. These infections will require antibiotics. The wound will then require specific home care as prescribed by your doctor.
• Herpetic whitlow: Antiviral drugs such as acyclovir (Zovirax) may shorten the duration of illness. Pain medication is often needed. The wound must be properly protected to prevent a secondary bacterial infection and to prevent you from infecting other sites on your body or other people. Incision and drainage is not proper and, if done, may actually delay healing.
• Cellulitis: This infection is superficial, and oral antibiotics are usually sufficient. If the area is extensive or your immune system is weakened, then you may be treated in the hospital with IV antibiotics.
• Infectious flexor tenosynovitis: This is a surgical emergency and will require rapid treatment, hospital admission, and early treatment with IV antibiotics. Usually, the area will need to be surgically opened and all debris and infected material removed. Because of the intricate nature of the fingers and hands, a hand surgeon will usually perform this procedure. After surgery, several days of IV antibiotics will be required followed by a course of oral antibiotics.

• Deep space infections: Much like flexor infectious tenosynovitis, this can require emergency care. If the infection is mild, then only oral antibiotics may be needed. If more severe, a hand surgeon should evaluate the wound and IV antibiotics begun. Often these wounds will require incision and drainage followed by a course of antibiotics.

You need to understand the doctor’s instructions completely and ask any questions you have in order to thoroughly understand your care at home.

• If you have been prescribed antibiotics for a finger infection, you must follow the directions and take them for the prescribed time period.
• Often, your doctor will instruct you to keep your hand elevated to prevent swelling. This is important and needs to be done both during the day and night. By placing pillows next to you while sleeping, your hand can remain elevated.
• Wound care will often need to be continued at home. This may include daily warm water soaks, dressing changes, and application of antibiotic ointment. The different types of wound care are extensive. Your doctor should explain in detail.
• The finger or hand may be placed in a splint. This provides both immobilization and protection. It will be important to follow the instructions regarding the care of the splint. You will need to protect and properly care for the splint. You should closely monitor the finger or hand to watch for complications such as swelling or infection under the splint.
• Often, you will be asked to return to the doctor’s office in 24-48 hours. This may be necessary to remove packing or change a dressing. It is very important that you have close follow-up care to monitor the progress or identify any further problems.

Common sense safety practices will help prevent many of the finger wounds that become a problem. Simple things such as wearing protective work gloves may prevent injury. Wearing latex or vinyl gloves is mandatory if possible exposure to bodily fluids is expected. Avoid chewing on your nails, and wash your hands as needed. Seek early medical attention as soon as you think an infection is present.

If the infections are treated early and properly, the prognosis for full recovery is good. However, if treatment is delayed, or if the infection is severe, the prognosis is not as good.

• With the infections that involve deep structures such as infectious flexor tenosynovitis, even with the best care, the outcome may be less than desirable. Loss of function, loss of sensation, disfigurement, or even loss of the finger is possible.
• Your doctor will need to evaluate each case individually and present the likely outcome based on the findings.

See the following for related finger injuries:

• Broken finger
• Nail injuries
• Subungual hematoma (smashed fingernail, blood under the nail)
• Skier’s thumb (jammed thumb usually in a fall, fall on an outstretched hand)
• Dislocated finger
• Mallet finger (jammed finger, painful tendon injury, common sports injury)
• Onychomycosis (fungal infection of the fingernail or toenail)

Media file 1: Flexor tendon sheaths and radial and ulnar bursae. Image courtesy of Randle L Likes, DO.
 

Media type: Illustration

Media file 2: A herpetic whitlow. Image courtesy of Glen Vaughn, MD.

Media type: Photo

Media file 3: A moderate paronychia. Swelling and redness around the edge of the nail is caused by a large pus collection under the skin. Image courtesy of Christina L Kukula, DO.

Media type: Photo

Media file 4: Drainage of pus from a paronychia. Image courtesy of Glen Vaughn, MD.

Media type: Photo

Media file 5: A paronychia can progress to a felon if left untreated. Image courtesy of A paronychia can progress to a felon if left untreated. Image courtesy of Glen Vaughn, MD.

Media type: Photo

Media file 6: Anatomy of the fingernail. Top – The normal fingernail. Bottom – Nail bed laceration with subungual hematoma.

Media type: Image
 

paronychia, hangnail, onychia lateralis, onychia periungualis, felon, whitlow, herpetic whitlow, cellulitis, infectious flexor tenosynovitis, pyogenic flexor tenosynovitis, flexor tendosynovitis, tendosynovitis, deep space infections, collar button abscess, finger injury, finger infection, onychomycosis

Top Picks

Why the finger is swollen and what to do about it

Likbez

Health

October 3, 2021

In some cases, you don’t have to worry, but sometimes you need the help of a doctor.

1. Fluid retention

Swelling on all fingers can occur if there is excess fluid in the body. This happens, for example, in athletes who exercise a lot and sweat. Together with sweat, they lose sodium, which normally retains water in the bloodstream. Otherwise, it comes out of it and impregnates the tissues, which leads to swelling.

Fluid retention is also due to hormonal changes in women during pregnancy.

What to do

If your fingers are swollen due to sports, try:

• Remove rings from your fingers before exercising;
• During exercise, rotate your arms periodically to improve blood flow;
• Stretch your fingers and clench your fists between sets.
• Drink enough fluid containing electrolytes to keep water in the blood. Suitable, for example, mineral water.

Pregnant women with swollen fingers should tell their gynecologist about it. Usually, the symptom does not portend serious problems, but it happens that edema is the first sign of a dangerous condition – preeclampsia.

2. Injury

If a finger is hit hard, broken, dislocated or sprained, swelling will occur. It will be accompanied by redness, pain, and sometimes bleeding.

What to do

For a minor bruise, you can put a cold compress on your finger and take an over-the-counter pain reliever. But if the pain is severe, the wound is large, or the finger is arched unnaturally, you need to see a doctor. A dislocation will require reduction, and a fracture will require fixation and repair.

3. Infection

Because of it, the finger on the hand can also swell. Even through a small wound, cut or puncture, bacteria enter the finger, which provoke inflammation. It can be superficial, or it can spread to the deep tissues of the fingers, between the muscles, in the fascia.

What to do

You need to see a surgeon. He will decide whether in your case it is enough to wash the abscess and take an antibiotic or surgery is needed.

4. Rheumatoid arthritis

Inflammation of the joints most often begins on the hands. It is believed that the disease is associated with autoimmune reactions, when the body attacks its own tissues and produces antibodies to them.

In addition to swelling of the fingers, rheumatoid arthritis is characterized by other symptoms:

• pain in the joints;
• joint stiffness, especially after sleep;
• fever;
• redness of the hands;
• fatigue and loss of appetite;
• bumps under the skin of the fingers – rheumatoid nodules.

What to do

You should see a doctor if you have these symptoms. He will do a physical examination that includes blood tests, X-rays of the joints, and possibly a study of joint fluid. Only after confirming the diagnosis, the specialist will prescribe treatment. There is no cure for rheumatoid arthritis, but symptoms can be reduced by:

• over-the-counter pain relievers;
• immunosuppressants;
• hormonal drugs;
• antirheumatic agents.

In addition, you will have to lose weight if you are overweight, stop smoking, eat right, reduce the load on the joints, but at the same time do aerobics and exercise therapy.

In severe cases, surgery may be necessary.

5. Carpal Tunnel Syndrome

In this disease, the nerve that runs from the forearm to the hand is compressed in the tissues of the wrist between the ligaments and bones. Unpleasant symptoms appear:

• numbness and tingling in fingers, especially thumb, index and middle fingers;
• soreness and swelling in fingers;
• weakness in the arms;
• atrophy of the muscles at the base of the thumb in advanced cases.

Numbness, tingling and pain may occur at night or in the morning on one or both hands. And then these signs begin to disturb during the day. For example, when a person holds a phone to his ear or drives a car.

What to do

You need to see a doctor. He can recommend:

• Wear a splint. This is a special device that is fixed to the brush at night;
• Avoid activities that aggravate symptoms;
• Take over-the-counter pain relievers;
• Use corticosteroids;
• Inject a local anesthetic into the joint.

If treatment fails and symptoms worsen, surgery may be necessary.

6. Gout

Due to pathology, uric acid is retained in the body. It settles in the kidneys, and also forms crystals in the joints and damages them. Therefore, they swell and hurt a lot. Usually the big toe is affected first, and then other bony joints. The fingers on the hands can also swell, and tophi sometimes form on them. So called painless tubercles from deposits of uric acid.

What to do

At the first symptoms, you should go to the doctor. He will examine you and prescribe treatment. It is impossible to completely get rid of gout. Therefore, a person will have to follow a low-protein diet for life, as well as take over-the-counter pain medications and hormonal drugs.

7. Raynaud’s disease

This is a disease in which the small arteries in the hands suddenly constrict in the cold or under stress, which stops the blood flow to the fingers. Therefore, they become numb, hurt, become pale and cold. When the attack passes and blood flow is restored, the fingers may swell.

What to do

To make spasms of blood vessels less frequent, you need to protect them from the cold, as well as avoid stress and sudden changes in temperature. If these measures are not enough, the doctor may prescribe medication. Usually these are drugs from the group of calcium channel blockers or antispasmodics. In some cases, specialists recommend nerve surgery or injections of Botox and local anesthetics.

8. Lymphedema

It develops when something blocks the lymphatic vessels and prevents them from collecting fluid from the tissues. This can happen due to rare hereditary factors, in people with cancer or infection of the lymph nodes, or after surgery or radiation therapy.

With lymphedema, not only the fingers swell, but also the whole leg or arm. In addition, there is a feeling of heaviness and constraint of movement, and the skin may become rougher and tougher. Another symptom is frequent infections.

What to do

There is no cure for the disease, but swelling can be reduced in the following ways:

• Do exercises that improve lymph flow.
• Practice tight wraps.
• Perform lymphatic drainage massage periodically.
• Use pneumatic compression when a special sleeve is put on the arm and air is pumped into it.
• Wear compression stockings if your feet and toes swell.

9. Mixed connective tissue disease

This is a rare autoimmune disease in which a person simultaneously develops symptoms of systemic lupus erythematosus, scleroderma and polymyositis, and sometimes Sjögren’s syndrome.

At an early stage, a person’s fingers hurt and swell, their tips become white and numb. There is pain in the muscles and joints, general malaise, and a red or red-brown rash appears on the knuckles. Raynaud’s symptoms may also be observed.

What to do

There is no cure for the disease. But a doctor can prescribe medications that will reduce symptoms. For example:

• over-the-counter pain relievers;
• corticosteroids;
• antimalarials;
• calcium channel blockers;
• immunosuppressants;
• remedies for pulmonary hypertension.

Mayo Clinic experts also advise you to quit smoking, protect your hands from the cold and avoid stress.

Read also 👩‍⚕️☝️🦵

• How to remove a ring from a swollen finger: 7 easy ways
• 9 doctor-approved ways to remove excess fluid from the body
• Why the eyelid is swollen and what to do about it
• What is panaritium and how to treat it
• Where does tunnel syndrome come from and how to treat it

Finger swollen | Causes and treatment

Causes of everything trouble

The most common cause of finger swelling is its injury. At the same time, along with edema, symptoms such as pain, hematoma, bleeding, and difficulty in mobility can be observed. A bruise, cut, sprain, dislocation, fracture or burn can cause the phalanges of the fingers to hurt and swell. In addition, an insect bite can also become the “culprit” of edema.

The finger seems to swell and hurt for no particular reason, but such symptoms may be associated with various forms of arthritis (infectious, post-traumatic, rheumatoid, metabolic, and post-operative). It should also be noted that joints can be prone to osteoarthritis or degenerative tissue damage. Symptoms of the above diseases are accompanied by the appearance of swelling of the entire hand, an increase in temperature (at the site of the affected area, less often of the entire body), as well as redness of the skin areas. There are cases when in men at a young age psoriasis (chronic skin inflammation), as well as ankylosing spondylitis (characterized by damage to the joints in the sacroiliac joints and spine) occur together with rheumatoid arthritis. At the same time, both hands, and only one of them, can fall under the influence of a pathological factor.

Symptoms of reactive arthritis, which appears after the transfer of infectious diseases (genitourinary, intestinal, nasopharyngeal), may be swollen and reddened fingers on the upper and lower extremities. Osteoarthritis, in which the destruction of the cartilage lining between the joints and the appearance of osteophytes (bone growths), is accompanied by the fact that the thumb on the hand swells and hurts, and in particular the bone on it. Oncological processes in tissues are also capable of causing a tumor, these include:

• melanoma,
• basilioma,
• nevus.

Meanwhile, as clinical practice shows, it is rarely possible to find neoplasms of bone tissue on the upper limbs.

Accompanying tumor symptoms of intoxication (pain in the head, vomiting, chills, nausea, fever, thirst) may indicate the presence of erysipelas. The disease appears when the immune system decreases and group B streptococcus develops. Reddening of the skin is observed in the affected area, when touched, heat is felt and painful sensations appear.

In contact dermatitis, swelling occurs in a specific area on the finger. This usually happens when the watch bracelet is very close to the hand or the material of the accessory causes an allergic reaction. On the fingers, swelling can also be the result of a cold allergy, which is characterized by the appearance of swelling, itching and rashes in the form of red spots.

Spasm in the blood vessels of the hands, which appears as a result of exposure to negative temperatures or an increased level of stress is called Raynaud’s syndrome. Reversible unpleasant sensations appear in the form of a change in skin color (first it turns white, then turns blue and red), which are provoked by a decrease in blood circulation and its subsequent normalization. Because of this, swelling is observed, a burning sensation and pain are felt.

Diagnosis is true…

At the first stage of diagnosis, a visual examination and anamnesis are carried out, followed by a series of studies, which include

• general and biochemical analysis of blood and urine;
• radiography;
• Ultrasound, MRI and CT.

If oncology is suspected, a biopsy may be ordered for subsequent more accurate examination under a microscope.

…but the essence of treatment is

When the reasons why the fingers are swollen and sore have been established, the patient is prescribed symptomatic and pathogenetic (the purpose of which is to eliminate the very cause) drugs, which include analgesics, NSAIDs, antihistamines, antibiotics, diuretics, chondroprotectors. Medicines containing synthetic hormones are prescribed for people with hormonal imbalance.

When the fingers are swollen and the joints hurt, the treatment may include complex therapy with physiotherapy (ultrahigh frequency, centimeter, ultraviolet therapy, electrophoresis).

Surgical methods – in case of emergency

Surgery will be necessary if there is an open fracture, ligament injury or severe injury. Panaritium can also serve as an indication for surgical intervention. To cope with this disease, it is imperative to eliminate the inflamed focus with pus, thoroughly clean the cavity with the infection and apply stitches.