Felon Clinical Presentation

Updated: Sep 27, 2017
  • Author: Jarod Fox, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Presentation

History

Wooden splinters or minor cuts are common predisposing causes, yet no history of injury exists in over one half of patients. Infection also may spread from a paronychia.

Initial minor injury causes cellulitis, which is first confined by tough fibrous septa that break up pulp into tiny compartments. This early infection causes tight or prickling pain. At this stage, infection may resolve spontaneously, particularly with antibiotics. The number of abortive cases is unknown because many patients never present to the hospital.

If resolution does not occur, abscess formation is accompanied by throbbing pain.

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Physical

Felons are characterized by marked throbbing pain, tension, and edema of the fingertip pulp.

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Causes

Staphylococcus aureus is the most common cause. Methicillin-resistant Staphylococcus aureus –infected felons have been reported. [3, 4, 5]

Gram-negative organisms have been reported in immunosuppressed patients. Lancet-induced trauma from fingertip blood glucose measurements have been implicated as an etiology.

Eikenella corrodens has been reported in persons with diabetes who bite their fingernails. [3, 6, 7]

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