Finger pulp infection

Finger pulp infection

Published by Bupa's health information team, March 2009.

This factsheet is for people who have a finger pulp infection, or who would like information about it.

A finger pulp infection most commonly affects the fleshy area at the tip of your finger known as the finger pulp. Often the infection starts from a cut or a splinter.

* About finger pulp infection
* Symptoms of finger pulp infection
* Complications of finger pulp infection
* Causes of finger pulp infection
* Diagnosis of finger pulp infection
* Treatment for finger pulp infection
* Questions and answers
* Related topics
* Sources

About finger pulp infection

A finger pulp infection is an infection in the fleshy part of your fingertip (palm side). It may also be referred to as staphylococcal whitlow or felon.

The infection in your fingertip often starts from an opening in your skin, for example a cut or splinter. This is the case for about half of people with a finger pulp infection.

A finger pulp infection can also result from a paronychia. A paronychia is an infection in the skin at the edge of your fingernail. The infection can spread to the fleshy part of your fingertip causing infection in the finger pulp.
Symptoms of finger pulp infection

Your symptoms will be concentrated around your fingertip and may include:

* a tightness or pricking sensation (usually at the start of the infection)
* redness
* swelling
* hotness and tenderness to touch
* inflammation around your fingernail
* an abscess, similar to a large fluid-filled blister
* throbbing pain, which usually starts quickly and can be severe

Complications of finger pulp infection

The main complication of finger pulp infection is osteomyelitis. This is when the infection spreads to the bone underneath your fingertip. If left untreated, it starts to destroy the bone and can eventually cause an abscess in the bone.

Other complications are listed below.

* Skin necrosis. This is when the tissue in and around the infected area starts to die. This happens because there is not enough blood getting through to the tissue. The skin on your fingertip will appear much darker and may turn a purple/black colour. This can lead to scarring.
* Septic arthritis. This happens when the infection spreads to your finger joint. This can cause your finger joint to become painful and swollen.
* Tenosynovitis. This is when the infection spreads to the sheath that surrounds the tendons in your finger. It causes pain, swelling and tenderness around the affected area. It's the most serious complication of a finger pulp infection because the infection can keep on spreading through the sheath.
* Compartment syndrome. This happens when swelling compresses the nerves and blood vessels within your fingertip. This can lead to poor blood flow and nerve and muscle damage.

Causes of finger pulp infection

The most common cause of a finger pulp infection is Staphylococcus aureus (or S.aureus for short). This is a bacterium that usually lives on your skin without causing you any harm. Occasionally it gets inside your body through breaks in your skin, for example a cut, and causes an infection.

Methicillin-resistant Staphylococcus aureus (MRSA) can also cause a finger pulp infection, although this is less common. MRSA is a type (or strain) of S. aureus. But unlike S. aureus, MRSA is resistant to several types of antibiotics, making it much more difficult to treat.

Other types of bacteria have been found to cause finger pulp infection, although this is quite rare and usually only happens to people who have a weakened immune system.
Diagnosis of finger pulp infection

Your GP will be able to diagnose a finger pulp infection. He or she will examine your finger and ask you about your symptoms.

Sometimes a swab of the infected area is taken for testing to see what is causing the infection. This is usually only done if your treatment hasn't worked.
Treatment for finger pulp infection

Treatment depends on whether or not the infection is severe enough to have developed a large collection of pus (abscess) in your fingertip. If not, your GP will recommend self-help tips and give you a course of antibiotics.

If you do have an abscess, it will need to be drained. This may be done by your GP or you may be referred to the hospital. You will be given a course of antibiotics once your abscess has been drained.
Self-help

Your GP will advise you to keep your finger elevated as much as possible. He or she may also recommend that you soak your finger in warm water between three or four times a day.
Medicines

To treat the infection, your GP will prescribe you antibiotic tablets called flucloxacillin (unless you are allergic to penicillin). A course of these normally lasts for five to seven days. Always read the patient information leaflet that comes with your medicine. It's important that you take the complete course of antibiotics.

If you are in pain, you can take painkillers that you would normally take for a headache, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine.
Incision and drainage

If you have an abscess, you will need to have it drained. This may be carried out by your GP or you may be referred to the hospital.

This procedure involves making a small cut over the most inflamed area of your fingertip so that the pus and fluid inside can be removed. The wound is then packed with gauze to keep it open and allow the fluid to continue draining. Your finger will be covered with a loose dressing and finger splint. A sling may also be used to keep it elevated above heart level.

You will be given a follow-up appointment to have the dressing removed at the hospital or your GP's surgery.

Incision and drainage is generally a safe procedure. However, complications do sometimes occur, this is when problems happen during or after the procedure. These can include:

* damage to the nerves or blood vessels in your fingertip
* a swelling or growth in the nerves in your fingertip
* damage to the fleshy part of your fingertip
* scarring of the fingertip

If your symptoms continue to get worse or you don't respond to these treatments, you should go back to see your GP. He or she will refer you to a hand surgeon for further investigation.
Finger pulp infection Q&As

See our answers to common questions about finger pulp infection, including:

* What is a paronychia? How can it cause finger pulp infection?
* What is the difference between finger pulp infection and herpetic whitlow?
* How long does a finger pulp infection take to heal?

Related topics

* Caring for surgical wounds
* MRSA (methicillin-resistant Staphylococcus aureus)
* Non-steroidal anti-inflammatory drugs (NSAIDs)
* Osteomyelitis
* Paracetamol

Sources

* Felon. eMedicine. www.emedicine.com, accessed 25 September 2008
* Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:669
* Boils and paronychia. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 25 September 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: March 2009
http://hcd2.bupa.co.uk/fact_sheets/html/finger_pulp_infection.html