Paronychia

Case contributed by Ashesh Ishwarlal Ranchod
Diagnosis certain

Presentation

Previous minor trauma a few weeks back. Now presents with left thumb pain, swelling, erythema and limitation of motion.

Patient Data

Age: 25 years
Gender: Male
x-ray

There is focal soft tissue swelling of the dorsal left thumb with an obvious "step" at the proximal nail bed.

There are no features of osteomyelitis or septic arthritis.

There is no retained radio-opaque or metallic foreign body.

Case Discussion

Features consistent with paronychia. Paronychia is the infection or inflammation of the proximal and/ or lateral nail folds. This may be acute or chronic.

Nail biting, chronic nail fold picking, manicures, ingrown nails, and the application of artificial nails are some of the causative factors. Infantile finger or thumb sucking can also precipitate paronychia.

Paronychia is a clinical diagnosis and X-rays are only done to exclude osteomyelitis and/or septic arthritis and to exclude retained foreign bodies.

There is usually a solitary site of involvement rather than multiple digits!

The age of the patient, the absence of osteoarthritic changes (DIP joints) and the solitary site of involvement help to exclude a Heberden node.

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