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181 Cards in this Set

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  • Back

Joint pain w/ a characteristic butterfly rash on cheeks could signify what?

Systemic Lupus Erythematous (SLE).

Joint pain w/ a scaly rash & pitted nails could signify what?

Psoriatic Arthritis.

Joint pain w/ a few papules,pustules,vesicles on reddened based located on distal extremities could signify what?

Gonococcal Arthritis.

Joint pain w/ an expanding erythematous patch (early in illness) or a mental status change, facial weakness, and neck stiffness could signify what?

Lyme Disease (CNS involvement).

Joint pain w/ hives could signify what?

Serum Sickness or Drug Reaction.

Joint pain w/ erosions/scaling of penis & crusted papules on the palms/soles could signify what?

Reiter's syndrome (urethritis, arthritis, uveitis).

Joint pain w/ a characteristic maculopapular rash of rubella could signify what?

Arthritis of Rubella.

Joint pain w/ clubbing of the finger nails could signify what?

Hypertrophic Osteoarthropathy.

Joint pain w/ red, burning, itching eyes (conjunctivitis) could signify what?

Reiter's Syndrome or Behcet's Syndrome.

Joint pain that was preceded by a sore throat could signify what?

Acute Rheumatic Fever or Gonococcal Arthritis.

Joint pain w/ diarrhea, abd pain, & cramping could signify what?

Arthritis of UC, regional enteritis, or scleroderma.

Joint pain w/ sx of urethritis could signify what?

Reiter's Syndrome or Gonococcal Arthritis.

What commonly occurs @ the DIP joints & PIP joints in pts w/ osteoarthritis?

Herberden's nodes (hard dorsolateral nodules) & Bouchard's nodes

TTP over the distal radius with a mechanism of injury involving a pt trying to catch themselves s/p falling suggests what potential dx?

Colles' Fx from Fall.

TTP over the extensor & abductor tendons of the thumb suggest what diagnoses?

de Quervain's Tenosynovitis or Gonococcal Tenosynovitis.

TTP over the anatomical "snuffbox" signifies what?

Scaphoid Fx; most common injury of carpal bones & @ increased risk for avascular necrosis.

A pt w/ TTP over MCPs that feel boggy (doughy) w/ noted symmetric deformities in PIPs, MCPs, & ulnar deviation suggests what?

Rheumatoid Arthritis (RA).

Pain @ base of the thumb occurs in what?

Carpometacarpal arthritis; most common in women.

When would you asses for CTS?

Pt (~woman) c/o dropping objects, inability to twist lids off jars, aching in wrist/~forearm, numbness in digits I-III, h/o repetitive motion w/ wrists flexed (keyboard typing or mail sorting), pregnancy, RA, DM, or hypothyroidism.

A woman pt, w/ slight hand grip weakness, wrist pain/TTP over abductor,extensor tendons of thumb, & + Finkelstein's test suggests what?

de Quervain's Tenosynovitis (more common in women).

What is the medical terminology for Bowlegs?

Genu Varum.

What is the medical terminology for Knock-knees?

Genu Valgum.

Midline back pain could suggest what?

Musculoligamentous Injury, Disc Herniation, Vertebral Collapse, Spinal Cord Metastases, or Epideral Abscess.

Off the midline back pain could suggest what?

MM Strain, Sacroilitis, Trochanteric Bursitis, Sciatica, Hip Arthritis, Renal Conditions (Pyelonephritis, Stones).

What often often overlies spina bifida?

Birthmarks,port-wine stains, hairy patches, & lipomas often overlie the bony defect.

What are 3 conditions commonly seen in neurofibromatosis?

Cafe-au-lait patches/spots, skin tags, & fibrous tumors.

What abnormal spinal curvature increased with aging?

Thoracic Kyphosis occurs w/ increased aging.

What are the concave curves in the nl spine vs the concave curves of the nl spine?

Cervical & Lumbar vs Thoracic & Sacrococcygeal.

Lateral & rotatory curvature of the spine to bring the head back to midline is a classical presentation of what?


When does scoliosis become most evident?


Unequal shoulder heights occur in what (4) conditions?

Scoliosis, Sprengel's deformity (attachment of + bone/band to C7), "Winging" of the Scapula due to loss of innervation to the serratus anterior mm (long thoracic NN), & contralateral contraction of trapezius mm.

"Listing" of the trunk to one side suggests what?

Herniated Lumbar Disc.

Unequal heights of iliac crests suggests what?

Unequal Lengths of the Legs or Scoliosis.

Pelvic tilt can be caused by what conditions?

Scoliosis & hip ABduction or ADduction.

A firm, knotted mm spasm often occurs in what conditions (5)?

Degenerative/Inflammatory processess, Overuse, Prolonged Contraction from abnormal posture, Anxiety.

Although difficult to palpate on most pts, sciatic nerve TTP suggests what?

Herniated disc, mass lesion impinging on contributing nerve roots (L4,L5,S1,S2,S3).

What is the most common location of herniated intervertebral discs?

L5-S1 or L4-L5; TTP over spinous processes, intervertebral joints, paravertebral mm, sacro-sciatic notch, & sciatic nerve.

Skull-C1(atlas) is responsible for what type of ROM in the neck?

Flexion & Extension. "Yes"

C1-C2(axis) is responsible for what type of ROM in the neck?

Rotation. "No"

C2-C7 is responsible for what type of ROM in the neck?

Lateral Bending.

Limited ROM in the neck can arise from what?

Arthritic stiffness, Pain secondary to trauma, overuse, torticollis (mm spasm).

Lateral deviation & rotation of the head secondary to contraction of the sternocleidomastoid mm suggests what?


TTP over the spinous processes suggests what (4) conditions?

Fx or dislocation, infection, arthritis.

Point TTP over the facet joints (1" lateral to SP of C2-C7) between C5 & C6 suggest what?


A vertebral "step-off" felt on palpation suggests what?

Spondylolisthesis; forward slippage of 1 vertebra which could cause spinal compression.

TTP over the SI joint could suggest what?

Sacroiliitis or Ankylosing Spondylitis.

Percussing the spine by "thumping" the ulnar surface of your fist produces pain, what could this suggest (3)?

Osteoporosis, infection, malignancy.

A pt w/ h/o RA has focal TTP @ C1-C2, what possible risks does this suggest?

Subluxation & High Cervical Compression prompt additional assessment needed.

During spinal column flexion noted deformity of the thorax & asymmetric heights of the scapulae suggests what?


Persistant lumbar lordosis could suggest what?

MM spasm or Ankylosing Spondylitis.

Focal TTP over the ischiogluteal bursa suggests what?

Bursitis aka "weaver's bottom."

During passive flexion of pt's opposite hip, the affected hip does permit full extension & therefore the thigh appears flexed, this could suggest what?

Flexion Deformity of the Hip.

What can mask Flexion Deformity of the Hip.

Increased Lumbar Lordosis & Anterior Pelvic Tip.

Restricted hip ABduction is common in what?

Hip Osteoarthritis.

What are sensitive indicators of Hip Disease such as Arthritis?

Restricted external & internal ROM of the hip.

What are some problems associated with patellar tracking commonly seen in woman pt's?

Shallower (trochlear) grooves leads to Arthritis, Anterior Knee Pain, & Patellar Dislocation.

Why is it common for women to have anterior knee pain?

Quadricep contraction (knee extension) has more of a lateral pull (Q-angle) which alters patellar tracking contributing to anterior knee pain.

Describe what the ACL vs PCL prevent.

The tibia from sliding forward vs the tibia slipping backward on the femur.

What are the concavities evident @ each side of the patella called?

Negative Infrapatellar Spaces (medial&lateral to patella)

Stumbling or "giving way" of knee during the heel strike of the stance phase during gait suggests what?

Abnormal patellar tracking or Quadriceps Weakness.

What is flexion contracture in quadriceps & when is it seen?

Inability to extend knee fully, seen in limb paralysis or hamstring tightness.

Swelling over the patella vs tibial tubercle vs medial aspect of knee joint suggest what?

Prepatellar vs Infrapatellar vs Anserine Bursitis.

TTP along the bony ridges of the joint margins, genu varum deformity, stiffness <30mins w/ possible crepitus suggests what?


What ligament is more common for a tear s/p trauma (MCL vs LCL)?


Patellar TTP or Inability to extend the knee could suggest what?

Partial/Complete Tear of the Patella Tendon.

+ Patellofemoral Grinding Test suggests what?***

Pain w/ compression & movement (due to quadriceps contraction) suggests chondromalacia or patellofemoral syndrome (degenerative patella).

Pain & crepitus due to compression of the patella against the femur & gentle medial/lateral movement suggests what?

Roughening of the patellar undersurface that articulates w/ femur. Similar sx when climbing, going down stairs, or getting up from chair.

Swelling above (~10cm above superior border) & adjacent to patella suggests what?

Synovial Thickening or Effusion.

Thickening, bogginess, warmth around sides of patella suggest what?

Synovitis or Non-Tender Effusion secondary to osteoarthritis.

Housemaid's knee arises from what?

Prepatellar Bursitis; arises from excessive kneeling.

Anserine Bursitis arises from what?

Running, Valgus Deformity, Fibromyalgia, or Osteoarthritis.

Baker's Cyst arises from what?

Popliteal cyst; arises from distention of the gastrocnemius semimembranosus bursa secondary to trauma or arthritis.

What are the 3 steps to perform a bulge sign & what type of effusions does it test for?

Milk downward (w/ L hand), apply medial P, tap lateral (w/ R hand) watching for fluid wave; tests for minor effusions.

What would a + Bulge sign consistent w/ effusion feel like?

Fluid Wave or Bulge on medial side of patella between patella & femur suggest what?

What would a + Ballon Sign consistent w/ a major/large effusion feel like?

Palpable fluid wave into spaces next to patella (under R thumb & index finger) due to compression of suprapatellar pouch against the femur (L hand) w/ fluid ballooning into the spaces, will then return back to pouch.

"Ballotee" or pushing the patella sharply against the femur w/ palpable fluid returning to the suprapatellar pouch further is known as what?

"Ballotting the Patella" in order to asses a large effusion. A palpable patellar click may yield FP results.

A defect in the calf mm (gastrocnemius, soleus) w/ TTP & swelling suggests what?

Achilles Tendon Rupture.

TTP & thickening of tendon above calcaneus ~ w/ protuberant posterolateral bony process suggests what?

Achilles Tendinitis.

+ Achilles Tendon test would indicate what?

Absence of plantar flexion which suggests Achilles tendon rupture (squeeze calf lower 1/3).

What are some sx or findings common with a rupture of Achilles Tendon?

A defect in the calf mm, TTP, swelling, absent plantar flexion (+ test), sudden severe pain "like a GSW," ecchymosis from calf into heel, flat-foot gait w/ absent "toe-off" may also be present.

Crepitus w/ flexion & extension of the knee suggests what?


McMurray Test tests for what structure abnormalities?

Medial & Lateral Meniscal tears.

Pt is supine, knee flexed, passive external rotation, apply valgus stress then slowly extend knee w/ TTP & click/pop along medial joint suggests what kind of tear?

Tear of the Posterior Portion of the Medial Meniscus causing meniscal tissue to become displaced "locking" on full knee extension.

Pt is supine, knee flexed, passive internal rotation, apply varus stress then slowly extend knee is asses for what?

Lateral Meniscus Tear.

Valgus or Abduction Stress test asses for what?

MCL Tear more common that LCL.

Pain or a gap in the medial joint line during the Abduction or Valgus Stress Test suggests what?

Ligamentous laxity, Partial Tear of MCL.

Pain or gap in the lateral joint line during the Adduction or Varus Stress Test suggests what?

Ligamentous laxity, Partial Tear of LCL.

A forward jerk of the contours of the upper tibia when performing the Anterior Drawer Sign suggests what?

ACL tear (11.5x)

Significant forward excursion while performing the Lachman Test suggest what?

ACL tear (17.0x)

If the proximal tibia falls back when performing a posterior drawer test than what is indicated?

PCL tear less common, resulting from direct blow to the proximal tibia.

How do typical ACL injuries occur?

Hyperextension & direct blows to the knee and twisting/landing on extended hip or knee.

The deltoid ligament of the ankle protects against what?

Eversion (heel bows outward).

The anterior talofibular ligament (ATL) is at most risk for what?

Inversion (heel bows inward).

What is known as the Ottawa Rule?

S/p trauma, inability to bear weight 4 steps & TTP posterior aspect of either malleoli (medial>lateral) is suspicious for ankle fx.

Pain with metatarsal joint compression suggests an early sign go what?


Describe the significant characteristics of PMR.

>50yo, W, associated w giant cell arthritis, insidious or abrupt progression w/ common joint pain located in symmetric mm of hip, shoulder, neck.

What is adhesive capsulitis?

"Frozen Shoulder" due to fibrosis of the glenohumeral joint capsule described as "diffuse, dully, aching pain," seen in pts 40-60yo. w/ an antecedent shoulder disorder (~MI) that has decreased ROM.

What would + apprehension sign suggest (arm abducted & externally rotated).

Anterior shoulder instability, dislocation, subluxation.

Swelling, inflammation of the olecranon bursa due to trauma, gout, or RA & able to reach 6cm in diameter?

Olecranon Bursitis.

Firm, subQ, non-TTP nodules that develop @ P points along extensor surfaces of the ulnar could suggest what?

RA (acute or chronic) or Rheumatic Fever.

Lateral Epicondylitis due to repetitive extension of wrist or pronation-supination of forearm is aka as what?

Tennis Elbow.

Medial Epicondylitis due to repetitive wrist flexion, as in throwing is aka as what?

Pitcher's, Golfer's, Little League Elbow

Describe different characteristics seen in Acute RA va Chronic RA.

Fusiform or spindle shaped swelling of PIP joints vs Thickening of MCP/PIP joints, ulnar deviation, interosseous mm atrophy, "swan-neck" & boutonniere deformities @ PIP joints.

What is a "Swan-Neck" deformity seen in Chronic RA?

Hyperextension @ PIP w/ fixed flexion @ DIP joint.

What is A "Boutonniere" deformity seen in Chronic RA?

Persistent flexion @ PIP w/ hyperextension @ DIP joint.

What are some characteristic of osteoarthritis (DJD) in the hands?

Herberden's nodes (on dorsolateral aspects @ DIP due to bony overgrowth), radial deviations of distal phalanx, & Bouchard's nodes @ PIP joints.

Describe some characteristics of Tophaceous Gout caused by accumulation of sodium urate in joints/tissues (commonly on extensor surfaces)?

Knobby swellings around joints that ulcerate & produce chalk-white urates.

What is Dupuytren's Contracture?

Due to an initial thickened nodule overlying the flexor tendon of the ring finger, skin puckering for fibrotic cord development therefore extension is limited but flexion is nl. (Flexion Contracture).

What is Trigger Finger?

Due to painless nodule development in flexor tendon near metacarpal head an audible or palpable snap occurs when the finger is extended or flexed w/ assistance.

What is a ganglion cyst?

Round non-TTP swelling containing synovial fluid along the tendon sheaths or joint capsules frequently located @ dorsum of wrist (~hands,ankles, feet) which can disappear spontaneously.

How can you make a ganglion cyst more prominent vs obscure?

Flexion vs Extension.

Hot, TTP, dusky red swelling that extends beyond the margins of the first metatarsophalangeal joint is known as what?

Acute Gouty Arthritis; no stiffness, limited ROM secondary to pain, ~fever due to inflammatory rxn to micro crystals of monosodium urate.

What are some signs of flat feet?

Longitudinal arch flattens so sole touches floor w/ nl concavity of medial foot becoming more convex. TTP along medial malleolus due to posterior tibial tendinitis secondary to obesity, DM, prior injury.

A pt presents c/o numbness, aching, burning in the 3rd-4th toes. On exam compression of metatarsal heads on planter surface provokes further pain radiating to the toes, what would this suggest?

Morton's Neuroma.

Lateral deviation of the great toe & head enlargement of 1st metatarsal on medial side forming a bunion/bursa is known as what?

Hallux Valgus.

What are 3 common forefoot abnormalities most commonly seen in women who wear high-heeled shoes w/ narrow toe boxes?

Hallux Valgus, Metatarsalgia, & Morton's Neuroma.

Sharp,burning, tingling pain in the neck & one arm w/ paresthesias, weakness in a myotomal pattern suggests what?

Cervical Radiculopathy from C7 or C6 due to Spinal Nerve Root Compression b/c of foramina impingement secondary to degenerative joint changes (70-75%) vs disc herniation (20-25%).

What is Lhermitte's Sign?

Neck flexion exhibits the sensation of electrical shock radiating down the spinal column.

Pt c/o neck pain, BUE weakness, paresthesia in all extremities w/ + Lhermitte's Sign, wrist/ankle clonus, + Babinski Sign, & slight gait disturbance on PEx suggests what?

Cervical Myelopathy from Cervical Cord Compression usually due to spondylosis.

What is Chronic Whiplash Syndrome?

Mechanical neck pain, stiffness s/p trauma due to musculoligamentous sprain/strain due to forced hyperflexion-extension injury to neck w/ sx lasting >6mo. (Associated sx occipital HA, dizziness, malaise, fatigue)

Neck pain, stiffness/ tightness in c-spine & paraspinal musculature due to sustained mm contraction seen in poor posture/sleep/head position, & stress lasting up to 6wks suggests what?

Mechanical Neck Pain.

A pt presents c/o low back pain that shoots down lateral leg (L5) or posterior calf (S1) w/ sx exacerbated by bending, coughing, straining during BM w/ + crossed-SLR on PEx suggests what?

Radicular Low Back Pain (Sciatica); usually due to disc herniation w/ compression of roots involving L5 & S1.

"Pseudoclaudication" vague back pain when ambulating that is alleviated w/ rest & lumbar flexion (decompression of spinal cord) that exhibits provokable thigh pain s/p 30s of lumbar extension suggests what?

Lumbar Spinal Stenosis.

Nocturnal back pain unrelieved by rest w/ loss of nl lumbar lordosis & limited ROM during anterior/lateral flexion raises concern for what?

Metastatic Malignancy to Spine.

The Apley Scatch Test asses what & a positive result would indicate what?

Overall ROM of shoulder via abduction/external rotation & adduction/internal rotation. + Rotator Cuff Disorder or Adhesive Capsulitis.

+ Neer's or Hawkin's Impingement Signs suggest what?

Inflammation or Rotator Cuff Tear of the shoulder.

+ Cross-over Test or localized TTP & pain w/ adduction of the shoulder, suggests what?

Inflammation or AC joint arthritis.

"Empty Can Test" asses what?

Supraspinatus strength.

Weakness provoked during the Infraspinatus Strength test indicates what?

Rotator Cuff Tear or Bicipital Tendinitis.

Testing Forearm Supination provokes pain indicates what?

Inflammation of Long Head of Biceps Tendon or Rotator Cuff Tear.

What does a + "Drop-Arm" Sign which signifies a Rotator Cuff Tear look like during examination?

Pt is unable to actively abduct to 90 degrees fully producing the characteristic shoulder-shrugging effort or uncontrolled lowering of the arm.

What should be considered if there is bladder/bowel dysfunction, saddle anesthesia, & perineal numbness?

Cauda Equina Syndrome (S2-4) due to tumor or midline disc herniation.

What is the probability of serious systemic disease in the case of low back pain w/ another indicator?


What are some conditions (4) suggested w/ pain in 1 joint?

Injury, Monoarticular Arthritis, Tendinitis, Bursitis.

Lateral hip pain near the greater trochanter of femur suggests what?

Trochanteric Bursitis.

Migratory joint pain is seen in what conditions?

Rheumatic Fever or Gonococcal Arthritis.

Progressive additive joint pain pattern w/ symmetric involvement suggests what?


Are women or men more likely to have inflammatory arthritides?


Extra-articular pain is often seen in what conditions (4)?

Bursitis, Tendinitis, Tenosynovitis, Sprains secondary to stretching/tearing of ligaments.

Severe pain, rapid onset, w/ red & swollen joint could indicate what in adults? What about children?

Acute Septic Arthritis or Gout in adults & Osteomyelitis b/c bone contiguous to joint in children.

Fever,chills, warmth, redness in a pt w/ joint pain could suggest what?

Septic Arthritis, Gout, Rheumatic Fever.

Pain, swelling, loss of active/passive ROM, "locking" suggest what?

Articular Joint Pain.

Loss of ACTIVE but not passive ROM w/ TTP outside joint could suggest what?

Non-articular Pain.

What is stiffness w/ limited ROM after inactivity & how long does it typically last?

Gelling (DJD) lasting only a few minutes.

Joint stiffness >30mins could suggest what?

RA or other inflammatory arthritides.

What is a common sx in Fibromyalgia & PMR?

Stiffness; prominent especially in the AM.

What are some examples of conditions in which generalized & systemic sx are seen?

RA, SLE, PMR, & other inflammatory arthritides.

What condition often infiltrates the synovium?

Leukemia & ~Chemotherapy.

What condition is polyarticular & symmetrical?


Acute involvement of 1 joint suggests what?

Trauma, Septic Arthritis, Gout.

Crepitus can be audible, palpable, or visualized in what (2) conditions?

Osteoarthritis or Tenosynovitis.

When is decreased ROM present?

Arthritis, Extra-articular inflammation, Joint Fibrosis, Ankylosis (bone fixation).

Ligamentous laxity of the ACL occurs when?

Knee Truma.

Palpable bogginess (doughiness) of synovial membrane suggests what?

Synovitis which is often accompanied by effusion

Upon palpation increased warmth of a joint could indicate what (4) conditions?

Arthritis, Tendinitis, Bursitis, Osteomyelitis.

Warmth, DIFFUSE TTP over thickened synovium vs FOCAL TTP suggests what conditions?

Arthritis/Infection vs Injury.

What should you suspect if the rounded lateral aspect of the shoulder appears flattened?

Anterior Dislocation of Shoulder.

What are (3) common sx that appear within 2-3wks of a rotator cuff tear?

Supraspinatus/Infraspinatus Atrophy & Increased prominence of scapular spine.

If the glenohumeral joint capsule appears distended you could suspect what?

Significant Amt of synovial fluid present.

TTP over SITS mm insertions & inability to actively abduct shoulder suggests what?

Sprains, Tears/Tendon Ruptures of Rotator Cuff.

What is the most commonly affected tendon in the Rotator Cuff?


What are the 6 motions of the shoulder girdle?

Flexion, Extension, Abduction, Adduction, Internal & External Rotation.

Restricted ROM of the shoulder girdle occurs when?

Bursitis, Capsulitis, Rotator Cuff Tears, Sprains, Tendinitis.

When would Thenar vs Hypothenar atrophy be seen?

Median NN Compression (CTS) vs Ulnar NN Compression.

What flexion contractors arise from thickening of the palmar fascia?

3rd-5th fingers or Dupuytren's Contractures (index finger).

Besides osteoarthritis what other condition involves the DIP joints?

Psoriatic Arthritis.

A + McMurray & "locking" of the knee suggests what?

Medial Meniscus Tear.

Sciatic Nerve TTP suggests what?

Herniated disc, mass lesion impinging on contributing NN root, however the nerve is difficult to palpate in most pts.

When do mm spams occur?

Degenerative & inflammatory processes of mm, Overuse, Prolonged Abnormal Posture, Anxiety.

What would a + Phalen's Sign feel like & suggest?

Numbness & tingling in Median NN within 60s (CTS).

What would a + Tinel's Sign feel like & suggest?

Aching & Numbness in Median NN upon tap (CTS).

Decreased sensation in the median NN distribution suggests what?


What would a + Thumb Abduction Test feel like & suggest?

Weakness on thumb abduction doubles carpal tunnel disease

Decreased hand grip strength (+ test) can occur in what conditions?

Arthritis (DJD secondary to pain), CTS, Epicondylitis, Cervical Radiculopahty, de Quervain's Tenosynovitis, Finger Flexors/Intrinsic mm of hand,

What (3) conditions can impair the ROM of the wrist?

Arthritis, Tenosynovitis, Dupuyteren's Contracture.

Decreased spinal mobility can be seen in what (2) conditions?

Osteoarthritis, Ankylosing Spondylitis.

Pain w/ compression of the MCP joints could suggest what?

Post-traumatic Arthritis & RA (w/ bogginess).

Red, Tender Joint could suggest what?

Septic Arthritis, Gouty Arthritis, Chronic Tophaceous Gout, RA (seldom red).

Name (3) joint deformities/malalignments.

Dupuytren's Contracture, Genu Varum (Bow-Legs) & Genu Valgum (Knock-Knees).

Tenderness, swelling along the course of the tendon sheath (distal phalanx-MCP) due to infection w/ finger held in slight flexion w/ pain exacerbated by extension could suggest what?

Acute Tenosynovitis; usually s/p local injury (if infection progresses it can extend aka Thenar Space Involvement).

An injury to fingertip w/ resulting infection which produces localized TTP, swelling, dusky redness around puncture wound is known as what?

Felon; if vesicles are present consider Herpetic Whitlow seen in HC workers due to HSV exposure).