The flexor tendon sheath of the index finger is an isolated bursa running from the A1 pulley at the MCP joint to the DIP joint insertion of FDP, enclosing both FDS and FDP tendons. It does not communicate with the radial or ulnar bursae of the wrist in most individuals, making index finger flexor sheath infections isolated to the finger.
Suppurative tenosynovitis of the index finger flexor sheath is identified by Kanavel's four cardinal signs: fusiform swelling, tenderness along the sheath, semi-flexed posture, and pain on passive extension. The isolated nature of the index sheath means infection remains confined to the finger unless it communicates with the radial bursa at the wrist. Surgical decompression via open or closed tendon sheath irrigation is required for established tenosynovitis.
Suppurative infection of the index finger flexor sheath producing Kanavel's signs, requiring urgent surgical drainage to prevent tendon necrosis and permanent stiffness.
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