The little finger (fifth finger) flexor tendon sheath communicates with the ulnar bursa of the wrist in approximately 80% of individuals, making it the most clinically important of the individual finger flexor sheaths. Infection in the little finger sheath readily spreads to the ulnar bursa and thence to the radial bursa (via a communicating channel) producing a horseshoe abscess.
Little finger flexor tenosynovitis should prompt urgent assessment of the ulnar bursa at the wrist because of the frequent communication. The horseshoe abscess — spreading from the little finger through the ulnar bursa to the thumb via the communicating radial bursa — is a surgical emergency. Kanavel's four signs apply: symmetric swelling, semiflexed posture, point tenderness along the sheath, and pain with passive extension. Irrigation of both the finger sheath and the ulnar bursa is mandatory.
Infection tracking from the little finger flexor sheath through the ulnar bursa to the radial bursa via their communicating channel, producing a horseshoe-shaped infection requiring urgent open drainage of both the wrist bursae and the digital sheaths.
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