The middle finger flexor tendon sheath is an isolated synovial bursa enclosing the FDS and FDP tendons of the middle finger from the A1 pulley to the DIP joint. Like the index finger sheath, it is typically isolated and does not communicate with the wrist bursae.
Middle finger flexor sheath tenosynovitis is the most common of the isolated finger sheath infections, due to the middle finger's exposed position during hand trauma. Its isolated sheath limits proximal spread. Closed continuous irrigation of the sheath via proximal and distal catheter placement is an effective minimally invasive treatment when initiated within 24-48 hours of onset.
Suppurative infection of the middle finger flexor sheath producing Kanavel's signs, managed by urgent closed irrigation or open drainage depending on severity and duration.
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