The radial bursa of the hand is the synovial sheath of the flexor pollicis longus tendon, extending from approximately 2 cm proximal to the wrist flexor retinaculum to the distal phalanx of the thumb. Unlike the digital sheaths of the fingers, the radial bursa is a continuous sheath from the forearm to the thumb tip because the FPL tendon does not leave its sheath at the level of the palm.
| Location | Enclosing the flexor pollicis longus tendon from about 2 cm above the flexor retinaculum, through the carpal tunnel, to the distal phalanx of the thumb |
|---|---|
| Nearby |
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Allows the flexor pollicis longus tendon to glide smoothly through the carpal tunnel and along the thumb
The radial bursa communicates with the ulnar bursa in a large proportion of individuals, which is the anatomical basis for horseshoe abscess formation where infection spreads between the thumb and small finger tendon sheaths. Stenosing tenosynovitis of the flexor pollicis longus at the A1 pulley (trigger thumb) involves the tendon within this sheath. In de Quervain tenosynovitis, the first dorsal compartment (APL and EPB) is inflamed at the radial styloid, not the radial bursa proper. The radial bursa is directly accessed during thumb FPL tendon surgery at the wrist.
Penetrating injury to the thumb pulp or palmar thumb can infect the radial bursa, producing Kanavel signs along the entire thumb and potentially spreading to the ulnar bursa through their communication, requiring urgent surgical drainage and irrigation.
Stenosing tenosynovitis of the flexor pollicis longus at the A1 pulley producing catching, locking or a fixed flexed thumb interphalangeal joint, treated with injection or A1 pulley release.
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