The ring finger flexor tendon sheath is an isolated synovial bursa from the A1 pulley to the DIP joint, enclosing the FDS and FDP tendons. In the vast majority of hands the ring finger sheath remains isolated, but occasional communications with the ulnar bursa of the wrist have been reported.
Ring finger flexor tenosynovitis may be mistaken for a ring avulsion injury due to the ring finger's vulnerability to clothing and machinery. The ring finger sheath's occasional communication with the ulnar bursa means spread to the wrist and hypothenar space is possible in advanced infections. Horseshoe abscess (ulnar bursa to radial bursa) typically involves the small finger and thumb rather than the ring finger.
Suppurative infection of the ring finger sheath that may rarely communicate with the ulnar bursa, requiring careful assessment of wrist extension during examination to exclude proximal spread.
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