The little finger flexor tendon sheath is the synovial sleeve around the superficialis and profundus tendons of the little finger. Unlike the index, middle and ring finger sheaths, it usually continues into the palm as the ulnar bursa (common flexor sheath), so an infection here can spread into the palm and wrist.
| Location | Palm side of the little finger, continuing into the palm and wrist as the ulnar bursa in most people |
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Lets the little finger flexors glide under the pulleys. Because it usually opens into the ulnar bursa, infection can spread into the palm and wrist and on to the radial bursa (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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