The middle finger flexor tendon sheath is the synovial sleeve around the superficialis and profundus tendons of the middle finger, running from about the A1 pulley to the end of the finger. It lets the tendons glide under the pulleys. Like the index sheath, it is usually closed off from the wrist bursae.
| Location | Palm side of the finger, from about the metacarpal neck (A1 pulley) to just beyond the distal interphalangeal joint |
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Lets the two flexor tendons glide smoothly under the pulleys. It usually does not connect with the wrist bursae, though infection can burst into the midpalmar space.
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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