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Anatomy

Upper Limb

Question 157 of 180

A 20 year old woman presents to ED with a painful swollen digit. The infection appears to have spread to the common flexor sheath. Which of the following digits is the most likely to be involved with spread of infection to this location:

Answer:

The synovial sheath of the little finger is usually continuous with the common flexor sheath, unlike the middle three fingers which have separated synovial sheaths. The synovial sheath of the thumb is continuous with the synovial sheath of the flexor pollicis longus.

Flexor Sheath Infection

Anatomy / Upper Limb / Wrist and Hand

Last Updated: 12th August 2019

Infections may occur in the digital synovial sheath for example after a puncture wound to a finger.

Infection in the middle three fingers is usually contained as they have separate synovial sheaths.

The synovial sheath of the little finger is usually continuous with the common flexor sheath (the ulnar bursa) and thus infection may spread to this sheath and from here to the midpalmar space.

Infections in the thumb may spread to the midpalmar space via the continuous synovial sheath of the flexor pollicis longus (the radial bursa).

By Henry Vandyke Carter [Public domain], via Wikimedia Commons

Flexor Sheaths. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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