A patient's radial bursa is a continuation of the tendon sheath of his flexor pollicis longus, so that any infection inevitably involves both of them. The distal phalanx of his thumb is flexed and rigid. He cannot extend it, although he can extend his other fingers normally. His hand is tender over the sheath of flexor pollicis longus, and you may be able to feel a swelling above his flexor retinaculum. If treatment is delayed, infection may spread to his ulnar bursa, or the tendon of his flexor pollicis longus may slough.
INFECTION OF THE RADIAL BURSA Incise the patient's radial bursa through incision 11 along the proximal phalanx of his thumb. Open it at its distal end; pass a probe proximally towards his wrist, and make a second incision over its proximal end (incision 12). Insert a fine catheter down the sheath and irrigate it with saline.
CAUTION ! (1) Don't incise along the radial border of his first metacarpal. Dissecting among the muscles there may impair the function of opposition, and prevent him bringing his thumb across his palm.
Fig. 8-8 SEPTIC ARTHRITIS. A, acute suppurative arthritis presenting with a sinus. B, exploring the lesion. C, mobilizing an intact extensor tendon to expose a suppurating distal interphalangeal joint. After Bailey DA, ''The Infected Hand', Figs. 65, 66 and 67. HK Lewis, with kind permission.