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Ulnar Bursae

- Anatomy:
    - ulnar bursae includes little finger tendon sheath which begins at terminal phalanx & extends proximally half way up the palm;
          - occassionally the distal unexpanded part of little finger tendon sheath does not communicate w/ ulnar bursae;
    - in the palm, the ulnar bursae extends laterally to envelop superficial and deep tendons of ring, long, & little fingers;
    - bursae extends two-three cm proximal to proximal volar wrist crease;
    - variations:
           - in 80% of patients, the ulnar bursae communicates w/ the radial bursae (this accounts for the horse shoe tenosynovitis);
           - occassionally index tendon sheath may extend to and communicate with the ulnar bursae;

- Tenosynovitis:
    - pus involving little finger tendon sheath may progress proximally to ulnar bursa extending from palm to a point 4-5 cm proximal to crease of wrist;
    - incision:
           - procedes along the radial border of 5th finger & radial border of the hypothenar eminence;
           - if swelling and tenderness are present cephalad to the proximal wrist crease & along medial border of ulna may be necessary;
           - horse shoe abscess is drained by combination of little finger-ulnar bursae and flexor pollicis-radial bursa incisions