Patients › Hand

Drainage of an Infected Flexor Sheath

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Updated Sep 2026

Why this operation has been suggested¶

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, treats infections of the finger's tendon sheath promptly because delay can affect the final result. The flexor sheath is the closed tunnel of tissue through which the bending tendons of your finger slide. When it becomes infected, pus can build up inside it, and the usual treatment is a small operation to wash the infection out, together with antibiotics. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate.

We recommend this operation when the signs point to infection inside the sheath: tenderness along the front of the finger, a finger held slightly bent, pain when the finger is straightened, and swelling of the whole finger. Not every person has all of these signs. Because this is an acute infection, surgery is usually arranged straight away rather than after a trial of non-operative care. Antibiotics alone are generally not enough. The aim of the operation is to clear the infection early, protect the tendons, and give your finger the chance to keep its bending movement.

Before the operation¶

Because this infection needs prompt treatment, your operation is usually arranged quickly and there is little to prepare. You will need to stop eating and drinking for seven hours beforehand. We ask for seven hours rather than six so that we can bring you forward if the theatre list runs early. Bring a list of your current medications and wear comfortable, loose clothing. Arrange someone to drive you home afterwards. Some scans, such as an X-ray, ultrasound or MRI, may be needed to plan the operation. If you have other medical conditions, you may need blood tests or a review with the anaesthetist (the doctor who gives your anaesthetic). Most people need neither. Your surgeon will give you exact instructions about your medications before the day.

On the day¶

You will arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You will then meet the anaesthetist, the doctor who gives your anaesthetic. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief; the anaesthetist will discuss this with you on the day.

You are then taken into the operating theatre, where the operation is performed. Afterwards, you will wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable, you will either go to the ward or go home, depending on the procedure and your recovery.

What the operation involves¶

The operation is a washout of the infected sheath. Your surgeon makes a cut on the palm side of your finger, over the area of concern. The cut follows the natural creases of the skin. Through this cut, your surgeon opens the sheath, the tunnel of tissue that wraps around the bending tendon. Any fluid inside is collected and sent for testing to identify which germ is causing the infection.

Your surgeon then washes the sheath out thoroughly with sterile salt water. A fine soft tube can be left in place so that washing can continue after the operation. This keeps fluid moving through the tunnel and helps clear any infection that remains. When the washout is finished, the wound is closed and a bulky soft dressing is applied to your hand.

If there is obvious pus when the sheath is opened, or if pus is found during a smaller washout done before theatre, your surgeon may need to do a more thorough clean in the operating theatre. Antibiotics are given as well, chosen to match the germ found on testing. You can expect to have some stiffness in the finger afterwards even when the infection clears well, because the tissues inside the tunnel are delicate.

The operation itself is usually not long, but the exact timing depends on what your surgeon finds.

After the operation¶

You will wake up in the recovery area, where nurses watch you closely while the anaesthetic wears off. Your hand will be in a bulky soft dressing. If a fine washing tube was left in place, it stays in for a short time so fluid can keep moving through the sheath. Nurses will give you pain relief to keep you comfortable, and they will check your finger regularly. You can move around as you feel able, though your hand will be sore at first. Someone should stay with you for the first 24 hours after you go home. Your team will tell you whether you go home the same day or stay one night in hospital.

Recovery¶

For the first few days your finger and hand will be sore and swollen. This settles gradually. Keeping your hand raised on pillows, even while you sit or sleep, helps ease the throbbing. Simple pain relief as directed by your team will keep you comfortable.

Your hand will stay in a bulky soft dressing at first. If a fine washing tube was left in place, it stays in for a short time while fluid keeps moving through the sheath. Once the dressing comes off, you will start gentle movement of the finger. Hand therapy after this surgery is with Ruby Doolan at Extend Rehabilitation. Your hand therapist will guide your exercises and make any splint you need to protect the finger while it heals.

At home you can do most everyday things with your other hand. Avoid heavy lifting, gripping and any activity that strains the sore finger until your therapist says it is safe. Sleep with your hand raised if the swelling is uncomfortable at night.

Movement usually returns in stages. The swelling settles first, then bending and straightening improve as the tissues inside the tunnel heal. Some stiffness in the finger is common even when the infection clears well, and therapy works on this over time. You will know things are going well when you can grip and use the finger without increasing pain.

Recovery varies from person to person. Your timeline may differ, and your surgeon and hand therapist will guide you along the way.

What can go wrong¶

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

This infection is an aggressive one inside a closed space, so it needs effective treatment. Even with prompt antibiotics and surgery, some stiffness in the finger is expected afterwards, even in otherwise healthy people. The tissues inside the tunnel are delicate, and scarring as they heal can limit bending. Your hand therapist will work on this with you.

A rare but serious form of this infection can spread quickly and become a threat to the limb or to life. Watch for pain that gets worse instead of better, redness that spreads out from the wound or up the hand, swelling that increases, fever or feeling generally unwell. If you notice any of these, call the clinic straight away or go to the emergency department. Early treatment makes a real difference with this kind of infection.

If you notice a deep, throbbing pain that does not ease with simple painkillers, or the finger becomes more tender, more swollen or more red than before, do not wait for your next appointment. Contact the clinic the same day.

Bring up anything that worries you at your next review, even if it seems minor. Stiffness that is not improving with therapy, or pain that lingers longer than expected, is worth mentioning so your team can adjust your plan.

The complications table on this page lists typical rates if you want the specifics.

When to call us¶

Call us if you develop a fever, feel generally unwell, or notice the wound becoming more red, swollen or discharging fluid. Call us if pain suddenly gets much worse, or if your finger becomes numb or will not move.

Go to the emergency department if you have calf swelling or pain, or shortness of breath. These can be signs of a blood clot and need checking straight away.

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