Flexor tenosynovitis of the wrist: A comprehensive review of current knowledge

Introduction and purpose. Flexor tenosynovitis of the wrist is inflammation of the volar (palmar) flexor tendon sheaths, an under-recognized but clinically important cause of volar wrist pain, swelling, and median-nerve symptoms. It spans mechanical, calcific, inflammatory, and infective forms that mimic one another and delay correct treatment. This review consolidates current knowledge on its anatomy, etiology, diagnosis, and management. Materials and methods. This review synthesized 55 articles, spanning 1940 to 2026, identified through an extensive search of PubMed and limited to English-language publications; no date restriction was applied, so that landmark anatomical descriptions could be retained alongside contemporary practice. Data were synthesized descriptively, organized by pathophysiology, clinical presentation, diagnosis, and management. Description of the state of knowledge. The condition comprises mechanical (notably flexor carpi radialis), calcific, inflammatory (rheumatoid), and infective (pyogenic, tuberculous, nontuberculous mycobacterial, and fungal) forms that overlap clinically and may compress the median nerve, causing secondary carpal tunnel syndrome. Diagnosis combines clinical examination with radiographs, ultrasound, and magnetic resonance imaging, supplemented by histopathology or culture when the cause is unclear. Management is form-specific, ranging from immobilization and anti-inflammatory drugs for self-limiting calcific disease, through corticosteroid injection, to tenosynovectomy with carpal tunnel release and urgent debridement for pyogenic infection, in which delay worsens outcomes. Conclusions. Flexor tenosynovitis of the wrist is uncommon, etiologically diverse, and frequently misdiagnosed; early differentiation of its forms is the key to correct treatment. The evidence base rests largely on case reports and retrospective series rather than controlled trials.