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Intersection Syndrome

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Other Names

  • Tenosynovitis of first and second dorsal compartment
  • Tenosynovitis of first and second extensor compartment
  • Oarsmen's wrist
  • Crossover syndrome
  • Squeaker's wrist
  • Abductor pollicis longus bursitis
  • Abductor pollicis longus syndrome
  • Subcutaneous polymyositis
  • Peritendinitis crepitans

Background


Pathophysiology

  • Etiology
    • Result of repetitive extension and flexion activities
    • Friction injury at crossover of two junctions leads to inflammation and subsequent tenosynovitis

Risk Factors

  • Sports[1]
    • Rowing
    • Canoeing
    • Skiing
    • Racquet sports
    • Horseback riding
    • Weight lifters

Differential Diagnosis

Differential Diagnosis Wrist Pain

Differential Diagnosis Forearm Pain


Clinical Features

  • General: Physical Exam Forearm
  • Patients will endorse pain approximately 4-6 cm proximal and dorsal to listers tubercle
  • Swelling and creptius may be appreciated on exam
    • Worse with wrist and thumb extension

Evaluation

  • Primarily a clinical diagnosis

Ultrasound

  • Point of care ultrasound can aid in diagnosis
  • Hypoechoic area in between the two dorsal compartments
  • Thickening of the tendon sheaths

Radiographs

CT

  • Not helpful in the diagnosis of intersection syndrome

MRI

  • Demonstrates peritendinous edema around 1st and 2nd extensor compartments[2]
  • Chronic cases may show a stenosing tenosynovitis

Classification

  • N/A

Management

Nonoperative

  • Most cases can successfully be managed conservatively
  • Medications
    • NSAIDS
    • Acetaminophen
    • Topical medications
  • Relative rest from offending activity or sport
  • Ice
  • Splinting
    • Removable forearm splint
  • Physical Therapy
    • No evidence based protocol
    • Consider eccentric strengthening, soft tissue manipulation, stretching
  • Corticosteroid Injection
    • Should be performed under ultrasound guidance

Operative

  • Rarely necessary for recalcitrant cases
  • Technique is surgical debridement and release

Return to Play

  • Relative rest for athletes
  • Graded return to play as they progress through therapy

Complications

  • Chronic pain

See Also


References


  1. Browne J, Helms CA. Intersection syndrome of the forearm. Arthritis Rheum. 2006 Jun;54(6):2038.
  2. Costa CR, Morrison WB, Carrino JA. MRI features of intersection syndrome of the forearm. AJR Am J Roentgenol. 2003 Nov;181(5):1245-9.
Created by:
John Kiel on 18 June 2019 23:15:09
Authors:
Last edited:
27 October 2020 23:09:52
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