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Intersection Syndrome
From WikiSM
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
- Intersection syndrome is inflammatory tenosynovitis at the intersection of the 1st and 2nd dorsal compartment
- Anatomy
- Extensor Tendon Compartments
- 1st extensor compartment: Abductor Pollicis Longus, Extensor Pollicis Brevis
- 2nd extensor compartment: Extensor Carpi Radialis Longus, Extensor Carpi Radialis Brevis
- The 1st dorsal compartment crosses over the 2nd dorsal compartment just proximal to the extensor retinaculum and radial styloid
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
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Differential Diagnosis Forearm Pain
- Fractures
- Pediatric Specific Fractures
- Dislocations & Instability
- Soft Tissue Trauma
- Tendinopathies
- Neuropathies
- Pediatric Considerations
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
- Standard Radiographs Wrist useful for excluding other pathology
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
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
Created by:
John Kiel on 18 June 2019 23:15:09
Authors:
Last edited:
13 October 2022 21:50:05
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