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Introduction
  • Due to inflammation at crossing point of 1st dorsal compartment (APL and EPB ) and 2nd dorsal compartment (ECRL, ECRB)
  • Epidemiology
    • common in
      • rowers
      • weight lifters
  •  Pathophysiology
    • mechanism is repetitive wrist extension
Anatomy
  • Extensor tendon compartments  
    • Compartment 1 (De Quervain's Tenosynovitis )
      •  APL
      •  EPB 
    • Compartment 2 (Intersection syndrome)
      •  ECRL 
      •  ECRB 
    • Compartment 3
      •  EPL 
    • Compartment 4
      •  EIP 
      •  EDC 
    • Compartment 5 (Vaughn-Jackson Syndrome )
      •  EDM
    • Compartment 6 (Snapping ECU )
      •  ECU
Presentation
  • Symptoms
    • pain over dorsal forearm and wrist
  • Physical exam 
    • tenderness on dorsoradial forearm
      • approximately 5cm proximal to the wrist joint
    • provocative tests
      • crepitus over area with resisted wrist extension and thumb extension
Imaging
  • Radiographs
    • not required for the diagnosis or treatment of intersection syndrome
  • MRI  
    • indications
      • to confirm diagnosis when clinical findings unclear
    • views
      • fluid sensitive sequences (short tau inversion recovery, STIR; fat suppressed proton density, FS PD; T2-weighted)
    • findings
      • most characteristic is peritendinous edema or fluid surrounding the 1st and 2nd extensor compartments  
      • other findings - tendinosis, muscle edema, tendon thickening, loss of the normal comma shape of the tendon, and juxtacortical edema may also be seen
Treatment
  • Nonoperative
    • rest, wrist splinting, steroid injections
      • indications
        • first line of treatment
      • technique
        • injection aimed into 2nd dorsal compartment (ECRL, ECRB) q
  • Operative
    • surgical debridement and release
      • indications
        •  rarely indicated in recalcitrant cases
      • technique
        • release of the 2nd dorsal compartment approximately 6 cm proximal to radial styloid
 

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