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Intersection Syndrome

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Topic updated on 02/07/14 11:14am
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
      •  EBP 
    • 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
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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Qbank (1 Questions)

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(OBQ07.235) A collegiate rower complains of dorsal wrist pain for 6 weeks refractory to NSAIDs and bracing. Maximal tenderness is palpated on the dorsoradial forearm approximately 5 cm proximal to the wrist. Pain is exacerbated with resisted wrist extension. Radiographs are unremarkable. A steroid injection should be directed into the compartment containing which of the following structures? Topic Review Topic

1. APL and EPB tendons
2. ECRL and ECRB tendons
3. EPL tendon
4. APL and ECRB tendons
5. Brachoradialis tendon

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