Updated: 10/4/2016

Intersection Syndrome

Topic
Review Topic
0
0
Questions
2
0
0
Evidence
2
0
0
https://upload.orthobullets.com/topic/6032/images/Illustration - hand university_moved.jpg
https://upload.orthobullets.com/topic/6032/images/extensor compartments_moved.jpg
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
 

Please rate topic.

Average 4.4 of 19 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (2)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(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? Review Topic

QID: 896
1

APL and EPB tendons

13%

(324/2574)

2

ECRL and ECRB tendons

75%

(1923/2574)

3

EPL tendon

3%

(79/2574)

4

APL and ECRB tendons

8%

(210/2574)

5

Brachoradialis tendon

1%

(25/2574)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 2
ARTICLES (4)
Topic COMMENTS (2)
Private Note