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Updated: Feb 7 2023

Intersection Syndrome

4.3

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Images
https://upload.orthobullets.com/topic/6032/images/mri_normal.jpg
https://upload.orthobullets.com/topic/6032/images/intersec.jpg
  • Summary
    • Intersection syndrome is an inflammatory condition that occurs at the crossing point of the 1st dorsal compartment (APL and EPB ) and the 2nd dorsal compartment (ECRL, ECRB).
    • Diagnosis is made clinically with pain over the dorsoradial forearm (5 cm from wrist joint) made worse with resisted wrist extension and thumb extension.
    • Treatment is conservative with rest, wrist splinting and steroid injections. 
  • Epidemiology
    • Incidence 
      • rare
        • < 1 per 100,000 annually
    • Demographics
      • males = females
    • Risk factors
      • rowing
      • skiing
      • horseback riding
      • weight lifting
  • Etiology
    • Pathophysiology
      • mechanism is repetitive wrist extension
        • repetitive motion results in friction at the crossover junction of the 1st and 2nd dorsal compartments
        • friction leads to and inflammatory response and subsequent tenosynovitis 
  • 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 (Vaughan-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
  • Differential
    • De Quervain's tenosynovitis
    • Wartenberg's syndrome 
  • Diagnosis
    • Clinical
      • diagnosis is made with careful history and physical examination
  • Treatment
    • Nonoperative
      • rest, wrist splinting, steroid injections
        • indications
          • first line of treatment
        • technique
          • injection aimed into 2nd dorsal compartment (ECRL, ECRB)
    • 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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