Intersection Syndrome

• Tenosynovitis - Intersection Syndrome:

  • intersection syndrome is a type of tenosynovitis
  • it is tenosynovitis at the intersection of the 1st compartment (abductor pollicis longus + extensor pollicis brevis) with the 2nd compartment (extensor carpi radialis longus + extensor carpi radialis brevis) of the forearm extensors
  • 2nd compartment more so than 1st
  • common in rowing, canoeing, tennis, skiing and weightlifting
  • often gets confused with De Quervains tenosynovitis
• Intersection Syndrome - Clinical Presentation:

  • history of recent increase of repetitive wrist flexion and extension
  • pain area: dorsal radial side of the distal forearm 4 cm proximal to Lister's Tubercle
  • report pain, tenderness, swelling and crepitus with wrist flexion and extension
  • investigation: not usually needed, MRI: peritendinous oedema surrounding 1st and 2nd compartment
• Intersection Syndrome:

  • observation - local oedema
  • palpation - pain or tenderness of extensor carpi radialis brevis and extensor carpi radialis longus
  • tendon crepitus with active or passive wrist and thumb extension
  • resisted wrist extension and pronation +/- palpation reproduces pain
  • painful gripping
  • ROM: pain with end range wrist flexion and ulna deviation
  • special test: Finkelstein's for De Quervains - highly sensitive however specificity can lead to false positives when the problem is intersection syndrome
• Intersection Syndrome - Management pt1:

  • advice and education
  • explain condition, expectation and prognosis
  • education: activity modification, avoid compression (dont stretch extensors) and avoid aggravating factors
  • symptom control
  • relative rest
  • partial or complete immobilisation in severe cases
  • cock-up wrist splint (20 degree extension), thumb spica splint & taping
  • immobilise - 3 weeks followed gradual weaning
  • medication: pain relief, NSAID Gel, NSAID tablets, ice
  • isometrics with wrist in neutral initially
• Intersection Syndrome - Management pt2:

  • build capacity
  • Isometrics through range Initially
  • Progressive strengthening building capacity and control through range (make it functional) - dont forget the rest of the kinetic chain
  • Work on Wrist control: good control between flexors and extensors (dynamic wrist strength)
  • Build Load tolerance: Gradual return back to aggravating positions and activity
  • return to function
  • Advanced rehab: Task modification: Review technique (i.e. racquet grip)
  • Gradual increase to specific activity/sport
  • Maintain strengthening local and remotely