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What is Intersection Syndrome

Intersection Syndrome describes a condition in which the radial-side wrist extensor tendons that cross under the wrist retinaculum —the fibrous band of fascia that covers the carpus—and serve to extend the wrist become irritated from overuse. The long thumb extensor is sometimes involved too.

Activities that entail repeatedly moving the wrist up and down—such as tennis, rowing, kayaking or skiing—can lead to Intersection Syndrome, which is indicated by pain on the back of the forearm a few inches below the wrist as well as a creaking sound/sensation as the tendons rub against the extensor retinaculum.

Characteristics and Clinical Presentation of Intersection Syndrome

Intersection syndrome is characterized by pain and swelling in the distal dorsal radial forearm. Symptoms may be exacerbated by repetitive wrist flexion and extension. Patients may report a creaking or squeaking sound as the tendons rub against the muscles in the affected region. This sound is called crepitus. Patients may also experience redness and swelling at the intersection point of the wrist.

Symptoms may include:

  • Pain and tenderness of the wrist tendons
  • Swelling of the tendons
  • A grinding sensation (crepitus) with the movement of the fingers

Causes of Intersection Syndrome

The chronic overuse of wrist extensor tendons become inflamed due to constant rubbing may contribute to Intersection Syndrome. As the slippery tenosynovial lining becomes irritated and inflamed, it thickens and swells.

These tendons may become inflamed by activities that require the wrist to curl downwards and in, towards the thumb. These wrist movements are common for skiers, racket sports, weight lifting, and canoeing.

Diagnosis of Intersection Syndrome

Radiographics of the wrist with distal forearm are useful in diagnosing intersection syndrome. Radiographs may also depict thumb carpometacarpal (CMC) arthritis and osteophytes around the distal radius.

Magnetic resonance imaging (MRI) is rarely indicated. However, an MRI scan could be ordered if the physician is suspicious of a soft tissue mass as the cause of the swelling. Ultrasound is useful in visualizing inflammation and edema.

Nonsurgical Treatments for Intersection Syndrome

Conservative treatment of intersection syndrome includes immobilization, activity modification, and pharmacologic intervention. Treatments should include resting the affected region, ice to alleviate the symptoms of inflammation, and anti-inflammatory medication.

Surgical Treatment Options for Intersection Syndrome

The condition is normally treated by rest, splinting, anti-inflammatory medications and a cortisone injection, followed by physical therapy. Surgery is only occasionally implicated.

Surgery may be required in patients with vague, nonspecific complaints or in patients who do not respond to conservative, non-invasive treatments.

Prognosis

Most patients with intersection syndrome respond to a program of conservative management. They may need to maintain changes in work or avocational activities to prevent recurrence of symptoms. Individuals who require surgery rarely experience recurrence of symptoms.

If You Believe You Have Intersection Syndrome, Contact HandSport Surgery Institute

Please contact us as soon as possible to schedule an appointment with our talented team. People experiencing intersection syndrome should be evaluated to try and prevent further injury and mobility issues.

If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment, obtain an accurate diagnosis, and start to restore comfort to your arm.

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