Intersection Syndrome

Aka: Intersection Syndrome, Cross-over Tendinitis, Tenosynovitis of the Radial Wrist Extensors, Extensor Tenosynovitis of Wrist

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II. Risk Factors

  1. Occupational
    1. Sledgehammer use
  2. Sports
    1. Racquet sports
    2. Rowing (Oarsman Syndrome)
    3. Weight Training

III. Pathophysiology

  1. Tenosynovitis of the Radial Wrist Extensors triggered by repetitive, resisted wrist extension
  2. Inflammation at intersection of compartment 1 and 2
  3. Dorsal Compartment 1 Tendons
    1. Abductor Pollicis longus
    2. Extensor Pollicis Brevis
  4. Dorsal Compartment 2 Tendons
    1. Extensor Carpi Radialis Longus
    2. Extensor Carpi Radialis Brevis

IV. Symptoms

  1. Crepitus (or "squeaking") and pain at dorsal wrist, provoked with wrist or hand movement

V. Signs

  1. Focal symptoms at dorsolateral wrist at base of thumb
    1. Localized at 4 to 8 cm proximal to lister's tubercle of distal radius
  2. Local, palpable swelling and possible redness
  3. Local discomfort with radiation into thumb

VI. Differential Diagnosis

  1. De Quervain's Tenosynovitis

VII. Management

  1. Conservative Management
    1. Rest and activity modification
    2. Thumb Spica Splint (e.g. Thumb Keeper Pre-fabricated splint)
    3. Cold Therapy
    4. Physical therapy, occupational therapy or hand therapy
  2. Measures in refractory cases
    1. Intersection Syndrome Steroid Injection
    2. Consider surgical management in refractory cases

VIII. References

  1. Chatterjee (2016) BMJ Case Rep +PMID: 27681354 [PubMed]
  2. Pujalte (2024) Am Fam Physician 110(4): 402-10 [PubMed]

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