Intersection Syndrome
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Overview

Intersection syndrome is a bursitis that occurs at the dorsal-radial aspect of the wrist, due to friction of the extensor pollicis brevis and abductor pollicis longus tendons (the 1st compartment tendons) up against the carpi radials tendons (the second compartment tendons)

It may be tricky to distinguish from De Quervain tenosynovitis.

  • This is a tenosynovitis of the tendons of the 1st compartment

It is commonly seen in rowers and weight lifters, and is a result of repetitive wrist extension. 

Presentation

  • Pain at the dorsal forearm and wrist
  • Tenderness over the dorsoradial forearm, typically most prominent about 5cm proximal to the wrist
  • Wrist extension and thumb extension may be reduced
  • Negative Finkelstein’s test – as opposed to De Quervain tenosynovitis

Diagnosis

  • Usually clinical
  • X-ray is not useful
  • MRI
    • May confirm diagnosis when the presentation is uncertain
    • May show oedema at the 1st and 2nd extensor compartments
    • Other findings might include tendon thickening, muscle oedema, loss of the normal “comma” shape of the tendon

Management

  • 1st line
    • Splinting
    • NSAIDs
    • Rest and avoidance of aggravating activities
  • 2nd line
    • Corticosteroid injection into the 2nd dorsal compartment
  • Surgical management
    • Considered in resistant cases – used only very rarely
    • Surgical debridement and release
    • Release of the 2nd dorsal compartment about 5-6cm proximal to the radial styloid

References

Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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