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

  • Intersection syndrome - Orthobullets
  • Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

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