Intersection Syndrome: Difference between revisions
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The affected site is where the muscle bellies of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) cross over the tendons of extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB). | The affected site is where the muscle bellies of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) cross over the tendons of extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB). | ||
These two compartments intersect at an angle of approximately 60 degrees. One theory is that the syndrome is caused by frictions between the muscle bellies of first compartment cross over the tendons of the second compartment. A second theory is that there is entrapment of muscles in the second compartment secondary to stenosis. | These two compartments intersect at an angle of approximately 60 degrees. One theory is that the syndrome is caused by frictions between the muscle bellies of first compartment cross over the tendons of the second compartment. A second theory is that there is entrapment of muscles in the second compartment secondary to stenosis - a "stenosing tenosynovitis". | ||
==Epidemiology and Risk Factors== | ==Epidemiology and Risk Factors== | ||
The condition is considered to be rare, however it may be under-reported because it is commonly self-limiting. | |||
In sport-people common culprits are heavy lifting, rowing, and racket sports. The highest risk is when beginning a new sport. The dominant hand is more commonly affected. It can also occur occupationally for example in typists. | In sport-people common culprits are heavy lifting, rowing, and racket sports. The highest risk is when beginning a new sport. The dominant hand is more commonly affected. It can also occur occupationally for example in typists. | ||
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===History=== | ===History=== | ||
The pain is slightly more proximal and dorsal than [[De Quervain Tendinopathy|de quervains]]. They will typically also report a "squeaking" sensation with wrist and thumb movement. | The pain is located radially but is slightly more proximal and dorsal than [[De Quervain Tendinopathy|de quervains]]. They will typically also report a "squeaking" sensation with wrist and thumb movement. | ||
===Examination=== | ===Examination=== | ||
Swelling and redness may be noted compared to the contralateral side. More prominent movement of the thumb is required to reproduce the pain in comparison to de quervains. Wrist extension and | Swelling and redness may be noted compared to the contralateral side. Pay careful attention to the location of tenderness to avoid misdiagnosis as de quervains - they should not be tender over the radial styloid. More prominent movement of the thumb is required to reproduce the pain in comparison to de quervains. Wrist extension and radial deviation may reproduce pain. Squeaking or crepitus may be noted at the site. Auscultation can be performed over the area of pain while the patient flexes and extends their wrist. | ||
==Investigations== | ==Investigations== | ||
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==Diagnosis== | ==Diagnosis== | ||
The diagnosis is made on clinical features, however imaging can be supportive. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Treatment== | ==Treatment== | ||
Rest | |||
* Rest - The condition is commonly self-limited. | |||
* Activity modification | |||
* Bracing (wrist splint in neutral extension) | |||
* Stretching | |||
* NSAIDs | |||
* Corticosteroid injection into the tendon sheath of the second compartment at the area of maximal tenderness. | |||
* Surgery. This involves release of the second extensor compartment. | |||
==Follow Up and Prognosis== | ==Follow Up and Prognosis== | ||
The prognosis is generally good. | |||
==Summary== | ==Summary== | ||
Revision as of 21:48, 11 May 2024
Intersection syndrome is a tenosynovitis of the second dorsal compartment tendons caused by the "crossover" of the muscle bellies of the first dorsal compartment of the wrist, occurring approximately 2-4 cm proximal to the radial tubercle.
| Intersection Syndrome | |
|---|---|
| Synonym | peritendinitis crepitans, crossover syndrome, adventitial bursitis, subcutaneous perimyositis with abductor pollicis longus syndrome and bugaboo forearm. |
Aetiopathophysiology
Intersection syndrome is an overuse injury caused by repetitive wrist extension.
The affected site is where the muscle bellies of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) cross over the tendons of extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB).
These two compartments intersect at an angle of approximately 60 degrees. One theory is that the syndrome is caused by frictions between the muscle bellies of first compartment cross over the tendons of the second compartment. A second theory is that there is entrapment of muscles in the second compartment secondary to stenosis - a "stenosing tenosynovitis".
Epidemiology and Risk Factors
The condition is considered to be rare, however it may be under-reported because it is commonly self-limiting.
In sport-people common culprits are heavy lifting, rowing, and racket sports. The highest risk is when beginning a new sport. The dominant hand is more commonly affected. It can also occur occupationally for example in typists.
Clinical Features
History
The pain is located radially but is slightly more proximal and dorsal than de quervains. They will typically also report a "squeaking" sensation with wrist and thumb movement.
Examination
Swelling and redness may be noted compared to the contralateral side. Pay careful attention to the location of tenderness to avoid misdiagnosis as de quervains - they should not be tender over the radial styloid. More prominent movement of the thumb is required to reproduce the pain in comparison to de quervains. Wrist extension and radial deviation may reproduce pain. Squeaking or crepitus may be noted at the site. Auscultation can be performed over the area of pain while the patient flexes and extends their wrist.
Investigations
Ultrasound and/or MRI
Diagnosis
The diagnosis is made on clinical features, however imaging can be supportive.
Differential Diagnosis
- De Quervain Syndrome
- Scaphoid fracture
- Osteoarthritis of the first metacarpal joint
- Ganglion cyst
- Wartenderg syndrome
- Sprain
Treatment
- Rest - The condition is commonly self-limited.
- Activity modification
- Bracing (wrist splint in neutral extension)
- Stretching
- NSAIDs
- Corticosteroid injection into the tendon sheath of the second compartment at the area of maximal tenderness.
- Surgery. This involves release of the second extensor compartment.
Follow Up and Prognosis
The prognosis is generally good.
Summary
References
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
