Intersection syndrome

Background

• Extensor wrist tenosynovitis
• Caused by overuse of wrist and hand
• Located at the intersection of the first and second dorsal compartments of wrist containing extensor carpi radialis brevis and longus (ECRB and ECRL). Has also been called “Oarsman’s Wrist,” “Bugaboo Forearm,” “Peritendinitis Crepitans,” “Crossover Syndrome,” and “Squeaker’s Wrist.” "Intersection Syndrome" more aptly describes the anatomy involved as this is an inflammatory condition occuring where the abductor pollicis longus and extensor pollicis brevis tendons cross the extensor carpiradialis brevis and extensor carpi radialis longus tendons in the forearm.
• Relatively uncommon, but has been seen in rowing, baseball, softball, hockey, cycling, golf, skiing, ice climbing and racquet sports

extensor compartments of wrist

Clinical Features

• Unilateral pain where ECRL and ECRB intersect with abductor pollicis longus (APL), extensor pollicis brevis (EPB) - over the dorsum of the wrist on the radial side of the dominant hand, about 5 cm proximal to wrist joint
• Swelling
• Crepitus may be present on active and passive wrist flexion, extension, radial, and ulnar deviation
• Neurovascular evaluation should be normal, and there is usually no associated pain or restriction is proximal joints (elbow, shoulder, neck)
• Easily confused with De Quervain tenosynovitis

Differential Diagnosis

Hand and finger injuries

• Distal finger
  • Finger amputation
  • Fingertip laceration
  • Nail avulsion
  • Nailbed laceration
  • Subungual hematoma
• Other finger/thumb
  • Boutonniere deformity
  • Mallet finger
    • Swan neck deformity
  • Jammed finger
  • Jersey finger
  • Trigger finger
  • Ring avulsion injury
  • De Quervain tenosynovitis
  • Infiltrative tenosynovitis
  • Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
• Hand
  • Dupuytren contracture
• Wrist
  • Drummer's wrist
  • Ganglion cyst
  • Lunotriquetral ligament instability
  • Scaphoid fracture
  • Extensor digitorum tenosynovitis
  • Compressive neuropathy ("bracelet syndrome")
  • Intersection syndrome
  • Snapping Extensor Carpi Ulnaris
  • Vaughn Jackson syndrome
• General
  • Hand and finger dislocations
  • Hand and finger fractures
  • Hand and finger infections
  • Gout and pseudogout
  • Hand and finger tendon injuries
  • High-pressure injection injury
  • Osteoarthritis
  • Rheumatoid arthritis
  • Ring removal

Evaluation

• Finkelstein’s Test may be positive, but the area of tenderness should be further proximal from the wrist, oppose to over the first compartment as is seen in DeQuervain tenosynovitis.
• Radiographs are not necessary for diagnosis
• MRI may be considered for diagnosis if clinical findings are unclear, will likely show peritendinous edema or fluid surrounding the 1st and 2nd extensor compartments. May also see tendinosis, muscle edema, tendon thickening, loss of the normal comma shape of the tendon, and juxtacortical edema.

Management

Nonoperative

• Thumb spica splint - to reduce thumb and wrist extension and radial deviation
• Compression - to reduce swelling
• Ice
• Depending on severity, may consider steroid injection to 2nd dorsal compartment (ECRL, ECRB)

Operative

• Rarely used, may consider surgical debridement and release of the second dorsal compartment approximately 6 cm proximal to the radial styloid if the condition becomes severe and chronic

Disposition

• Conservative
• One case report of two ice axe climbers found that creating a thumb spica split using zinc oxide tape, in combination with icing, was sufficient to reduce symptoms within days, in both a climber who continued to climb and one who rested

See Also

• Hand and finger diagnoses

External Links

• See Dr. Nabil Ebraheim's video on dorsal wrist compartment syndromes