Intersection Syndrome: Difference between revisions

Intersection Syndrome
Synonym	peritendinitis crepitans, crossover syndrome, adventitial bursitis, subcutaneous perimyositis with abductor pollicis longus syndrome and bugaboo forearm.

Revision as of 21:55, 11 May 2024

This article is a stub.

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.

Aetiopathophysiology

Intersection syndrome is an overuse injury caused by repetitive wrist extension. There are two forms - the more common proximal form, and less common distal form.

The most commonly affected site is where the musculotendinous junctions of the first compartment containing abductor pollicis longus (APL) and extensor pollicis brevis (EPB) cross over the tendons of the second compartment containing 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".

There is a rarer distal intersection site - where the third extensor compartment tendon intersects the second extensor compartment tendons.

Epidemiology and Risk Factors

The condition is considered to be rare. For example in a study of 1,131 patients referred for wrist ultrasound, intersection syndrome was only identified in 21 cases (1.9%).^[1]

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 and carpenters.

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

↑ Draghi, Ferdinando; Bortolotto, Chandra (2014-03). "Intersection syndrome: ultrasound imaging". Skeletal Radiology (in English). 43 (3): 283–287. doi:10.1007/s00256-013-1786-1. ISSN 0364-2348. Check date values in: |date= (help)

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,

[1] Draghi, Ferdinando; Bortolotto, Chandra (2014-03). "Intersection syndrome: ultrasound imaging". Skeletal Radiology (in English). 43 (3): 283–287. doi:10.1007/s00256-013-1786-1. ISSN 0364-2348. Check date values in: |date= (help)

[1]

@@ Line 23: / Line 23: @@
 ==Aetiopathophysiology==
-Intersection syndrome is an overuse injury caused by repetitive wrist extension.
+Intersection syndrome is an overuse injury caused by repetitive wrist extension. There are two forms - the more common proximal form, and less common distal form.
-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 most commonly affected site is where the musculotendinous junctions of the first compartment containing abductor pollicis longus (APL) and extensor pollicis brevis (EPB) cross over the tendons of the second compartment containing 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.
-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".
+A second theory is that there is entrapment of muscles in the second compartment secondary to stenosis - a "stenosing tenosynovitis".
+There is a rarer distal intersection site - where the third extensor compartment tendon intersects the second extensor compartment tendons.
 ==Epidemiology and Risk Factors==
-The condition is considered to be rare, however it may be under-reported because it is commonly self-limiting.
+The condition is considered to be rare. For example in a study of 1,131 patients referred for wrist ultrasound, intersection syndrome was only identified in 21 cases (1.9%).<ref>{{Cite journal|last=Draghi|first=Ferdinando|last2=Bortolotto|first2=Chandra|date=2014-03|title=Intersection syndrome: ultrasound imaging|url=http://link.springer.com/10.1007/s00256-013-1786-1|journal=Skeletal Radiology|language=en|volume=43|issue=3|pages=283–287|doi=10.1007/s00256-013-1786-1|issn=0364-2348}}</ref>
-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 and carpenters.
 ==Clinical Features==