Intersection Syndrome of the Forearm

Wrist injuries are common in sports and in tasks requiring repetitive movement of the wrist. A common, but easily overlooked condition, is the intersection syndrome.  Intersection syndrome of the forearm is a painful condition caused by inflammation of the second extensor compartment tendons of the forearm.  Location of pain is where the first extensor compartment tendons (abductor pollicis longus and extensor pollicis brevis tendons) intersect or cross over the second extensor compartment tendons (extensor carpi radialis longus and extensor carpi radialis brevis tendons) (Costa et al. 2003).  The tendons intersect approximately 4 cm proximal to the wrist (Grundburg, 1985) at an angle of 60 degrees (Costa et al. 2003).

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Intersection syndrome can be common in acute traumatic injuries to the area (eg. falling) or through repetitive strain (eg. rowing, canoeing).  Signs and symptoms include swelling, redness, tenderness at the point of intersection, and crepitus during thumb and wrist movement.

Treatment

Initial treatment includes inflammation control: Ice, immobilization through splint/brace, avoidance of aggravating movements, and NSAIDS. Symptoms typically resolve within 2–3 weeks in 60% of patients (Costa et al. 2003). Surgery is indicated only for those not responding to conservative therapy (Stern, 1990). When conservative treatment fails, a tenosynovectomy (removal of the tendon sheath) and a fasciotomy (cut away the fascia to relieve pressure) of abductor pollicis longus can be performed (Costa et al. 2003). 

Intersection Syndrome

Dobyns et al. (1978), coined the term “intersection syndrome,” to simplify and relate the syndrome to its anatomical reference.  In the literature, intersection syndrome has been also referred to as:

  • “peritendinitis crepitans,”
  • “oars- men’s wrist,”
  • “crossover syndrome,”
  • “subcutaneous perimyositis,”
  • “squeaker’s wrist,”
  • “bugaboo forearm,” 
  • “abductor pollicis longus bursitis” 
  • “abductor pollicus longus syndrome (Costa et al. 2003)

 

Cheers,

Jessie Wong, Physiotherapist from the Physio Room

 

*The exercises provided on this website are for educational purposes only, and are not to be interpreted as a recommendation for a specific treatment plan, or course of action. Exercise is not without its risks, and this or any other exercise program may result in injury. They include but are not limited to: risk of injury, aggravation of a pre-existing condition, or adverse effect of over-exertion such as muscle strain, abnormal blood pressure, fainting, disorders of heartbeat, and very rare instances of heart attack.

To reduce the risk of injury, before beginning this or any exercise program, please consult a healthcare provider for appropriate exercise prescription and safety precautions. The exercise instruction and advice presented are in no way intended as a substitute for medical consultation. We disclaim any liability from and in connection with this program. As with any exercise program, if at any point during your workout you begin to feel faint, dizzy, or have physical discomfort, you should stop immediately and consult a physician.

 

References:

Costa, Morrison, Carrino. MRI Features of Intersection Syndrome of the Forearm. American Journal of Roentgenology. 2003.

Dobyns & Linscheid. Sports stress syndrome of hand and wrist. Am J Sports Med. 1978.

Grundberg & Reagan. Pathologic anatomy of the forearm: Intersection Syndrome. Journal of hand surgery. 1985.

 Stern. Tendinitis, overuse syndromes, and tendon injuries. Hand Clin. 1990.

Picture: Costa et al. 2003