Clinical CommunicationsIntersection syndrome: a case report and review of the literature
Introduction
A 37-year-old, right-hand-dominant man presented to the Emergency Department (ED) with a 2-day history of pain and swelling along the radial aspect of the right wrist. The pain was increased by movement, specifically ulnar deviation and wrist extension. The patient specifically denied any recent direct trauma to the area. He denied parasthesias or weakness. He had performed 10 hours of landscaping 1 day before the onset of symptoms. This activity consisted primarily of digging with a shovel and the manual spreading of mulch. Previous problems with the wrist were denied. There were no associated systemic complaints. Past medical history was unremarkable. Social history was noncontributory.
Physical examination of the right upper extremity revealed an area of swelling and tenderness approximately 4 cm proximal to the radial styloid on the radial aspect of the forearm (Figure 1). Significant crepitus was noted on palpation, and was exacerbated by ulnar deviation of the hand. Finkelstein’s test elicited pain in the area of tenderness but not directly over the radial styloid process. There was no overlying erythema and only minimal warmth. The neurovascular examination was intact.
A clinical diagnosis of intersection syndrome was made. The patient was placed in a thumb spica splint and treated with nonsteroidal antiinflammatory drugs (NSAIDS). At follow-up with a hand surgeon, he was noted to have minimal improvement after 2 weeks. Subsequently, he received a steroid injection adjacent to the area of maximal swelling. He recovered clinically within 10 days of the injection. After 6 months, the patient had no recurrence of symptoms despite resuming all activities.
Section snippets
Discussion
Wrist pain is a common presenting complaint in the adult patient. While it is frequently diagnosed in general terms such as sprains, strains, fractures, and overuse syndromes, more specific diagnoses often can be made. A condition not frequently recognized is the intersection syndrome (1), first described by Velpeau in 1841 (2). This also has been referred to as peritendinitis crepitans, crossover syndrome, adventitial bursitis, subcutaneous perimyositis, and abductor pollicus longus (APL)
Conclusion
In summary, the diagnosis and appropriate management of wrist injuries require detailed history taking and a meticulous physical examination. Only through awareness of the subtle differences in these entities will the underdiagnosed intersection syndrome become more recognized and patient care optimized. 8, 10, 11
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“Ice Axe Wrist”: A Case Report of Intersection Syndrome in 2 Climbers
2017, Wilderness and Environmental MedicineCitation Excerpt :Both cases resolved with conservative management, and in 1 case, the aggravating activity was continued with the aid of strapping and without significant limitations. Indeed the literature confirms that the majority of cases should resolve with conservative management.3,4,10 Intersection syndrome is typically associated with repetitive flexion and extension of the wrist,2 but it has also been reported in skiers on repetitive withdrawal of the planted ski pole in deep snow.13
Clinical manual assessment of the wrist
2016, Journal of Hand TherapyCitation Excerpt :Carpal bosses, dorsal wrist ganglia, dorsal wrist impingement, and scaphoid impaction syndrome are usually diagnosed with imaging or within the BCE, and no special tests currently exist for these pathologies. Intersection syndrome is a tenomyosynovitis of the first and second dorsal compartments.27 The irritation occurs at the musculotendinous junction of the abductor pollicis longus/extensor pollicis brevis and ECRL/extensor carpi radialis brevis, and swelling is observed in this region.
The intersection syndrome: Ultrasound findings and their diagnostic value
2010, Journal of UltrasoundCitation Excerpt :Pain and inflammation can be relieved with oral nonsteroidal anti-inflammatory drugs and local application of ice [2]. If the symptoms persist, local infiltration of slow-acting steroids may be useful [4]. If the conservative approach fails, surgery may be indicated.
Proliferative Extensor Tenosynovitis of the Wrist in the Absence of Rheumatoid Arthritis
2009, Journal of Hand SurgeryCitation Excerpt :Proliferative extensor tenosynovitis, which presents with exuberant tenosynovitis causing a clinically visible and palpable mass, differs from stenosing tenosynovitis, which is not associated with proliferative tenosynovium. In the nonrheumatoid population, stenosing tenosynovitis is commonly seen in the first compartment (de Quervain's tenosynovitis)6 and has also been reported in the second compartment (intersection syndrome),7 third compartment (extensor pollicis longus syndrome), fourth compartment (extensor indicus proprius syndrome),8 and fifth compartment.9–10 It typically presents as pain that secondarily limits range of motion.
Distal intersection syndrome: An unusual cause of forearm pain
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