Elsevier

The Journal of Emergency Medicine

Volume 17, Issue 6, November–December 1999, Pages 969-971
The Journal of Emergency Medicine

Clinical Communications
Intersection syndrome: a case report and review of the literature

https://doi.org/10.1016/S0736-4679(99)00125-0Get rights and content

Abstract

Intersection syndrome is a condition that should be differentiated from DeQuervain’s stenosing tenosynovitis, as there are many subtle differences in treatment and prognosis. We present a case of intersection syndrome, describing its characteristic clinical and anatomic features, and highlighting differences in the areas of diagnosis and treatment relative to the better known DeQuervain’s tenosynovitis.

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

References (11)

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