Diagnosis and management of intersection syndrome as a cause of overuse wrist pain

Abstract

Wrist pain due to repetitive motion or overuse is a common presentation in primary care. This case reports the rare condition of intersection syndrome as the cause of the wrist pain in an amateur tennis player. This is a non-infectious, inflammatory process that occurs where tendons in the first extensor compartment intersect the tendons in the second extensor compartment. Suitable history and examination provided the diagnosis, which was confirmed by MRI. Management consisted of early involvement of the multidisciplinary team, patient education, workplace and sporting adaptations, rest, analgesia, reduction of load, protection and immobilisation of the affected joint followed by a period of rehabilitation.

MRI-Based Evaluation of the Flexor Digitorum Superficialis Anatomy: Investigating the Prevalence and Morphometry of the “Chiasma Antebrachii”

“…Notably, the chiasma antebrachii possesses similarities to the proximal (crossing of the abductor pollicis longus and extensor pollicis brevis tendons over the extensor carpi radialis longus and brevis tendons) and distal extensor tendon intersections (crossing of the extensor pollicis longus tendon over the extensor carpi radialis longus and brevis tendons) on the dorsal side of the wrist [13,17]. The two listed tendon intersections are of great clinical relevance: Repetitive extension-flexion movements at these junctions commonly seen in sporting activities can result in a localized friction injury, generating tenosynovitis and characteristically leading to pain, swelling, and functional limitations; a clinical condition termed "intersection syndrome" [18,19]. Considering the anatomic similarities, the occurrence of a clinically relevant flexor-sided intersection syndrome in patients with intensive use of the index and middle fingers is conceivable.…”

Intersection syndrome: A proximal cause of radial-sided wrist pain

“…Radial-sided dorsal wrist pain has numerous differentials, including intersection syndrome and de Quervain's tenosynovitis. 2 Intersection syndrome is an overuse disorder, with repetitive extension and flexion resulting in friction injury at the crossover junction of the first dorsal compartment (abductor pollicis longus and extensor pollicis brevis) and the second dorsal compartment (extensor carpi radialis brevis and extensor carpi radialis longus) tendons. This subsequently leads to inflammation and tenosynovitis of the involved compartments.…”

“…The location of pain in intersection syndrome typically occurs approximately 4 cm proximal to Lister's tubercle at the distal radius, while in de Quervain's tenosynovitis, the location is usually slightly more distal. 2 Ultrasound and magnetic resonance imaging can help differentiate de Quervian's tenosynovitis from intersection syndrome and exclude other pathologies in radial-sided wrist pain. Typical imaging features include tenosynovitis of the involved tendons with adjacent soft tissue edema.…”

“…de Quervain’s tenosynovitis is a similar overuse disorder that results in radial-sided wrist pain. The location of pain in intersection syndrome typically occurs approximately 4 cm proximal to Lister’s tubercle at the distal radius, while in de Quervain’s tenosynovitis, the location is usually slightly more distal 2 …”

“…Steroid injections may also be helpful. Surgical treatment is typically reserved for rare cases when conservative treatment fails 2,3 …”