Wrist pain can be debilitating. Simple tasks can be almost impossible at times. Your doctor is unsure as to the cause of your wrist pain and you are concerned. What is Intersection Syndrome? What is the underlying cause of intersection syndrome? How do you test for intersection syndrome? What are the treatment options for intersection syndrome? Are there other possible sources of wrist pain? Let’s dig in.
What Is Intersection Syndrome?
Intersection syndrome is a painful medical condition in the wrist and backside of the forearm. It is not very common with an overall incidence that ranges between 0.2 to 0.37 % (1). It is an overuse use or motion injury due to repetitive bending and flexion of the wrist (3). It is more common in women aged between 30-50 years and noted in new mothers carrying their children (2). It is also common in weightlifters, rowers, skiers, tennis, and racketball players (4). It occurs as a result of different wrist ligaments crossing over one another and becoming inflamed.
Tendons are thick pieces of connective tissue that connect muscle to bone. There are a large number of tendons on the backside of your wrist. They are grouped into 5 different compartments based upon their location. This is illustrated in the diagram to the right. The compartments are labeled 1-5. The letters are the abbreviations of the tendons involved. Intersection syndrome occurs where the tendons of the 1st compartment cross over the tendons of the second compartment. At this intersection, the tendons become inflamed and a source of pain. This occurs on the back side of the wrist near the thumb. Tendons in the first compartment move the thumb towards and away from the palm. (extend). The first compartment tendons consist of the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) tendons.
What Is the Underlying Cause of Intersection Syndrome?
Intersection syndrome is an overuse injury. It occurs as a result of repetitive bending and flexion of the wrist. As such it is common in individuals and athletes who use their wrist extensively.
The diagnosis of intersection syndrome is usually a diagnosis based upon history and clinical exam. Pain is localized on the backside of the wrist near the thumb. (pic). Localized redness, swelling, and tenderness to touch are common (5). Popping, grating, and cracking sounds may also be present (6). At the Centeno-Schultz Clinic, ultrasound is used which can easily identify tendon inflammation and swelling. MRI has been demonstrated to be effective with specific radiographic findings (7). X-ray and CT scans are not helpful as they can not visualize tendons.
How Do You Treat Intersection Syndrome?
Conservative care is the first-line treatment for intersection syndrome. This involves rest, activity modification, elevation, and the use of safe anti-inflammatory medications such as fish oil and curcumin and physical therapy. Immobilization has been demonstrated to be effective (5).
Steroids are oftentimes recommended when conservative therapy fails. Steroids are toxic to orthopedic tissue and should be avoided. Steroid complications include discoloration of the skin, skin atrophy, and tendon rupture (8).
At the Centeno-Schultz Clinic, we acknowledge the significant side effects of steroids. Treatment options include ultrasound-guided injections of PRP. PRP is rich in growth factors that can increase blood flow and reduce inflammation. PRP injections are a natural treatment option as they use your own blood products to accelerate healing.
Other Possible Sources of Wrist Pain
Intersection syndrome is just one of the many causes of wrist pain. It is important to review a patient’s history, perform a physical examination, and review imaging. Identifying the proper diagnosis is essential. Other causes of pain on the backside of the wrist and forearm include:
De Quervain’s Tenosynovitis
Arthritis of the thumb
Wrist ligament injury
Wrist muscle injury
Cervical nerve irritation due to disc herniation or bulges
Intersection syndrome is a painful medical condition that involves the wrist and backside of the forearm. It is an overuse or motion injury due to repetitive bending and flexing of the wrist. It is seen in mothers and weightlifters, rowers, and other athletes that use their wrists extensively. It occurs as a result of the inflammation and injury that occurs as the 1st compartment tendons cross the second compartment tendons. At the intersection, the tendons become inflamed creating pain and restricted movement. The diagnosis is based upon history and physical examination. The pain is located on the backside of the wrist near the thumb. Localized redness and swelling are often present. Ultrasound is useful and a standard of care at the Centeno-Schultz Clinic.
Conservative care is the first line of treatment. Steroids should be avoided due to the toxicity. PRP is an effective treatment option. Growth factors within PRP can accelerate healing, improve blood flow, and reduce inflammation.
If your wrist pain has not responded to conservative care you may have intersection syndrome. Stop the pain and limitations and get some answers. Schedule a Telemedicine consult with a board-certified physician who can review your history, studies, and provide you the best nonsurgical treatment option. Listen to your body as it is warning you!
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2.Anderson SE, Steinbach LS, De Monaco D, Bonel HM, Hurtienne Y, Voegelin E. “Baby wrist”: MRI of an overuse syndrome in mothers. AJR Am J Roentgenol. 2004;182(3):719-724. doi:10.2214/ajr.182.3.1820719
3.Palmer DH, Lane-Larsen CL. Helicopter skiing wrist injuries. A case report of “bugaboo forearm”. Am J Sports Med. 1994;22(1):148-149. doi:10.1177/036354659402200124
4.Rettig AC. Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 2004;32(1):262-273. doi:10.1177/0363546503261422
5.Jean Yonnet G. Intersection syndrome in a handcyclist: case report and literature review. Top Spinal Cord Inj Rehabil. 2013;19(3):236-243. doi:10.1310/sci1903-236
6. Montechiarello S, Miozzi F, D’Ambrosio I, Giovagnorio F. The intersection syndrome: Ultrasound findings and their diagnostic value. J Ultrasound. 2010;13(2):70-73. doi:10.1016/j.jus.2010.07.009.
7.Lee RP, Hatem SF, Recht MP. Extended MRI findings of intersection syndrome. Skeletal Radiol. 2009;38(2):157-163. doi:10.1007/s00256-008-0587-4.
8.Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-DeJong B. Randomised controlled trial of local corticosteroid injections for de Quervain’s tenosynovitis in general practice. BMC Musculoskelet Disord. 2009;10:131. Published 2009 Oct 27. doi:10.1186/1471-2474-10-131