The patient, an industrial worker whose job required repetitive wrist flexion and extension presented with several months history of chronic pain of the forearm.
The patient, an industrial worker whose job required repetitive wrist flexion and extension presented with several months history of chronic pain of the forearm. MRI examination was performed and found a peritendinous edema surrounding the junction of the abductor pollicis longus and extensor of pollicis brevis tendons with the extensor carpi radialis longus and brevis and peritendinous enhancement. This peritendinitis was located at the cross over point and extended few centimetre proximally.
Intersection Syndrome is a specific painful disorders of the forearm. First described in 1841 by Velpeau, it has also been referred to in literature by the terms “peritendinitis crepitans”, “oarsmen’s wrist”, “crossover syndrome”, “subcutaneous perimyositis”, “squeaker’s wrist”, “bugaboo forearm”, and “abductor pollicis longus syndrome”. It has been encountered in those whose activities involve repetitive wrist flexion and extension. Friction between the muscle bellies of the abductor pollicis longus and extensor pollicis brevis (first dorsal extensor tendon compartment) with the tendon sheath containing with the extensor carpi radialis longus and the extensor carpi radialis brevis tendons (second dorsal extensor tendon compartment) was believed to be the cause of intersection syndrome. The symptoms include pain, edema, redness, tenderness to palpation, and crackling or crepitance with flexion and extension of the wrist. MRI findings in intersection syndrome show peritendinous edema concentrically surrounding the second and first extensor compartments, beginning at the point of crossover, 4-8 cm proximal to the Lister tubercle and extending proximally.After the administration of gadolinium solution, there is a peritendinous enhancement. Symptoms resolve within 2-3 weeks in 60 % patient with rest and nonsteroid anti-inflammatory drugs, and splinting. Surgery is indicated for patients not responding to therapy. Tenosynovectomy and fasciotomy of abductor pollicis longus can be performed.
Intersection Syndrome of Forearm
The patient is a 33-year-old male with an occupational history of repetitive wrist flexion and extension. On the axial MRI images, notable soft tissue signal changes can be seen in the radial side of the distal forearm near the dorsal extensor tendons. The specific findings are as follows:
Based on the imaging findings and the patient’s occupational requirement of repetitive wrist flexion and extension, possible diagnoses include:
Considering the patient’s occupational background (repetitive wrist flexion and extension), history of chronic radial forearm pain, and MRI findings showing edema and enhancement around the intersecting regions of the first and second dorsal extensor compartments, the most likely diagnosis is:
Intersection Syndrome.
The goals of treatment and rehabilitation are to reduce inflammation, alleviate pain, and restore wrist function. The following strategies can be considered:
Rehabilitation and Exercise Prescription:
The above plan should be adapted based on individual fitness levels, pain severity, and work requirements. Adjust the frequency, intensity, duration, and methods of exercise accordingly. If the patient has any underlying bone structural issues, circulatory dysfunction, or other systemic diseases, they should be guided by a specialist or rehabilitation therapist and be closely monitored.
Disclaimer: The above report is based on the provided medical history and imaging findings for discussion and reference purposes only. It does not replace an in-person diagnosis or treatment by a clinical physician. Please consult a qualified medical institution or specialist for a personalized treatment plan.
Intersection Syndrome of Forearm
