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INTERSECTION SYNDROME
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What is it?
Intersection syndrome is an overuse injury similar to De Quervain’s tenosynovitis and is characterized by irritation and swelling of the back side or radial side (the side of the wrist by the thumb) of the wrist and forearm. It is also called “oarsmen’s wrist” because it is most common in sports like rowing, with repetitive wrist movements. It also affects racquet sport athletes and people who participate in weight training.

Symptoms
Patients with intersection syndrome have pain and swelling on the back of their wrist and forearm above their thumb that is worse with movement. They may also have swelling at the site of tendon irritation. The symptoms of intersection syndrome are very similar to De Quervain’s, and the difference is often out found by physical examination.

Sports Medicine Evaluation
A Sports Medicine specialist will carefully examine the wrist looking for tenderness and swelling. They may also feel for “crepitus” which is a crackling or squeaking over the tendons as they are moved by the examiner, representing fluid around the tendons. Intersection syndrome, like de Quervain’s, is diagnosed by clinical exam, though x-rays may be ordered if the specialist is concerned about an additional bone injury. An MRI may show tendon injury, but is usually not needed for diagnosis.

Sports Medicine Treatment
This condition is generally treated conservatively by avoiding activities that are painful, and by immobilizing the thumb and wrist in a splint. Ice and non-steroidal anti-inflammatory medications like ibuprofen can also help with pain and swelling. Corticosteroid injections into the area are sometimes recommended. Surgery is rarely needed.

Injury Prevention
Intersection syndrome can be prevented by avoiding overuse of the wrist, especially if an athlete starts having mild pain with activity. Rowers can also focus on their rowing technique to avoid straining the wrist. In patients who participate in activities such as racquet sports, weight lifting, golfing, and rowing, a strengthening program for the wrist and forearm prior to starting activities may be useful.

Return to Play
Patients can return to activity when they have pain-free full movement of their wrists without swelling. Bracing during activities may be recommended.

AMSSM Member Authors: Sarah Kinsella, MD and Margot Putukian, MD

References:
Hanlon DP, and Luellen JR. Intersection Syndrome: A Case Report and Review of the Literature. J Emerg Med.
1999;17(6):969-971.

Yonnet GJ. Intersection Syndrome in a Handcyclist: Case Report and Literature Review. Top Spinal Cord Inj
Rehabil. 2013;19(3):236-243.

Category: Hand and Wrist, Overuse Injuries,

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