Radial intersection syndrome

(Radial) Intersection Syndrome

An overuse syndrome

Area of intersection between compartment 1 and 2 tendons

SYMPTOMS:
- Radial aspect of wrist & forearm pain, a/w local swelling (inflammation)


EXAMINATION:
- Friction/Crepitus at distal dorso-radial forearm upon active/passive wrist motion (where the tendons intersect)
- Weak and/or pain on wrist & thumb movement
- Tender over radial tubercle and lateral aspect of the anatomical snuff box


ETIOLOGY / RISK FACTORS:
- Tenosynovitis of the extensor muscles - (Dorsal compartment 2) ECRL, ECRB, (Dorsal compartment 1) APL, EPB
- Friction between the tendons of Compartment 1 & Compartment 2 where it intersects in the distal forearm dorso-radially.
- Overuse of wrist extensor muscles, tenosynovitis of the 2nd compartment tendons
- Repeated wrist extension-flexion
- More common in woman, 30-50s
- Athlete: eg Rowers


DDx:
- de Quervain's tenosynovitis (Check Finkelstein test)
- 1st Carpo-metacarpal joint osteoarthritis (CMC OA) (Check thumb grinding maneuvre)
- EPL tendinitis
- Wartenberg syndrome (Superficial sensory Radial nerve neuropathy) (Check Tinel sign)


MANAGEMENT:
- Rest (give 3/52)
- Physical therapy (stretching & strengthening)
- Anti-inflammatory medications
- Splinting - 15-20deg wrist extension thumb splint. (gradually wean off)
- Modification of triggering activity
- Injection & Hydrodissection
- Surgery (last resort)

Reference:
- https://www.jabfm.org/content/30/4/547