eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Intersection Syndrome: Follow-up

Author: David R Steinberg, MD, Director of Hand Fellowship, Associate Professor, Department of Orthopedic Surgery, University of Pennsylvania Health System
Contributor Information and Disclosures

Updated: Oct 22, 2008

Outcome and Prognosis

Most patients with intersection syndrome respond to a program of conservative management. They may need to maintain changes in work or avocational activities to prevent recurrence of symptoms. Individuals who require surgery rarely experience recurrence of symptoms.

No large series documenting treatment outcome exist in the literature. Eight patients in one study all responded to immobilization and corticosteroid injection. Grundberg and Reagan state that about 60% of patients in their practice with intersection syndrome respond to conservative management.11 They report that 100% of their patients who require surgery obtain long-term symptomatic relief. In the author's experience, nonoperative treatment of intersection syndrome is successful in approximately 75% of cases; surgical decompression of the second extensor compartment is effective in the remainder of patients.

Future and Controversies

The major controversies surrounding intersection syndrome pertain to diagnosis and pathophysiology. The examining physician must be convinced that the patient's wrist or forearm pain is not due to inflammation or compression of other radial-sided structures, such as the flexor carpi radialis (FCR), tendons of the first extensor compartment, thumb CMC joint, or radial sensory nerve. Obviously, location of corticosteroid injection or surgical management would differ greatly for these other conditions. In academic circles, some disagreement exists as to the exact location of tenosynovitis—whether it solely involves the second extensor compartment or represents an abnormal interaction between the tendons of the first and second compartments. While one's belief could affect choice of immobilization (cock-up wrist splint versus thumb spica splint), injection therapy and surgical release would not be altered.

 


More on Intersection Syndrome

Overview: Intersection Syndrome
Workup: Intersection Syndrome
Treatment: Intersection Syndrome
Follow-up: Intersection Syndrome
References
Further Reading
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References

  1. Thorson E, Szabo RM. Common tendinitis problems in the hand and forearm. Orthop Clin North Am. Jan 1992;23(1):65-74. [Medline].

  2. Browne J, Helms CA. Intersection syndrome of the forearm. Arthritis Rheum. Jun 2006;54(6):2038. [Medline].

  3. Descatha A, Leproust H, Roure P, Ronan C, Roquelaure Y. Is the intersection syndrome an occupational disease?. Joint Bone Spine. May 2008;75(3):329-31. [Medline].

  4. Wood MB, Dobyns JH. Sports-related extraarticular wrist syndromes. Clin Orthop. Jan 1986;(202):93-102. [Medline].

  5. McNally E, Wilson D, Seiler S. Rowing injuries. Semin Musculoskelet Radiol. Dec 2005;9(4):379-96. [Medline].

  6. Wood MB, Linscheid RL. Abductor pollicis longus bursitis. Clin Orthop. Jun 1973;93:293-6. [Medline].

  7. de Lima JE, Kim HJ, Albertotti F, Resnick D. Intersection syndrome: MR imaging with anatomic comparison of the distal forearm. Skeletal Radiol. Nov 2004;33(11):627-31. [Medline].

  8. Lee RP, Hatem SF, Recht MP. Extended MRI findings of intersection syndrome. Skeletal Radiol. Sep 23 2008;[Medline].

  9. Costa CR, Morrison WB, Carrino JA. MRI features of intersection syndrome of the forearm. AJR Am J Roentgenol. Nov 2003;181(5):1245-9. [Medline].

  10. Williams JG. Surgical management of traumatic non-infective tenosynovitis of the wrist extensors. J Bone Joint Surg Br. Nov 1977;59-B(4):408-10. [Medline].

  11. Grundberg AB, Reagan DS. Pathologic anatomy of the forearm: intersection syndrome. J Hand Surg [Am]. Mar 1985;10(2):299-302. [Medline].

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Further Reading

Forearm, wrist, & hand (acute & chronic), not including carpal tunnel syndrome.
Work Loss Data Institute.  2004 (revised 2007 May 16).  80 pages. [NGC Update Pending] NGC:005799
 
Chronic wrist pain.
American College of Radiology.  1998 (revised 2005).  7 pages.  NGC:004619
 
Forearm, wrist and hand complaints.
American College of Occupational and Environmental Medicine.  1997 (revised 2004).  34 pages.  NGC:004754

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Keywords

intersection syndrome, tenosynovitis of the radial wrist extensors, tendinitis, de Quervain tenosynovitis, thumb carpometacarpal arthritis, thumb CMC arthritis, wrist pain, forearm pain

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Contributor Information and Disclosures

Author

David R Steinberg, MD, Director of Hand Fellowship, Associate Professor, Department of Orthopedic Surgery, University of Pennsylvania Health System
David R Steinberg, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Society for Surgery of the Hand
Disclosure: Johnson & Jonhnson nothing received, but own stock in company from personal investment None

Medical Editor

Peter M Murray, MD, Associate Professor of Orthopedic Surgery, Mayo Clinic College of Medicine; Director of Education, Mayo Foundation for Medical Education and Research, Jacksonville; Consultant, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville; Consulting Staff, Nemours Children's Clinic and Wolfson's Children's Hospital
Peter M Murray, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, Florida Medical Association, Orthopaedic Research Society, and Society of Military Orthopaedic Surgeons
Disclosure: Small Bone Innovations Workshop Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas R Hunt III, MD, John D Sherrill Professor and Director of Orthopaedic Surgery, Surgeon in Chief of UAB Highlands Hospital, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham
Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association
Disclosure: Tornier Consulting fee Review panel membership; Tornier Royalty None; Tornier Ownership interest None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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