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Intersection Syndrome Workup

  • Author: David R Steinberg, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Jul 13, 2016
 

Imaging Studies

Anteroposterior (AP), lateral, and oblique radiographs of the wrist (including distal forearm) may be ordered.[10] Ancillary studies do not help with the diagnosis of intersection syndrome but do allow the physician to exclude other causes of forearm pain. Radiographs can depict thumb carpometacarpal (CMC) arthritis and osteophytes around the distal radius.

Magnetic resonance imaging (MRI) is rarely indicated. However, an MRI scan could be ordered if the physician is suspicious of a soft tissue mass as the cause of swelling.[11, 12, 13, 14]

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Histologic Findings

Nonspecific thickening, adhesions, and fibrocyte proliferation are seen in the tenosynovium. Histologic evidence of acute inflammation is rarely found.

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Electrodiagnostic Testing

If the physician suspects a radial sensory nerve neuropraxia rather than intersection syndrome as the cause of the patient's symptoms, nerve conduction studies may be helpful.[15] Slowing of radial nerve conduction cannot always be demonstrated in Wartenberg syndrome.

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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, American Society for Surgery of the Hand

Disclosure: Received nothing received, but have long-term ownership of public equities from Johnson & Johnson for none.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine

Thomas R Hunt III, MD is a member of the following medical societies: American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Southern Orthopaedic Association, AO Foundation, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the Hand, Mid-America Orthopaedic Association

Disclosure: Received royalty from Tornier for independent contractor; Received ownership interest from Tornier for none; Received royalty from Lippincott for independent contractor.

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, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern 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, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Peter M Murray, MD Professor and Chair, Department 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 Orthopaedic Association, American Society for Reconstructive Microsurgery, Orthopaedic Research Society, Society of Military Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the Hand, Florida Medical Association

Disclosure: Nothing to disclose.

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

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

  3. Draghi F, Bortolotto C. Intersection syndrome: ultrasound imaging. Skeletal Radiol. 2014 Mar. 43(3):283-7. [Medline].

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

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

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

  7. Tagliafico AS, Ameri P, Michaud J, Derchi LE, Sormani MP, Martinoli C. Wrist injuries in nonprofessional tennis players: relationships with different grips. Am J Sports Med. 2009 Apr. 37(4):760-7. [Medline].

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

  9. Sato J, Ishii Y, Noguchi H. Clinical and ultrasound features in patients with intersection syndrome or de Quervain's disease. J Hand Surg Eur Vol. 2016 Feb. 41(2):220-5. [Medline].

  10. De Maeseneer M, Marcelis S, Jager T, Girard C, Gest T, Jamadar D. Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections. J Ultrasound Med. 2009 Jun. 28(6):779-86. [Medline].

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

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

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

  14. Lee RP, Hatem SF, Recht MP. Extended MRI findings of intersection syndrome. Skeletal Radiol. 2009 Feb. 38(2):157-63. [Medline].

  15. Shehab R, Mirabelli MH. Evaluation and diagnosis of wrist pain: a case-based approach. Am Fam Physician. 2013 Apr 15. 87(8):568-73. [Medline].

  16. Villafañe JH, Silva GB, Fernandez-Carnero J. Short-term effects of neurodynamic mobilization in 15 patients with secondary thumb carpometacarpal osteoarthritis. J Manipulative Physiol Ther. 2011 Sep. 34(7):449-56. [Medline].

  17. [Guideline] American College of Occupational and Environmental Medicine. Hand, wrist, and forearm disorders, not including carpal tunnel syndrome. National Guideline Clearinghouse. Available at http://guideline.gov/content.aspx?id=34435. Accessed: December 10, 2014.

  18. Brunton LM, Wilgis EF. A survey to determine current practice patterns in the surgical treatment of advanced thumb carpometacarpal osteoarthrosis. Hand (N Y). 2010 Dec. 5(4):415-22. [Medline].

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

  20. [Guideline] ACR Appropriateness Criteria: Chronic Wrist Pain. American College of Radiology. Available at https://acsearch.acr.org/docs/69427/Narrative/. Accessed: July 11, 2016.

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