UMEM Educational Pearls

Category: Orthopedics

Title: Dorsal wrist pain

Keywords: overuse injury, wrist (PubMed Search)

Posted: 5/25/2023 by Brian Corwell, MD (Emailed: 5/27/2023)
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Intersection syndrome

Intersection syndrome is an overuse injury of the forearm.

Pain is located approximately 2 finger breaths (4cm) proximal to the wrist joint.

Pathology occurs at the “intersection” of the 1^st (APL and EPB) and 2^nd (ECRL and ECRB) dorsal compartments.
Friction occurs at the muscle bellies of the abductor pollicis longus (APL) and extensor pollicis brevis (EPB), where they cross over the extensor carpi radialis longus (ECRL) and brevis (ECRB)

Mechanism: friction is caused by repetitive wrist extension activities

Commonly: Rowing, skiing, tennis, canoeing and weightlifting

Friction may cause crepitus with finger/wrist extension.

Tenderness, mild swelling may be present

Key distinguishing features:
- Location of the pain: Intersection syndrome is more dorsal while de Quervain’s is more radial
- https://www.reumatologiaclinica.org/en-distal-intersection-syndrome-an-unusual-articulo-S2173574319300656#imagen-2
- Exacerbating maneuvers: Pronation/extension vs ulnar wrist deviation
- Noise: Crepitus with wrist extension