Intersection Syndrome

Pain and Swelling of the Wrist Tendons

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Intersection syndrome is a condition of tendon inflammation of the tendons over the back of the forearm and wrist. The pain of intersection syndrome is located about 4 cm above the back of the wrist joint where two major tendons that move (straighten) the fingers cross over each other.  Intersection syndrome is a type of wrist tendonitis.

Intersection syndrome is most common in athletes who do specific sports activities.

  The most common sport where athletes get intersection syndrome is competitive rowing.  The rowing motion is repetitive and places tremendous stress on the wrist extensor tendons.

Symptoms of Intersection Syndrome

The symptoms of intersection syndrome are very predictable.  Patients with this complaint almost always have the same symptoms.  These symptoms typically develop a day or two after a repetitive activity, such as sports or gardening activity.  Often this condition develops in competitive rowers a day or two after a particularly difficult workout session.  Typical signs of intersection syndrome include:

  • Pain and tenderness of the wrist tendons
  • Swelling of the tendons
  • A grinding sensation (crepitus) with movement of the fingers

Treatment of Intersection Syndrome

Treatment of intersection syndrome is almost always easily accomplished with some simple steps.  Foremost, the tendons require rest, and this means avoiding activity with the affected wrist for at least 3-5 days while the inflammation subsides.

  Not resting the condition will exacerbate symptoms and prolong symptoms.  Athletes should ensure that the symptoms have resolved, as premature return to sports will be likely to make the problem recur. 

Treatments for intersection syndrome should include:

  • Rest:  Most people benefit from the use of a wrist brace to fully rest the tendons for at least 5 days.
  • Ice Ice can help to relieve the symptoms of inflammation.
  • Anti-Inflammatory Medications: A short course of an oral anti-inflammatory medication is also helpful to settle symptoms.

Once symptoms have improved, athletes should gradually return to activity to ensure the problem is completely resolved.  Even if there is no pain while doing an activity, too early of a return may cause inflammation that is not apparent for several days.

In some persistent situations, more aggressive treatment can be considered.  Occasionally a cortisone injection is used to help with treatment.  In some rare situation, surgery to clean up the inflammation may be considered.  However, most patients will improve with 1-2 weeks of simple treatment.  In very rate circumstances, a surgical debridement (clean-up) of the tendons can be performed.  During surgery, any abnormally tight tissue, called fascia, can be released from around the tendons to prevent the problem from coming back.  The good news, is that almost all patients can recover without having to undergo a surgical procedure for this problem.

Sources:

Adams JE, Habbu R. "Tendinopathies of the Hand and Wrist" J Am Acad Orthop Surg. 2015 Dec;23(12):741-50.

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