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Wrist pain is a very common problem, comprising up to 20% of ambulatory care musculoskeletal complaints, with a multitude of varying presentations. Intersection syndrome is a form of tenosynovitis (inflammation of the synovial sheath surrounding a tendon) that occurs at the crossover or “intersection” of the 1st dorsal wrist compartment (containing the APL and EPB tendons) with the 2nd dorsal wrist compartment (containing the ECRB and ECRL tendons). Most commonly developed via repetitive flexion and extension of the wrist, especially extension against resistance, intersection syndrome presents as pain over the dorsal forearm and wrist.

Intersection syndrome is typically identified based on patient history and a thorough physical exam. Tenderness and/or swelling over the dorsum of the forearm 4-6 centimeters proximal to the dorsal tubercle of the radius, worsening of pain with resisted wrist or thumb extension, and crepitus (“crunching” or “grating” sounds/sensations on movement) are all common findings. Intersection syndrome can also be identified on MSK ultrasound and MRI imaging; both techniques can visualize the inflammatory peritendinous edema, tendon sheath thickening, and possible nodular synovial proliferation that characterize intersection syndrome. XR and CT perform poorly at identifying MSK soft-tissue pathologies.

Treatment usually begins with conservative management, utilizing muscle rest, splinting, and general activity modification to allow the inflammatory process to resolve. Acutely, NSAIDs may have a role in reducing inflammation and controlling pain. If these treatment options are ineffective, corticosteroid injection (ideally under ultrasound guidance) into the area surrounding the 1st and 2nd dorsal wrist compartments crossover point has been shown to provide strong relief. Additional treatment possibilities include prolotherapy in lieu of corticosteroid injection, with surgical release or debridement as final options.

Giovagnorio F, Miozzi F. Ultrasound findings in intersection syndrome. J Med Ultrason (2001). 2012 Oct.