Clinical History
The patient, an industrial worker whose job required repetitive wrist flexion and extension presented
with several months history of chronic pain of the forearm.
Imaging Findings
The patient, an industrial worker whose job required repetitive wrist flexion and extension presented
with several months history of chronic pain of the forearm. MRI examination was performed and found a peritendinous edema surrounding the junction of the abductor pollicis longus and extensor of
pollicis brevis tendons with the extensor carpi radialis longus and brevis and peritendinous enhancement. This peritendinitis was located at the cross over point and extended few centimetre
proximally.
Discussion
Intersection Syndrome is a specific painful disorders of the forearm. First described in 1841 by Velpeau, it has also been referred to in literature by the terms “peritendinitis
crepitans”, “oarsmen’s wrist”, “crossover syndrome”, “subcutaneous perimyositis”, “squeaker’s wrist”, “bugaboo forearm”,
and “abductor pollicis longus syndrome”. It has been encountered in those whose activities involve repetitive wrist flexion and extension. Friction between the muscle bellies of the
abductor pollicis longus and extensor pollicis brevis (first dorsal extensor tendon compartment) with the tendon sheath containing with the extensor carpi radialis longus and the extensor carpi
radialis brevis tendons (second dorsal extensor tendon compartment) was believed to be the cause of intersection syndrome. The symptoms include pain, edema, redness, tenderness to palpation, and
crackling or crepitance with flexion and extension of the wrist. MRI findings in intersection syndrome show peritendinous edema concentrically surrounding the second and first extensor compartments,
beginning at the point of crossover, 4-8 cm proximal to the Lister tubercle and extending proximally.After the administration of gadolinium solution, there is a peritendinous enhancement. Symptoms
resolve within 2-3 weeks in 60 % patient with rest and nonsteroid anti-inflammatory drugs, and splinting. Surgery is indicated for patients not responding to therapy. Tenosynovectomy and fasciotomy
of abductor pollicis longus can be performed.
Differential Diagnosis List
Intersection Syndrome of Forearm
Final Diagnosis
Intersection Syndrome of Forearm
