The intersection syndrome: Ultrasound findings and their diagnostic value
Introduction
Ultrasonography plays a fundamental role as a first-line imaging study in the diagnosis of musculotendinous injuries. The intersection syndrome is a noninfectious, inflammatory condition that affects that portion of the distal forearm where the first extensor compartment tendons (those of the abductor pollicis longus and the extensor pollicis brevis) pass over—or intersect—those of the second extensor compartment (the extensor carpi radialis longus and the extensor carpi radialis brevis tendons). In patients suffering from this syndrome, US reveals tenosynovitis (synovial fluid within the tendon sheaths) and peritendinous edema. The underlying pathophysiological mechanisms are still the subject of debate, but the syndrome is clearly caused by overuse of the muscles of the forearm, which is associated with typical signs and symptoms [1], including pain, swelling, erythema, edema at palpation, and crepitus during flexion and extension of the wrist. The area of involvement is proximal to the Lister tubercle of the distal radius [2], and pain is reported at the point of intersection between the extensor tendons of the first and second compartments [3].
The intersection syndrome must be differentiated from inflammatory forms of tenosynovitis (particularly De Quervain’s disease), ganglion cysts, infections, sprains involving the ligaments of the wrist, muscle strains, soft-tissue tumors, and Wartenberg’s syndrome (entrapment of the sensory branch of the radial nerve) [4].
The aim of our study was to demonstrate the value of US in the work-up of patients with the intersection syndrome based on a review of cases diagnosed by our group.
Section snippets
Materials and methods
In a 3-year period, 4 patients were referred to our institute for evaluation of symptoms typical of the intersection syndrome (i.e., pain and swelling involving the dorsal aspect of the wrist, crepitus during active or passive movement of the wrist, and swelling in the region of the involved tendons). The mean age of the patients (2 men aged 28 and 53 years [Fig. 1] and 2 women, 45 and 34 years of age) was 40 years. In all 4 cases, the involved wrist was examined with a sonographic scanner
Results
In all four patients, the US examination revealed peritendinous edema and synovial effusions within the tendon sheaths of the first and second compartments, which eliminated the hyperechoic plane that normally divides the two tendon groups (Fig. 1). Significant degrees of subcutaneous edema, which have been reported in patients with the intersection syndrome [2], were not present in any of our patients. In two of the patients with longer-standing symptoms, the tendon sheaths presented irregular
Discussion
The intersection syndrome was described for the first time in 1841 by Velpeau, and it is also referred as adventitial bursitis, subcutaneous perimyositis, Abductor pollicis longus syndrome, peritendinitis crepitans, cross-over syndrome, and oarsmen’s wrist [1]. The term intersection syndrome was proposed by Dobyns et al. in 1978. It refers to the intersection (at an angle of around 60°) of the musculotendinous junctions of the first and second extensor compartment tendons [5]. It should not be
Conflict of interest statement
The authors have no conflict of interest.
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