Intersection Syndrome : Causes, Symptoms, Treatment, Recovery and Prevention

Intersection syndrome is a condition in which the tendons in a person’s wrist and the back of the forearm get swollen and inflamed.⁽¹⁾ These tendons are located 2 inches above the wrist joint and are responsible for controlling movements of the thumb and wrist. It is mostly seen occurring in people involved in sports.

Tendons are thick cords of fibrous tissue that connect muscles to the bones. They cross each other in the wrist. There are certain actions that can make these tendons rub against each other. According to the National Center for Biotechnology Information, friction can lead to tenosynovitis or swollen tendons.⁽¹⁾

Intersection syndrome is caused by repetitive wrist movements such as weightlifting, rowing, and playing musical instruments. Some of the common causes of intersection syndrome include:

• Repetitive Motions: There are certain activities that may involve repetitive wrist and thumb motion that can lead to intersection syndrome. These can be weight lifting, racquet sports, and activities like playing a musical instrument, knitting, or typing.
• Overuse: Overuse of wrist and thumb muscles can contribute to the development of intersection syndrome, particularly if the muscles and tendons do not get adequate time to rest.
• Poor Technique: Using a poor technique in performing certain activities such as weight lifting or rowing can increase the risk of developing intersection syndrome.
• Direct Trauma: Intersection syndrome can also occur after direct trauma to the affected area.
• Anatomical Factors: Certain anatomical factors such as the shape and position of the bones and tendons in the forearm can contribute to the development of intersection syndrome.

Proper diagnosis and treatment for intersection syndrome are important to prevent further damage to the affected tendon and muscles to ensure the following:

• Preventing complication
• Accurate diagnoses
• Tailored treatment
• Faster recovery

The wrist is a joint where the bones of the forearm and the hand bones connect. It is made up of several bones, ligaments, tendons, and muscles that work together to provide stability and flexibility to the hands and forearm.

The wrist includes the following bones:

• There are eight carpal bones in the wrist arranged in 2 rows and make up the bulk of the wrist joint.
• There is the distal end of the radius and ulna that articulate with the carpal bones to form the wrist joint.

There are ligaments in the wrist that connect the bones and provide the stability to the joint. The wrist ligament includes:

• Radial collateral ligament that connects the radius bone to the scaphoid and trapezium.
• Ulnar collateral ligament that connects the ulna bone to the triquetrum and pisiform bones.
• Palmar radiocarpal ligament that connects the radius to the carpal bones on the palmar side of the wrist.
• Dorsal radiocarpal ligament that connects the radius bone to the carpal bones on the dorsal side of the wrist.

The tendons of the wrist are responsible for moving hands and fingers. These include:

• Extensor tendons that attach to the back of the hand and are responsible for extending the wrist and fingers
• Flexor tendons that are attached to the front of the hand and are responsible for flexing the wrist and fingers.

The muscles of the wrist are responsible for moving the hands and fingers. These include:

• Extensor muscles that are located in the back of the forearm and are responsible for extending the wrist and fingers.
• Flexor muscles that are located on the front of the forearm and are responsible for flexing the wrist and fingers.
• The anatomy of the wrist is complex and involves the interaction of bones, ligaments, tendons, and muscles to provide stability and movement to the forearm.

Most people with intersection syndrome have a painful spot on the back of the wrist that stretches down a little into the back of the forearm. They feel pain usually on the thumb side of the wrist, starting below the wrist and extending just 2 inches down the arm.⁽²⁾

A rubbing sensation is felt while moving the wrist and the area may also feel warm to the touch. The pain may intensify on bending or straightening the wrist.

The symptoms of intersection syndrome include:

• Pain and tenderness in the forearm and wrist area especially when performing gripping, lifting, and twisting activities
• Swelling and inflammation above the wrist in the area where the tendons cross each other
• A popping or clicking sensation while moving the wrist
• Difficulty in performing daily activities where the thumb and the wrist are needed
• Sensation of warmth or redness in the affected area
• Weakness and loss of grip strength

The symptoms may be different in different people and may range from mild to severe. If any such symptoms are experienced, a healthcare professional should be consulted for accurate diagnosis and treatment.

Diagnosis of intersection syndrome begins with the healthcare professional taking a complete medical history and performing a physical examination. During the exam the healthcare professional may:

• Palpate the area around the wrist and forearm to look for swelling, pain, and tenderness.
• The range of motion of the wrist and forearm is assessed in different directions.
• Finkelstein’s test is done that involves bending the thumb across the palm and making a fist with fingers. The wrist is then moved towards the pinky finger. Pain during this motion may indicate an intersection syndrome.
• If unsure with the physical examination imaging tests are ordered which include the ultrasound and MRI scan. It helps in checking where the inflammation starts.

Other conditions that may show similar symptoms like intersection syndrome include:

• De Quervain’s Tenosynovitis: This condition involves inflammation of the wrist and forearm but the tendons involve are different from those involved in intersection syndrome.
• Tendinitis: This can affect any tendon of the body including the wrist and forearm and is mostly caused by repetitive motion or overuse.
• Carpal Tunnel Syndrome: In this condition there is compression of the nerve of the wrist, leading to pain, numbness, and tingling in the hand and fingers.
• Ganglion cyst: It is a fluid-filled sac that develops on the wrist and causes pain and weakness.
• Radial tunnel syndrome: This condition involves compression of the nerve in the forearm leading to pain and weakness in the wrist.

Getting diagnosed by a healthcare professional and developing an appropriate treatment plan can be helpful in getting relief from the symptoms.

Most doctors recommended people with intersection syndrome stop the sport and other activities and give the injury time to heal.

People may take over-the-counter medications that may provide relief from pain and inflammation.⁽³⁾ Rest, ice, compression, and elevation (RICE) are also recommended to manage the symptoms.

After the swelling has subsided the person can start with gentle stretching and exercising of the arm and hand. Gradually the intensity of exercise can be increased to help prevent the condition from recurring.

In severe cases, a wrist splint or brace may be recommended to limit the movement and provide support.

Physical therapy may also be recommended for restoring the range of motion and giving strength to the wrist.

If a person does not get relief from conservative treatments, corticosteroid injections may be recommended.⁽⁴⁾

Surgery may be recommended very rarely in cases where the doctor may release tendons to provide relief. The several surgical options include:

• Release: This procedure involves cutting the tight fascia around the affected tendons to relieve pressure and reduce inflammation.
• Arthroscopic debridement and decompression: In this procedure, the inflamed and irritated tissue in the affected area is removed and affected tendons are decompressed. It is considered a safer and an effective option.

After the surgery is done the person may be asked to be immobile for a short period of time. Once this period is over, physical therapy, massage therapy, and exercise therapy may be recommended. These may help improve muscle strength and wrist flexibility.

The treatment for intersection syndrome should always be guided by a medical professional and a physical therapist for a better outcome.

The recovery period for Intersection Syndrome can vary depending on the severity of the condition and the treatment approach used. In general, the recovery period can range from a few weeks to several months.

During the recovery period, it’s important to rest the affected area, avoid activities that exacerbate symptoms, and follow a rehabilitation program prescribed by a healthcare professional. Rehabilitation typically involves exercises to restore strength and flexibility in the affected muscles and tendons.

In cases where conservative treatments are not effective, surgical intervention may be required. The recovery period after surgery can take several months and may involve immobilization of the affected area, followed by a gradual return to activity under the guidance of a physical therapist.

Overall, the recovery period for Intersection Syndrome can be challenging, but with appropriate treatment and management, most people are able to return to their normal activities without long-term complications.

Intersection syndrome can be managed effectively with the help of anti-inflammatory medications, physical therapy, exercise, ice, and compression. If all the conservative treatment option fails to produce any effect, surgery can provide the necessary relief.

It is also possible to prevent the condition from occurring with the help of proper care and attention. The techniques for prevention include:

• Engaging in proper techniques for activities involving forearm movements so that less strain is put on the muscle and tendons.
• Before engaging in any physical activity, it is important to warm up and stretch the muscles properly.
• Any new activity should be increased gradually to avoid overexertion of the muscles.
• Proper equipment and protective gear should be used to reduce the risk of injury.

With proper management and prevention tips, the risk of occurrence of intersections syndrome can be prevented and the condition can be effectively managed if it does occur.

Intersection syndrome is a type of tendinitis of the wrist and can occur on repetitive bending of the wrist making the tendons rub against each other. This friction causes inflammation and swelling mostly on the back of the forearm, just below the wrist.

Anyone experiencing the symptoms related to intersection syndrome should consult a healthcare professional. With proper recommendation, treatment, and care the condition can be effectively managed. This can also help reduce the risk of future injuries.