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  • Writer's pictureRobin R Varghese, PT.

We excel in diagnosing and treating "Intersection syndrome" of hand. So, let's begin the journey.





What is intersection syndrome of hand?


Intersection syndrome is a condition that affects the first and second compartments of the dorsal wrist extensors. The condition is thought to occur as a result of repetitive friction at the junction in which the tendons of the first dorsal compartment cross over the second, creating a tenosynovitis.


Wondering what are 'compartments' of wrist extensors?


  • The forearm extensor tendons pass under the extensor retinaculum (thick fibrous fascia around the wrist that prevents the displacement of extensor tendons) at the level of the wrist. The ligament is divided into six extensor compartments, separated by fibrous septa passing to the bones of the forearm.

  • The term "intersection syndrome" refers to the intersection (at an angle of around 60°) of the musculotendinous junctions of the first and second extensor compartment tendons.





What causes intersection syndrome?


  • The syndrome is typically the result of repetitive extension and flexion exercises or activities. It is commonly seen in sporting activities such as rowing or canoeing, skiing, racquet sports, and horseback riding


Mechanism

  • The repetitive extension-flexion results in a friction injury at the crossover junction of the first dorsal compartment (abductor pollicis longus and extensor pollicis brevis) and the second dorsal compartment (extensor carpi radialis brevis/extensor carpi radialis longus) tendons.

  • This leads to an inflammatory response and subsequently tenosynovitis particularly of the second extensor compartment possibly caused by friction from the overlying first compartment tendons

  • This intersection is at an angle of approximately 60°, approximately 4 cm proximal to Lister's tubercle (a bony protuberance on the dorsal surface of the distal radius).

Symptoms

  • Patient complains of pain or tenderness over the dorsal aspect of the wrist proximal to the radial styloid.

  • There may also be swelling and crepitus on the wrist and/or thumb extension.

  • Pronation is typically found more uncomfortable than supination

How to differentiate intersection syndrome from De Quervain syndrome?




  • Resisted pronation that leads to the recreation of the patient's pain, along with the palpable finding of crepitus about 2 cm - 3 cm proximal to the radial styloid, can help differentiate from tenosynovitis of De Quervain Syndrome.




Treatment

  • Corticosteroids

  • Anti-inflammatory

  • Analgesics

  • Physical Therapy

  • Surgery (last resort)


Physical therapy management


  1. Modification of work and sport

  2. Cryotherapy (LINK TO TOPIC)

  3. Immobilization by splinting with wrist in neutral position

  4. Taping techniques Progressive stretching

  5. Muscle strengthening

Muscle Strengthening


a). Exercises to improve strength will include eccentric exercises for the area.

  • Eccentric contractions occur as the muscle lengthens and the tendon is put under stretch while resisting a force.

  • Your Physical Therapist will advise you when it is the appropriate time to start these exercises. Eccentric exercises for the wrist are done by dropping the wrist down slowly at first and then, as able, progressing to a quick motion. Let you therapist guide you through these exercises.

  • These exercises will put enough stress through the injured area to start building up the tensile strength in the tissues and associated muscles.


b.) In addition to eccentric exercises, therapeutic putty or ball exercises might be used which adds some resistance to finger and hand motions.


c.) As muscles get stronger, weights or resistance bands will be used to further build up strength.


d.) Your physical therapist may add Fine motor control and dexterity exercises for your thumb and hand in your rehabilitation routine depending on your occupation or the cause of your injury.


e.) Further, we will simulate the functional activities used in daily living or in your occupation.



Physical therapy after a surgical intervention plays a major role.

Post surgical PT includes

Researches

  • All patients demonstrated considerable improvement of upper limb function over the 3-week taping period, as well as maintenance of upper limb function at the 1-year follow-up. This indicates the potential usefulness of taping for the management of intersection syndrome.

  • Pulsed laser therapy can be an additional useful tool in the global approach treatment for intersection syndrome, contributing with splint and manual therapy, to full recovery even in mechanically stressful conditions


At Valley Healing Hands, Brownsville, Texas, we provide the best physical therapy treatment for intersection syndrome of hand. Our highly skilled Physical Therapists and Occupational Therapists will assess your condition and plan a customized session for you. They are very dedicated to their profession and will be more than happy to assist you to recovery. Our Patients are completely satisfied with our services. You may learn about what they have to say about us here and get connected to us here. Our patients love us, You too will!!!



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