Intersection Syndrome

Description

Intersection syndrome is characterized by pain and inflammation in the forearm, on the thumb side, as a result of irritation where the two tendons that extend the wrist, the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB), cross over the two tendons that extend and move the thumb, the extensor pollicis brevis (EPB) and abductor pollicis longus (APL). The two groups of two tendons are covered by a sheath that secretes a fluid that lubricates the tendon. When the sheath becomes inflamed from irritation as the tendons cross over each other, the tendon cannot glide smoothly within the sheath.

The EPB tendon is the anchor of the EPB muscle, which is important for straightening the thumb; the APL tendon is the attachment for the APL muscle, which is important in moving the thumb away from the index finger; the ECRL and ECRB are the tendons that attach the respective muscles to the wrist and extend (straighten) or pull back the wrist.

Common signs and symptoms

• Pain, tenderness, swelling, warmth, or redness where the tendons cross each other on the thumb side of the forearm, about 2 inches above the wrist

• Pain that worsens when moving the wrist or thumb against resistance

• Limited motion of the thumb or wrist

• Crepitation (a crackling sound) when the tendon or wrist is moved or touched

Causes

• More likely with repetitive motions of the hand and wrist because of friction of the two groups of tendons within the sheath

• A sudden increase in activity or change in activity

Factors that increase risk

• Sports that involve repetitive hand and wrist motions, including rowing, weightlifting, and racket sports

• Heavy labor

• Poor physical conditioning (strength, flexibility)

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