dorsal tenosynovitis

Last reviewed 01/2018

Intersection syndrome

• tenosynovitis of the radial wrist extensors
  • caused by friction where the tendons of the second extensor compartment (extensor carpi radialis longus and extensor carpi radialis brevis) pass under the tendons of the first extensor compartment (extensor pollicis brevis and abductor pollicis longus - the tendons affected in de Quervain's tenosynovitis)
• patients present with pain and swelling in the distal dorsoradial forearm
  • intersection syndrome is caused by activities that require repetitive wrist flexion and extension (racquet sports, weightlifting, rowing or canoeing) or by direct trauma to the second extensor compartment
  • the patient will present with pain and swelling (often subtle) over the distal dorsoradial aspect of the wrist
    • may be palpable crepitus with wrist extension
• key differential diagnosis is the more common de Quervain's tenosynovitis

Management:

• treatment involves:
  • avoidance and modification of exacerbating hand and wrist movements
  • a thumb spica (splint) and NSAIDs may offer temporary relief
  • localised hydrocortisone injection may offer relief in resistant cases
  • surgery involves tendon release and is seldom required

Reference:

• (1) Arthritis Research UK (April 2013). The upper limb in primary care. Part 2: Wrist, hand. Hands On 2(7).