Intersection Syndrome: A cause of forearm pain

At the Centeno-Schultz Clinic we acknowledge that forearm pain can be disabling.

Intersection syndrome is a painful condition on the radial (thumb) side of the forearm when inflammation occurs at the intersection of the first and second extensor tendons. 

The first compartment is compromised of EPB (extensor pollicis brevis) and APL (abductor pollicis longus) whereas the second compartment includes ECRB and ECRL (extensor carpi radialis brevis and longus).

Presentation:  pain approximately 4 cm above the back of the wrist joint where the first and second compartment tendons cross.

 

Tendons are surrounded by a slippery sac called a tenosynovium which allows the tendons to glide.  Inflammation of the tenosynovium (tenosynovitis) impairs the tendons ability to glide and results in pain.

Etiology can be traumatic or due to repetitive wrist flexion and extension commonly seen in weightlifters ad rowers.

 Other causes of radial forearm pain include de Quervain tenosynovitis, thumb CMC arthritis, radial sensory nerve irritation and extensor pollicis longus (EPL) tendinitis.

In cases unresponsive to conservative therapy a guided injection under ultrasound is indicated.  At the Centeno-Schultz Clinic MSK US is utilized in joint, ligament and tendon injections.  Accuracy and visualization is critical for successful clinical results.  Below is an ultrasound image of the first and second compartment tendons crossing.  The white arrows identify the tendons of compartment 1 superficially crossing those of compartment 2.  This is the site of inflammation in intersection syndrome that results in radial side forearm pain.

Carpal Tunnel Syndrome: Overview

At the Centeno-Schultz Clinic we acknowledge that wrist pain can be painful and limiting.

Carpal Tunnel syndrome (CTS) is an entrapment of the median nerve in the carpal tunnel causing pain and numbness.  The carpal tunnel is an anatomical compartment located at the base of the palm.  Nine flexor tendons and the median nerve pass through the carpal tunnel that is surrounded on three sides by the carpal bones that form an arch as illustrated below.

A successful case report utilizing  hydrodissection, a non surgical treatment has been discussed in a prior blog.

Patients commonly experience numbness, tingling, or burning sensations in the thumb, index, long and radial half of the ring finger.

Common clinical examinations include Phalen’s maneuver and Tinel’s sign.

Most cases of CTS are of unknown causes.

Diagnosis is often made by EMG/NCS study whereby needles are placed into muscles and electrical activity is evaluated.  The needles and the procedure  can be painful.  At the Centeno-Schultz Clinic MSK ultrasound is a non painful alternative.  A median nerve greater than 10mm in area indicates carpal tunnel syndrome.  A transverse ultrasound image of the median nerve is illustrated below.

Wrist Pain: Alternatives to Steroid Injections

De Quervain snydrome is a common cause of wrist pain.

It is inflammation of the sheath that surrounds two critical tendons which are responsible for thumb moment.  Just a like the outer plastic lining on any electrical cord holds all the small wires together, the tendon sheath holds the extensor pollicis brevis and abductor pollicis longus tendons in a protective sleeve.

Inflammation and or chronic degeneration of the sheath or tendons can result in pain, swelling over the radial side of  the wrist accompanied with difficulty in gripping.  The Finkelstein test is a common diagnostic test.

Treatment options include rest, splinting, injection of steroids and surgery.

At the Centeno-Schultz Clinic we understand the risks involved with steroids and offer alternatives in the form of prolotherapy, PRP and Regenexx PL.  Clinical success comes from accurately delivering the prescribed  solution to the targeted area.  To that extent we use ultrasound to that ensure growth factors or stem cells are placed within the damaged tissue.  Below is  an ultrasound image from clinic of the two tendons and the enveloping sheath.