Intersection syndrome is an overuse injury involving friction at the intersection between two compartments of the wrist, each wrapped in their own sheath. The affected compartments in the wrist are shown in the pictures below – within each compartment are various muscles and their tendons that act to extend the wrist and move the thumb.
Rowing has long been considered a sport with considerable load on the forearms. Intersection syndrome is common in rowers due to repetitive flexion and extension of the wrist over prolonged periods of time. This condition can lead to a significant loss of on-water training time for elite rowers, impacting not only them, but also the other members of their crew. Aside from rowing, there have also been presentations of Intersection syndrome reported in sports such as skiing, sailing, tennis and weightlifting.
SYMPTOMS
- Pain localised to the back of the forearm around 3-8cm from the wrist joint
- Localised swelling in this area
- Crepitus (squeaking or creaking noises) when bending and extending the wrist
These symptoms are the result of inflammation caused by the friction occurring between the muscle bellies of the first compartment and the tendon sheaths of the second compartment at the point where they cross over. This can be seen in the picture below. Some research has also suggested that this condition can be caused by increased bulk in the muscles of the first compartment, leaving reduced room for the tendons and muscles to move freely in their respective compartments.
MANAGEMENT
- Most research advocates for a period of conservative management consisting of rest, activity modification, splinting, icing and massage
- Athletes will often end up modifying the way they row or perform certain activities in order to reduce symptoms
- Although many individuals do respond to conservative treatment, symptoms can often be exacerbated during periods of increased training prior to major events or races - this creates interruptions to training schedules and negatively impacts event preparation
- If conservative management is not effective, athletes may elect to undergo corticosteroid injections or operative release of the affected compartments
- The decision to perform an operative release is based on failure of a conservative approach and the relevant indications for surgery
It is important to differentiate this condition from other overuse injuries of the wrist such as DeQuervain’s tenosynovitis - this condition has quite a similar location of symptoms. Consult a physiotherapist if you are experiencing pain in this area of the wrist and work with them to develop the best management plan going forwards.