Distal intersection syndrome

Changed by Craig Hacking, 28 Jul 2016

Updates to Article Attributes

Body was changed:

Show markup changes

The distal intersection syndrome relates to tenosynovitis of the extensor pollicis longus (EPL) tendon, where it crosses the extensor carpi radialis longus (ECRL) and brevis (ECRB) tendons¹. It is distinct from intersection syndrome which occurs more proximally in the forearm at the intersection of the first and second extensor compartments.

Anatomy

The crossing of the second extensor compartment is typically located just distal to Lister’s tubercle. The tendon sheaths of the EPL and the ECRB are connected by a communicating foramen². This is probably why inflammation of the EPL tendon spreads to the second compartment or vice versa.

Pathology

Aetiology

Attrition is related to a biomechanical pulley effect by Lister’s tubercle (overuse syndrome).

Direct blunt trauma of the EPL tendon.

Distal (not necessarily displaced) radius fracture.

Trauma is the most frequent cause. EPL tenosynovitis usually occurs within 8 weeks, but can still be found years after an injury.

Predisposing factors

rheumatoid arthritis
systemic lupus erythematosus
gout
degenerative carpal joint disease

Clinical presentation

Symptoms

Pain and swelling over Lister’s tubercle.Less commonly, local crepitus during thumb movements.

Treatment and prognosis

Early operative release is advocated due to a high risk of EPL tendon rupture (drummer boy’s palsy) ³.

Differential diagnosis

On imaging consider

-<p>The<strong> distal intersection syndrome</strong> relates to tenosynovitis of the <a href="/articles/extensor-pollicis-longus">extensor pollicis longus</a> (EPL) tendon, where it crosses the <a href="/articles/extensor-carpi-radialis-longus-muscle">extensor carpi radialis longus</a> (ECRL) and <a href="/articles/extensor-carpi-radialis-brevis-muscle">brevis</a> (ECRB) tendons<sup>1</sup>. It is distinct from <a href="/articles/intersection-syndrome">intersection syndrome</a> which occurs more proximally in the forearm at the intersection of the first and second extensor compartments. </p><h4>Anatomy</h4><p>The crossing of the second extensor compartment is typically located just distal to <a href="/articles/lister-s-tubercle">Lister’s tubercle</a>. The tendon sheaths of the EPL and the ECRB are connected by a communicating foramen<sup>2</sup>. This is probably why inflammation of the EPL tendon spreads to the second compartment or vice versa.</p><h4>Pathology</h4><h5>Aetiology</h5><p>Attrition is related to a biomechanical pulley effect by Lister’s tubercle (overuse syndrome).</p><p>Direct blunt trauma of the EPL tendon.</p><p>Distal (not necessarily displaced) radius fracture.</p><p>Trauma is the most frequent cause. EPL tenosynovitis usually occurs within 8 weeks, but can still be found years after an injury.</p><h5>Predisposing factors</h5><ul>
+<p>The<strong> distal intersection syndrome</strong> relates to tenosynovitis of the <a href="/articles/extensor-pollicis-longus">extensor pollicis longus</a> (EPL) tendon, where it crosses the <a href="/articles/extensor-carpi-radialis-longus-muscle">extensor carpi radialis longus</a> (ECRL) and <a href="/articles/extensor-carpi-radialis-brevis-muscle">brevis</a> (ECRB) tendons<sup>1</sup>. It is distinct from <a href="/articles/intersection-syndrome">intersection syndrome</a> which occurs more proximally in the forearm at the intersection of the first and second extensor compartments. </p><h4>Anatomy</h4><p>The crossing of the second extensor compartment is typically located just distal to <a title="Lister tubercle" href="/articles/lister-tubercle">Lister’s tubercle</a>. The tendon sheaths of the EPL and the ECRB are connected by a communicating foramen<sup>2</sup>. This is probably why inflammation of the EPL tendon spreads to the second compartment or vice versa.</p><h4>Pathology</h4><h5>Aetiology</h5><p>Attrition is related to a biomechanical pulley effect by Lister’s tubercle (overuse syndrome).</p><p>Direct blunt trauma of the EPL tendon.</p><p>Distal (not necessarily displaced) radius fracture.</p><p>Trauma is the most frequent cause. EPL tenosynovitis usually occurs within 8 weeks, but can still be found years after an injury.</p><h5>Predisposing factors</h5><ul>

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":7741213,"studyId":30795,"caseSlug":"distal-intersection-syndrome-illustration","caption":"Figure 1: iIllustration","thumbnail":"https://prod-images-static.radiopaedia.org/images/7741213/6f88779ed49103e676016e4efad740_big_gallery.jpg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":1179014,"studyId":14045,"caseSlug":"distal-intersection-syndrome","caption":"Case 1","thumbnail":"https://prod-images-static.radiopaedia.org/images/1179014/de9c7a384b2f0eb1fa6d53425ef995_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":4137573,"studyId":23819,"caseSlug":"distal-intersection-syndrome-1","caption":"Case 2: annotated","thumbnail":"https://prod-images-static.radiopaedia.org/images/4137573/da4230d707f7d0fb89eacc09967b88_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":43282128,"studyId":72664,"caseSlug":"distal-intersection-syndrome-4","caption":"Case 3","thumbnail":"https://prod-images-static.radiopaedia.org/images/43282128/90333a40ce0ad2cd9833cc2c6ee5f5_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":45438086,"studyId":74599,"caseSlug":"distal-intersection-syndrome-5","caption":"Case 4","thumbnail":"https://prod-images-static.radiopaedia.org/images/45438086/68cd1143165154101e75b5d3e8d3e4_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":41091454,"studyId":69952,"caseSlug":"distal-intersection-syndrome-3","caption":"Case 5","thumbnail":"https://prod-images-static.radiopaedia.org/images/41091454/9eb1195cd42a085cf82a3eea9c8ef7_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":42926007,"studyId":72126,"caseSlug":"distal-intersection-tenosynovitis-of-the-wrist","caption":"Case 6","thumbnail":"https://prod-images-static.radiopaedia.org/images/42926007/bfcff5a866735c438dc39b0fa70f2f_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"probable"},{"imageId":51696450,"studyId":82371,"caseSlug":"distal-intersection-syndrome-7","caption":"Case 7","thumbnail":"https://prod-images-static.radiopaedia.org/images/51696450/288fc9be953ff871d112858157edc8_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":54283255,"studyId":102241,"caseSlug":"distal-intersection-syndrome-11","caption":"Case 8","thumbnail":"https://prod-images-static.radiopaedia.org/images/54283255/005_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":57037878,"studyId":116823,"caseSlug":"distal-intersection-syndrome-12","caption":"Case 9","thumbnail":"https://prod-images-static.radiopaedia.org/images/57037878/10._big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":54206871,"studyId":101659,"caseSlug":"distal-intersection-syndrome-10","caption":"Case 10","thumbnail":"https://prod-images-static.radiopaedia.org/images/54206871/016_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":64990357,"studyId":147446,"caseSlug":"distal-intersection-syndrome-wrist","caption":"Case 11","thumbnail":"https://prod-images-static.radiopaedia.org/images/64990357/1655df104719674148dda6c42f641d9e2220ff134aaac84a0784892fcdbd212e_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"ddx_inclusions":[{"imageId":469976,"studyId":10458,"caseSlug":"de-quervain-tenosynovitis-mri-2","caption":"De Quervain tenosynovitis","thumbnail":"https://prod-images-static.radiopaedia.org/images/469976/978af2eed67cff3f7e62a0f7e71484_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":2060034,"studyId":18127,"caseSlug":"proximal-intersection-syndrome","caption":"Proximal intersection syndrome","thumbnail":"https://prod-images-static.radiopaedia.org/images/2060034/144d4771671bb6c061520c88240d8c_big_gallery.jpg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"}],"lang":"us"}