A 23 to 25 gauge needle at a length of 1 to 1.5 inch is preferred. The typical injection is a one to one mixture of a corticosteroid and anesthetic (0.5ml to 1ml of steroid, commonly used is triamcinolone 40mg/1ml along with a local anesthetic of choice at 0.5ml to 1ml). Using the ultrasound visualization technique noted in the evaluation process confirm the diagnosis. ![]() When conservative measures are not effective corticosteroid injection under ultrasound guidance can be utilized. One may consider extrapolating the use of eccentric strengthening and stretching for rehab protocols. A temporary splint for protection and comfort at night may also be beneficial. There is no compelling evidenced based rehab protocol for intersection syndrome at this time. Typically rest and activity modification will be more effective. Acetaminophen also may be utilized for pain relief as well. Common medications are ibuprofen, naproxen, meloxicam or diclofenac. Īnti-inflammatory medications are maybe useful for acute injury and pain relief. Corticosteroid injection has shown significant improvement and is a known next best step if little or no improvement has been made with other conservative treatment. Treatment is conservative management with rest and activity modification. There also may be a thickening of the tendon sheaths. This represents swelling/edema as caused by friction. The findings that would correlate to the diagnosis would be a hypoechoic area in between the two dorsal compartments as they are on top of each other. When observing Intersection syndrome under ultrasound, the ideal image is in the transverse plane in short axis. Therefore a linear ultrasound probe is utilized. ![]() Remember that as in most musculoskeletal conditions, the anatomy is mostly superficial. There have been some that say it can be as specific as MRI in the hands of the skilled user. Ultrasound technology has pushed musculoskeletal medicine forward in both diagnosis and treatment provided by physicians. MRI would give excellent soft tissue picture and diagnosis, although MRI would not be a cost- or time-effective choice. Plain film imaging and CT will not be helpful in the diagnosis of Intersection syndrome. ![]() This condition is noted below the radial styloid and can be classically tested via the Finkelstein maneuver. ![]() De Quarvein Syndrome is a condition that also involves the first dorsal compartment of the wrist extensors. When developing or working through your differential diagnosis, resisted pronation that leads to the recreation of the patient's pain, along with the palpable finding of crepitus about 2 cm - 3 cm proximal to the radial styloid, can help differentiate from tenosynovitis of De Quarvein Syndrome. Pronation is typically found more uncomfortable than supination. As the two dorsal compartments cross the movements of pronation and supination, create friction resulting in the exam finding of crepitus. This is a finding that is specific to intersection syndrome. Crepitus is a very common finding on the exam over the site of irritation. Look for swelling over the distal forearm as there can be some cases that present with a palpable finding on exam 4 cm - 6 cm proximal to Lister's tubercle. Each joint above and below the injury should be tested in all motions. Īs with all musculoskeletal exam, you must have a structured approach that includes inspection, a range of motion, palpation, muscle testing, and other special tests. The initial steps for diagnosis include a focused physical exam of the elbow, wrist, and hand. Intersection syndrome is a clinical diagnosis, although a musculoskeletal ultrasound can easily confirm it.
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