What is the prevalence of intersection syndrome compared to other causes of wrist pain?

Prevalence of Intersection Syndrome Among Wrist Pain Causes

Intersection syndrome is a relatively uncommon cause of wrist pain, with a prevalence of only 0.37% among patients presenting with arm or hand pain. 1

Epidemiology and Prevalence

• Intersection syndrome is a rare form of tenosynovitis affecting the extensor compartments of the wrist, making it an uncommon diagnosis among wrist pain presentations 2
• In a 4-year prospective study of 8,080 patients with arm or hand pain, only 30 patients (0.37%) were diagnosed with intersection syndrome 1
• The condition predominantly affects males (70%) and is particularly common among farmers (60%) due to occupational activities requiring repetitive wrist movements 1

Clinical Presentation and Diagnosis

• Intersection syndrome presents with characteristic symptoms including:
  • Forearm pain (100% of cases)
  • Swelling at the intersection point (73.3% of cases)
  • Crepitus in the intersected region (40% of cases) 1
• Pain is typically provoked by specific movements:
  • Twisting hand motions with radial deviations (46.7%)
  • Pulling movements (13.3%)
  • Combinations of multiple hand movements including threshing, planting, hammering, and hand washing (40%) 1
• MRI is the preferred diagnostic imaging modality for confirmation of intersection syndrome 2, 3

Comparison to Other Wrist Pain Causes

• Intersection syndrome is significantly less common than other causes of wrist pain such as:
  • Carpal tunnel syndrome (CTS), which has much higher prevalence and is frequently evaluated with ultrasound or MRI 4
  • Tendinopathies and tenosynovitis of other compartments, which are more commonly diagnosed in patients with chronic wrist pain 5
• The American College of Radiology guidelines recognize intersection syndrome as one of several tendon abnormalities that can be diagnosed with MRI or ultrasound, but it is mentioned less prominently than more common conditions 5

Occupational and Activity Associations

• Intersection syndrome has been recognized in specific activities and occupations:
  • Sports activities: rowing (oarsman's wrist), racquet sports, baseball, cycling, hockey, golf, skiing, and softball 6
  • Recently documented in climbers using ice axes ("ice axe wrist") 6
  • Occupational settings with repetitive wrist extension and flexion, such as supermarket cashiers 7
• The condition may be recognized as an occupational disease in some healthcare systems, allowing for compensation and workplace modifications 7

Diagnostic Imaging

• Both ultrasound and MRI are effective in diagnosing intersection syndrome:
  • Ultrasound is well-suited for evaluating tendon injuries due to the superficial location and ability to dynamically assess the tendons 5
  • MRI without IV contrast can effectively diagnose intersection syndrome along with other tendon abnormalities 5
• The American College of Radiology recommends either ultrasound or MRI without IV contrast as appropriate next imaging studies when tendon pathology is suspected after normal radiographs 5

In clinical practice, maintaining awareness of this uncommon condition is important, as early diagnosis and appropriate management can prevent progression to more serious complications such as extensor tendon rupture 2.