What is the treatment for intersection syndrome?

Treatment of Intersection Syndrome

The treatment of intersection syndrome should begin with conservative measures including rest, use of a thumb spica splint, analgesics, and oral nonsteroidal anti-inflammatory drugs (NSAIDs) for 2-3 weeks, followed by progressive stretching and muscle strengthening. 1

Diagnosis

Before treatment, proper diagnosis is essential:

• Intersection syndrome is characterized by tendinitis or tenosynovitis at the intersection of the first and second dorsal compartments of the wrist 2
• Clinical examination typically reveals tenderness and crepitation or squeaking several centimeters proximal to Lister's tubercle 2
• Ultrasound is recommended as the first-line imaging modality due to its excellent visualization of superficial tendon structures and ability to perform dynamic assessment 3
• MRI is an alternative when ultrasound findings are inconclusive or when deeper structures need evaluation 3

First-Line Treatment

Initial management should focus on conservative measures:

• Rest and activity modification to reduce stress on the wrist 4
• Application of ice to reduce inflammation 2
• Use of a thumb spica splint for immobilization 1, 5
• Oral NSAIDs for pain and inflammation control 1, 4
• This conservative approach should be maintained for 2-3 weeks 1

Second-Line Treatment

If symptoms persist beyond the initial treatment period:

• Corticosteroid injections adjacent to the site of injury may be beneficial 1, 2
• Continue with modified activities to avoid symptom exacerbation 4
• Progressive stretching and muscle strengthening exercises should be introduced gradually 1

Third-Line Treatment

For refractory cases that do not respond to conservative management:

• Surgical intervention may be warranted, which could include tenosynovectomy 1, 2
• One study reported successful outcomes with surgical debridement and partial tenosynovectomy in a patient with distal intersection syndrome 5

Follow-Up and Monitoring

• Patients should be seen for follow-up within 7 days of initial treatment 4
• Monitor for symptom improvement and adjust treatment plan accordingly
• Long-term follow-up shows favorable outcomes with conservative treatment, with one study reporting no symptom recurrence in patients followed for 12-18 months 4

Prevention Strategies

For patients who engage in activities that may trigger intersection syndrome:

• Modify equipment when possible (e.g., changing grip diameter on ski poles for skiers) 2
• Proper technique education to reduce wrist stress 4
• Early recognition and intervention at first signs of symptoms 6

Special Considerations

• Intersection syndrome is relatively uncommon, with one study finding a prevalence of only 0.37% among patients with arm or hand pain 4
• The condition is often associated with activities involving repeated radial deviation of the wrist 4
• It has been reported in various sports including rowing, canoeing, racket sports, weight lifting, skiing, and climbing 2, 6