Wednesday, August 10, 2011

Intersection Syndrome or DeQuervain's?

I love it when former alums swing by my office to chat.  I really enjoy hearing the clinical cases they've come across as professionals and how they've handled them.  Last week, Rob Brookes, an ATC currently working summer camps in between his graduate assistant responsibilities, stopped by and during conversation mentioned how he came across a lacrosse athlete who suffered a direct blow to the forearm, and suffered consequent pain and "creaking" in his distal forearm.  The diagnosis: Intersection Syndrome.  While this condition can be caused by an acute trauma, it is often seen as an "overuse injury" (think rowers/weight lifters).   Now comes the interesting part...I searched through the index of my AT texts looking for this particular term, and could not find it. Anywhere.
Curiosity piqued, I turned to the internet.
Pain is exhibited along the "thumb line" on the lateral aspect of the distal wrist (remember lateral, because we're describing it in the anatomical position.  It can easily be confused for DeQuervain's Syndrome, which is usually diagnosed utilizing Finkelstein's Test, seen here.

The main difference between the two is location of discomfort.  In the case of Intersection Syndrome, pain is more proximal to the wrist whereas in DeQuervain's, pain would be a bit more distal to the thumb.  Anatomically, the difference between the two can be explained as follows:
Intersection:  Inflammation at the intersection of both the extensor carpi radialis brevis and longus, as well as the abductor pollicis longus and extensor pollicis brevis.
DeQuervain's: Inflammation of either/both abductor pollicis longus and extensor pollicis brevis.

This video, which seems to be shot in an ER, does and excellent job of briefly but accurately describing the malady as well is offering a clinical differentiation  between DeQuervain's and Intersection.
An interesting clinical differentiation which can help make us all a more effective health care provider!

2 comments:

  1. Interesting article, sheds a little light on my own potential pains!

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