Age / Sex : 42 / M

Chief complaint : pain & swelling in left forearm

What is your impression? 

Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)

Courtesy: Jeongmi Park, Yeouido St. Mary’s Hospital,  The Catholic University of Korea.

Intersection syndrome

Discussion

Answer:  (Proximal) Intersection syndrome

Findings: Peritendinous fluid collection with
soft-tissue edema and enhancement at crossover point between first and second
extensor compartments of wrist.

Differential Diagnosis: de Quervain’s disease, usually more distally located

Discussion:

•       Noninfectious inflammatory process
of the tendons of the second extensor compartment (extensor carpi radialis
longus & brevis) cross over the tendons of the first compartment (abductor pollicis
longus & extensor pollicis brevis) in the distal forearm, 4 to 8 cm
proximal to Lister’s tubercle.

•       This is most commonly an overuse
syndrome secondary to repetitive microtrauma from friction. It is therefore
frequently seen in racquet sports, weight training, rowing and other activities
requiring wrist extension.

•       Conservative treatment includes
rest, nonsteroidal anti-inflammatory medications, and splinting. Surgery
such as tenosynovectomy and fasciotomy is indicated typically only for patients
not responding to therapy.

I
Pope, Thomas Lee, et al Imaging of the Musculoskeletal system,1^st
ed. Philadelphia: Saunders Elsevier., 2008:385-387.

de
Lima JE, Kim HJ, Albertotti F, Resnick D. Intersection syndrome: MR imaging
with anatomic comparison of the distal forearm. Skeletal Radiol
2004;33:627-631.