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Age / Sex : 15 / M
Chief complaint: distal forearm pain 1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.) Courtesy: 류혜진(Yoo Hye Jin), 서울대병원(Seoul National University Hospital)
Diagnosis: Intersection syndrome
Discussion
Findings:
T2 weighted
images and post-contrast images show marked peritendinous soft tissue edema and
contrast enhancement at crossover point between first and second extensor
compartment tendons
Differential Diagnosis:
de
Quervain's tenosynovitis, Wrist ligament sprain, ganglion cyst, tendinitis, and
muscle strain
Diagnosis: Intersection syndrome
Discussion:
The intersection
syndrome is a noninfectious inflammatory process of the second extensor
compartment tendons of the forearm, characterized by the presence of pain and
swelling proximal to the Lister tubercle of the distal radius. Symptoms occur
where the first extensor compartment tendons (the abductor pollicis longus and
the extensor pollicis brevis tendons), crosses over the second extensor
compartment tendons (the extensor carpi radialis longus and the extensor carpi
radialis brevis tendons)
There is no consensus about the
pathophysiology of this condition. Two main hypotheses regarding the
pathogenesis have been postulated. One hypothesis considers intersection syndrome
to be a result of friction between the muscle bellies of the first extensor
compartment tendon and the adjacent tendons of the second extensor compartment
Another hypothesis implicates
entrapment from stenosis; the syndrome may result from tightness of the tendon
sheath of the extensor carpi radialis longus and extensor carpi radialis brevis
tendons, causing swelling and tenderness proximally.
the common pathologic features are noninfectious
peritendinitis and an associated local tenosynovitis in the acute setting with
the potential to develop into a stenosing tenosynovitis in the chronic setting
There is an
association with sports-related activities, such as rowing, canoeing, playing
racket sports, horseback riding, and skiing
The
treatment paradigm is similar to other overuse injuries. Conservative measures
are the first line of treatment. Symptoms resolve within 2–3 weeks in 60% of
patients with rest, administration of nonsteroid antiinflammatory drugs, and
splinting. Surgery is indicated typically only for patients not responding to
therapy. When conservative treatment fails, a tenosynovectomy and a fasciotomy
of abductor pollicis longus can be performed.
References:
1.
AJR 2003;
181:1245-1249
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