Orthopedic surgeon and hand expert, Dr. Jeffrey E. Budoff, MD

Arthroscopic and open surgery of the hand, wrist, elbow and shoulder

Intersection Syndrome

Intersection syndrome leads to pain, swelling and occasionally ‘squeaking’ on the back (dorsum) of the wrist. The pain is worse with gripping or lifting. Intersection syndrome is usually due to overuse from activities that require repetitive wrist extension, such as raking leaves, shoveling, rowing, weight lifting or skiing.

Similar to DeQuervain’s tendinitis, intersection syndrome is due to a space problem, that is too much stuff in too little space. The tendons of your wrist travel through tunnels. When you overuse them, swelling enters the tunnels. In cases of intersection syndrome, the tendons become compressed in the tunnel next door to the tunnel that causes DeQuervain’s tendinitis.

Treatment of intersection syndrome starts with avoiding lifting with the palm down, which stresses the involved tendons; lifting with the palm up causes less pain. A splint and a steroid injection are also used to decrease swelling and inflammation about the wrist.

If these treatments don’t work, or if they work but the intersection syndrome recurs, a surgical release is very effective. This release decompresses the tendons and allows them to heal. How long it takes to feel better is often dependent on how damaged the tendon was by the tunnel’s constriction. This is an outpatient procedure. The adjacent tunnel, that leads to DeQuervain’s tendinitis is often released at the same time, as these conditions may coexist.

After surgery, please keep the wound clean and dry for four days. Bathing is safer than showering. Wrap a towel around the dressing in case any water gets in, then place a plastic bag over your hand and secure it tightly with rubber bands. After 4 days you can remove your dressings and the splint and get your incision wet in the shower. Blot it dry. There are no stitches to remove (they’re buried and absorbable). There are little pieces of tape over your wound. The longer they stay, the nicer the final wound may look. They’ll fall off when they’re ready. Please don’t submerge your incision under water (like swimming, or putting your hand under water while doing dishes) for 10 days after surgery.

Try to avoid heavy lifting and gripping while the tendon is trying to heal. Otherwise, computer use and typing are fine immediately after surgery.

In conclusion, intersection syndrome is a very treatable overuse syndrome that causes pain, swelling and occasionally ‘squeaking’ on the back of the wrist. The earlier treatment starts, the better people do so, as usual, get any medical issues addressed in a timely fashion.