Dados do Trabalho

Título

Intersection syndrome: case report

Introdução

Pain of the dorsal aspect of the distal forearm and wrist is common. History and physical examination often provide a specific diagnosis or limit the differential, but the diagnosis remains uncertain in a subset of patients. MRI can improve the evaluation of forearm and wrist symptoms.

Descrição

The intersection syndrome is a tenosynovitis of the radial wrist extensors, the extensor carpi radialis longus, and the extensor carpi radialis brevis of the second dorsal compartment. The condition also affects the extensor pollicis brevis and the abductor pollicis longus, causing pain and swelling of these muscle bellies.
It is characterized by pain and swelling in the distal dorsoradial forearm, approximately 5 cm proximal to Lister’s tubercle. Symptoms occur where the first extensor compartment tendons (the abductor pollicis brevis and extensor pollicis brevis) cross over the second extensor compartment tendons (the extensor carpi radialis longus and extensor carpi radialis brevis).
Repetitive wrist motion and trauma may lead to tenderness and crepitus.
In this case, the pacient E. L. S., male, 46 years, was complaining of pain in the right forearm. He had a history of local trauma 3 months before the MRI. It was helpful in establishing the diagnosis, showing peritendinous edema around the first and second extensor compartment tendons, extending proximally from the crossover point, which is the most characteristic finding.

Discussão

In some cases, the changes may be subtle, however, and difficult to identify. Others findings could be interstitial fluid surrounding the tendons and tendon sheaths or in the interval between them at the intersection point. Mild subcutaneous edema adjacent to the intersection point is also a feature, probably resulting from surrounding hyperemia. Findings of tendinosis (thickening and signal abnormality) may not be present, reflecting principally a peritendinous phenomenon; mild tendon thickening and morphologic alterations are often subjective and raise a set of observer performance issues when trying to apply these findings consistently in practice.

Palavras Chave

Intersection syndrome; second extensor compartment tendons; extensor carpi radialis longus; extensor carpi radialis brevis; wrist / forearm pain.