Distal intersection syndrome

The distal intersection syndrome relates to tenosynovitis of the extensor pollicis longus (EPL) tendon (3rd extensor compartment), where it crosses the extensor carpi radialis longus (ECRL) and brevis (ECRB) tendons (2nd extensor compartment) 1. It is distinct from intersection syndrome which occurs more proximally in the forearm at the intersection of the first and second extensor compartments

The crossing of the second extensor compartment is typically located just distal to Lister’s tubercle. The tendon sheaths of the EPL and the ECRB are connected by a communicating foramen 2. This is probably why inflammation of the EPL tendon spreads to the second compartment or vice versa.

Pain and swelling over Lister’s tubercle. Less commonly, local crepitus during thumb movements.

Various mechanisms, including:

  • attrition is related to a biomechanical pulley effect by Lister’s tubercle (overuse syndrome)
  • direct blunt trauma of the EPL tendon
  • distal (not necessarily displaced) radius fracture

Trauma is the most frequent cause. EPL tenosynovitis usually occurs within 8 weeks, but can still be found years after an injury.

May show peritendinous edema and fluid within the tendon sheaths at the intersection point between the 2nd and 3rd dorsal extensor tendon compartments 6.

Typically shows features of peritendinous edema (peritendinitis) around the 2nd and 3rd extensor compartment tendons, extending proximally from the crossover point of the EPL in the dorsal wrist.

An early operative release is advocated due to a high risk of EPL tendon rupture (drummer boy’s palsy) 3.

On imaging consider:

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Article information

rID: 14205
Section: Syndromes
Synonyms or Alternate Spellings:
  • EPL tenosynovitis

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Cases and figures

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