Distal intersection syndrome

Case contributed by Bahman Rasuli
Diagnosis certain

Presentation

Wrist pain and swelling. History of hand trauma a year ago.

Patient Data

Age: 15 years
Gender: Female
mri
This study is a stack
Sagittal
T1
This study is a stack
Sagittal
PD fat sat
This study is a stack
Sagittal
T2
This study is a stack
Axial PD
fat sat
This study is a stack
Axial
T1
This study is a stack
Coronal PD
fat sat
This study is a stack
Coronal
T1
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Info

Abnormal intrasubstance increased signal and surrounding edema is seen along the course of extensor pollicis longus (EPL) when crossing the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) tendons associated with ECRL and ECRB tenosynovitis.

Bony protuberance at the site of swelling pointed by the patient is prominent osteophytes at the base of the third metacarpal and its articulation with the capitate bone representing carpal boss. 

Case Discussion

The ECRB, ECRL, and EPL tendons intersect distal to Lister’s tubercle and radiocarpal joint. The tubercle acts as a pulley, changing the EPL tendon angle when it crosses superficially over the ECRL and ECRB tendons. This creates a mechanically disadvantageous arrangement, where the motion of the thumb and hand may cause friction between these tendons.

The carpal boss is a hypertrophied bony protuberance on the dorsal surfaces of the base of the second or third metacarpals, near the capitate and trapezium. It may be bilateral.

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