Distal intersection syndrome

Case contributed by Dr Andrew Dixon

Presentation

Circus performer with several month history of increasing dorsal wrist pain.

Patient Data

Age: 20
Gender: Female
MRI

MRI Wrist

There is high signal within the EPL tendon just distal to Lister's tubercle as it crosses over the second extensor tendons (ECRB and ECRL) and is flattened by the overlying extensor retinaculum. There is localised tenosynovitis around this area and a small amount of increased fluid is present within the EPL and ECRL tendon sheaths distally. This appearance is consistent with distal intersection syndrome. There is also thickening and hyperintensity of the dorsal wrist capsule which is likely due to repetitive sprain.  A ganglion / effusion is noted at the triquetral-pisiform articulation. A linear cleft is seen within the proximal (membranous) portion of the scapholunate ligament with the volar and dorsal bands intact. There is loss of cartilage at the scaphoid-trapezoid articulation.    

Annotated image

Top row - axial PD images showing loss of the normal low signal with EPL just before and as it crosses the second extensor compartment tendons. 

Bottom row - axial PD fat sat images at same level with the EPL virtually invisible amongst the surrounding tenosynovitis. 

Case Discussion

Features of distal intersection syndrome (EPL tenosynovitis) in the setting of overuse. 

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Case information

rID: 23673
Case created: 2nd Jul 2013
Last edited: 25th Nov 2015
Inclusion in quiz mode: Included

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