How to Treat Intersection Syndrome

Intersection syndrome, the common term for tenosynovitis of the radial wrist extensors, occurs when these wrist tendons become inflamed and swollen after rubbing against the thumb muscles. This condition can cause pain radiating from the wrist and extending up the thumb and forearm. You may also notice other symptoms, including swelling, numbness, weakness, some muscle atrophy, and a popping or clicking sound in your joints, known as crepitus. Repetitive extension and flexion exercises, such as rowing or playing racket sports, can trigger this relatively uncommon condition. If you’re struggling with intersection syndrome, these treatment options may provide some relief:

Rest and Reduced Activity

Most medical experts recommend treating intersection syndrome conservatively at first. This problem may resolve on its own if you modify your activity and rest your wrist until it recovers. Doctors typically prescribe three weeks of total rest and reduced activity.

During the rest period, it’s important that you don’t strain your body. You should avoid any physical exercise that stresses your wrist, such as rowing, racket sports, horseback riding, and skiing. You may need to hire help or delegate chores, such as vacuuming, ironing, and cooking, to other members of your household. Depending on your job, you may consider taking time off work or assuming light duties until your body recovers.

Splinting

During your rest period, your doctor may immobilize your joint with a cock-up wrist splint. They may also add a thumb spica splint to reduce irritation. At the end of your total rest period, your doctor may gradually wean you off your splints. This process slowly puts a little more pressure on your body before you resume normal activity.

Taping

Your doctor may tape your joint to reduce crepitus. They’ll use kinesiology tape to immobilize the joint and protect it while you’re healing. You may also notice less pain after taping your wrist.

Ice Packs

Applying an ice pack to your impacted wrist may help if you have acute pain from intersection syndrome. Ice slows blood flow to reduce swelling and pain. Icing isn’t recommended for chronic pain, as it may make your wrist feel stiffer.

You can use a commercial ice pack or a makeshift solution, like a bag of frozen peas or a freezer bag filled with ice cubes. Wrapping the ice pack with a towel or cloth reduces the intensity of the cold and makes the application more pleasant. When you have acute pain, you can apply the ice pack for 10 minutes every hour. After three days, you can reduce your ice pack usage to 15 to 20 minutes three times a day.

Heat Therapy

If you’re experiencing chronic pain from intersection syndrome, heat therapy may be more useful than icing your wrist. Heat therapy boosts blood flow so oxygen, nutrients, and natural anti-inflammatories can reach the site of the pain more easily. Some doctors may also recommend heat therapy after three days of icing. Heat therapy isn’t suitable for treating acute pain, as it can increase inflammation in these cases.

Heating pads, saunas, steamed towels, and hot baths are all good ways of administering heat therapy at home. You may also benefit from professional heat treatments like ultrasound. Research has shown that moist heat is a little more effective than dry heat.

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs may ease your intersection syndrome pain while you’re resting your wrist. Your doctor may suggest you take over-the-counter drugs like ibuprofen, naproxen, diclofenac, meloxicam, or acetaminophen. Regardless of how intense your pain is, it’s important to only take these drugs according to the instructions on the pack.

Corticosteroid Injection

If resting and reducing your activity haven’t resolved or greatly improved your condition, your doctor may recommend a corticosteroid injection. These injections can reduce pain and swelling. Your doctor will clean the injection site with iodine or alcohol and palpate the dorsal radial wrist to assess the injury. They’ll then inject a mix of lidocaine for pain reduction and corticosteroid into the second compartment of the extensor retinaculum in the wrist. Since repeated corticosteroid injections can have negative side effects, doctors limit the number of shots you can get each year.

Wrist Surgery

If corticosteroid injections provide only marginal relief, or you feel you need them more than every six weeks, your doctor may recommend wrist surgery. Surgery is usually considered a last resort for intersection syndrome after more conservative treatment options have been fully explored. However, your doctor may recommend surgery earlier if you’re an elite athlete to minimize disruption to your training regime and performance.

Intersection syndrome is addressed via surgical tendon release, which involves removing the swollen tenosynovium around the wrist tendons. The surgeon makes a small incision where the thumb muscles cross over the inflamed wrist tendons. They separate and remove the inflamed tenosynovium from the tendons, then close the incision. A tendon release is usually an outpatient procedure performed under a general or regional anesthetic. In some cases, the surgeon may simply use lidocaine to numb the area and reduce your pain. You’ll go home shortly after the surgery and return in 10 to 14 days to have your stitches removed.

Recovery From Wrist Surgery

Physical therapy is an important part of your rehabilitation after wrist surgery. Your doctor may encourage you to participate in therapeutic exercises or stretch your wrist. Soft tissue massage may also help you recover from your surgery. Bouncing back from wrist surgery takes time, so follow your surgeon’s instructions and modify your movements until you’re cleared to resume normal activity. Depending on your recovery, you may return to normal activity a week after surgery.

If you’re diagnosed with intersection syndrome or suspect you may suffer from this condition, see the experts at The Hand and Wrist Institute. We can assess your condition and give personalized information about the treatment options that may benefit you. Life’s too short to live with pain. Contact our Southlake office at 817-968-1221 or our Dallas team at 214-308-1958 to schedule an appointment.

Woman with painful wrist by Marco Verch Professional Photographer is licensed with CC BY 2.0

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.