Clinical Images  |   February 2012
Bilateral Intersection Syndrome
Author Notes
  • From the Department of Neurology at the Riverview Regional Medical Center in Gadsden, Alabama (Dr Gary Mellick), and the Department of Emergency Medicine at Georgia Health Sciences University in Augusta (Dr Larry Mellick) 
  • Address correspondence to Gary A. Mellick, DO, Chairman, Department of Neurology, Riverview Regional Medical Center, 301 S Fourth St, Gadsden, AL 35901-5212. E-mail:  
Article Information
Emergency Medicine / Imaging / Neuromusculoskeletal Disorders / Clinical Images
Clinical Images   |   February 2012
Bilateral Intersection Syndrome
The Journal of the American Osteopathic Association, February 2012, Vol. 112, 98. doi:10.7556/jaoa.2012.112.2.98
The Journal of the American Osteopathic Association, February 2012, Vol. 112, 98. doi:10.7556/jaoa.2012.112.2.98
A 52-year-old man had a 1-month history of bilateral wrist pain. Although the patient participated in weight-lifting activities, his symptoms began shortly after he mowed the grass. Physical examination revealed bilateral and painful fusiform swelling at the distal forearms (pictured) with crepitus noted at the right distal forearm. Two variants of the Finkelstein test were performed, the results of which indicated bilateral intersection syndrome. The patient was treated with bilateral wrist immobilization and ibuprofen (600 mg 4 times/d). 
Tenosynovitis is inflammation of a tendon sheath. Intersection syndrome is tenosynovitis that involves the second compartment muscles (ie, extensor carpi radialis longus and extensor carpi radialis brevis); De Quervain disease is a type of tenosynovitis that involves first compartment muscles (ie, extensor pollicis brevis and abductor pollicis longus). Repetitive resisted extension (eg, rowing, weight lifting, pulling) is a common mechanism of injury. The video of this patient's examination with a discussion of these conditions can be viewed at 
   Financial Disclosures: Dr Gary Mellick serves on the speakers' bureau for Depomed, Inc, and is retained by Actavis, Inc; Lupin Pharmaceuticals, Inc; Teva Pharmaceutical Industries LTD; and Sandoz in a joint consulting agreement. Dr Larry Mellick is the editor in chief of Emergency Department Legal Letter and receives a small monthly stipend. He also acts as a consultant in medical malpractice cases.
Costa CR, Morrison WB, Carrino JA. MRI features of intersection syndrome of the forearm. AJR Am J Roentgenol. 2003;181(5):1245-1249. [CrossRef] [PubMed]
Forman TA, Forman SK, Rose NE. A clinical approach to diagnosing wrist pain. Am Fam Physician. 2005;72(9):1753-1758. [PubMed]