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- 10th May 2025
SGD$695.00
MRI WRIST IMAGING FINDINGS IN DISTAL INTERSECTION SYNDROME
FROM TODAY'S REPORTING
DISTAL INTERSECTION SYNDROME
Distal intersection syndrome on MRI is relatively uncommon and occurs at the crossover of the extensor pollicis longus (EPL) over the extensor carpi radialis brevis (ECRB and ECRL) distal to Lister’s tubercle.
MRI FINDINGS IN DISTAL INTERSECTION SYNDROME
CAUSE OF DISTAL INTERSECTION SYNDROME
Lister’s tubercle acts as a pulley for the EPL tendon, which changes its angle of course, leading it to cross superficially over the second compartment tendons.
This can lead to increased friction between the tendons.
There is ALSO a potential communication foramen between the second and third compartments, which can allow inflammation to spread between them.
FINDINGS IN THIS CASE
In this case there is significant tenosynovitis around the EPL (Pink arrow), ECRL (Green arrow) and ECRB (Blue arrow) with distension of the tendon sheaths of the second and third dorsal compartments.
ADDITIONAL FINDINGS IN DISTAL INTERSECTION SYNDROME
There can also be additional findings of:
- Tendinosis, which can manifest as thickening and/or increased signal intensity within the involved tendons (EPL, ECRB, ECRL).
- Partial tendon tears.
- Reactive marrow oedema in adjacent bony structures, such as Lister’s tubercle.
- In severe cases, a complete tear and retraction of the EPL tendon.
EXTERNAL SOURCE FOR CITATIONS
Radsource – MRI Features of Distal Intersection Syndrome.
TEST YOURSELF ON SOME COMMON & FREQUENTLY ASKED QUESTIONS
WHAT MRI FINDINGS INDICATE DISTAL INTERSECTION SYNDROME?
MRI typically shows tenosynovitis of the EPL and ECRL/ECRB, +/- peritendinous oedema, synovial thickening, and at times T2 hyperintensity at Lister’s tubercle.
HOW IS PROXIMAL INTERSECTION SYNDROME DIFFERENT FROM DISTAL
Proximal Intersection syndrome occurs 4-8 cm proximal to the wrist joint in the distal forearm and involves the first extensor compartment (abductor pollicis longus – APL and extensor pollicis brevis – EPB) crossing over the second compartment (ECRL and ECRB).
HOW IS DISTAL INTERSECTION SYNDROME DIFFERENT FROM DE QUERVAIN’S TENOSYNOVITIS?
Distal intersection syndrome involves the second and third extensor compartments, whereas de Quervain’s tenosynovitis affects the first extensor compartment (abductor pollicis longus and extensor pollicis brevis).
WHAT SEQUENCES ARE BEST FOR DETECTING DISTAL INTERSECTION SYNDROME ON MRI?
Fat-suppressed PD or T2-weighted and STIR sequences are ideal for identifying inflammation, peritendinous edema, and synovial thickening.
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- 10th May 2025
SGD$695.00