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Naredo E, Murillo-González J, Mérida Velasco JR, Olivas Vergara O, Kalish RA, Gómez-Moreno C, García-Carpintero Blas E, Fuensalida-Novo G, Canoso JJ. Examining the Forearm Intersection through Palpation and Ultrasonography. Diagnostics (Basel) 2024; 14:116. [PMID: 38201426 PMCID: PMC10802148 DOI: 10.3390/diagnostics14010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/10/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Forearm intersection syndrome causes pain, swelling, and a rub at the dorsal distal forearm where the first extensor compartment muscles intersect with the second compartment tendons. Although primary care settings tend to treat mild cases, high-performance athletes may suffer from severe symptoms that require surgery. This proof-of-concept study aims to help detect the anatomical substrate of forearm intersection syndrome using palpation and ultrasonography when available. METHODS Five individuals were studied using independent palpation and ultrasonography to identify the first dorsal compartment muscles and the second dorsal compartment tendons. The distances between the dorsal (Lister's) tubercle of the radius and the ulnar and radial edges of the first dorsal compartment muscles were measured to determine the location and extent of the muscle-tendon intersection. The palpatory and ultrasonographic measurements were compared using descriptive statistics and the paired t-test. RESULTS The mean distances from the dorsal tubercle of the radius to the ulnar and radial borders of the first dorsal compartment muscles were 4.0 cm (SE 0.42) and 7.7 cm (SE 0.56), respectively, based on palpation. By ultrasonography, the corresponding distances were 3.5 cm (SD 1.05, SE 0.47) and 7.0 cm (SD 1.41, SE 0.63). Both methods showed a similar overlap length. However, ultrasonography revealed a shorter distance between the dorsal tubercle of the radius and the ulnar border of the first compartment than palpation (p = 0.0249). CONCLUSIONS Our findings indicate that a basic knowledge of anatomy should help health professionals diagnose forearm intersection syndrome through palpation and, if available, ultrasonography.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Diaz, IIS Fundación Jiménez Díaz, Autónoma University, 28049 Madrid, Spain; (E.N.); (O.O.V.)
| | - Jorge Murillo-González
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| | - José Ramón Mérida Velasco
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Otto Olivas Vergara
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Diaz, IIS Fundación Jiménez Díaz, Autónoma University, 28049 Madrid, Spain; (E.N.); (O.O.V.)
| | - Robert A. Kalish
- Division of Rheumatology, Tufts University School of Medicine, Boston, MA 02111, USA; (R.A.K.); (J.J.C.)
| | - Cristina Gómez-Moreno
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, 28049 Madrid, Spain; (C.G.-M.); (E.G.-C.B.); (G.F.-N.)
| | - Eva García-Carpintero Blas
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, 28049 Madrid, Spain; (C.G.-M.); (E.G.-C.B.); (G.F.-N.)
| | - Gema Fuensalida-Novo
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, 28049 Madrid, Spain; (C.G.-M.); (E.G.-C.B.); (G.F.-N.)
| | - Juan J. Canoso
- Division of Rheumatology, Tufts University School of Medicine, Boston, MA 02111, USA; (R.A.K.); (J.J.C.)
- Department of Medicine, Emeritus, ABC Medical Center, Mexico City 01120, Mexico
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Blood TD, Morrell NT, Weiss APC. Tenosynovitis of the Hand and Wrist: A Critical Analysis Review. JBJS Rev 2018; 4:01874474-201603000-00007. [PMID: 27500430 DOI: 10.2106/jbjs.rvw.o.00061] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Trigger FingerTrigger finger is common in patients with diabetes.Corticosteroid injections are effective in about 60% to 92% of cases.Proximal interphalangeal joint contracture may occur in long-standing cases.The outcomes of open and percutaneous releases are similar; however, surgeons are split on preferences. Intersection SyndromeThe classic finding is crepitus with wrist motion at the distal one-third of the radial aspect of the forearm. Extensor Pollicis Longus (EPL) TenosynovitisCorticosteroid injections should be used with caution because of the potential for rupture.EPL tenosynovitis is very rare. de Quervain DisorderThis condition is common in postpartum women.A positive Finkelstein test is considered to be pathognomonic of de Quervain disorder, but care should be taken to differentiate this condition from thumb carpometacarpal arthritis.Corticosteroid injections are effective in about 80% of cases.Patients in whom corticosteroid injections fail to provide relief of symptoms frequently have a separate extensor pollicis brevis (EPB) compartment.The abductor pollicis longus (APL) tendon has multiple slips; care should be taken not to confuse one of these slips as the EPB.Traction on the APL pulls up the thumb metacarpal but not the thumb tip.Traction on the EPB extends the thumb metacarpophalangeal joint.Care should be taken to avoid injury to the sensory branch of the radial nerve. Fourth Compartment TenosynovitisThis uncommon condition is most often seen in patients with rheumatoid arthritis.The condition involves a large diffuse area, as opposed to the compact dorsal ganglion cyst.
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Affiliation(s)
- Travis D Blood
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island
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Chatterjee R, Vyas J. Diagnosis and management of intersection syndrome as a cause of overuse wrist pain. BMJ Case Rep 2016; 2016:bcr-2016-216988. [PMID: 27681354 DOI: 10.1136/bcr-2016-216988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Wrist pain due to repetitive motion or overuse is a common presentation in primary care. This case reports the rare condition of intersection syndrome as the cause of the wrist pain in an amateur tennis player. This is a non-infectious, inflammatory process that occurs where tendons in the first extensor compartment intersect the tendons in the second extensor compartment. Suitable history and examination provided the diagnosis, which was confirmed by MRI. Management consisted of early involvement of the multidisciplinary team, patient education, workplace and sporting adaptations, rest, analgesia, reduction of load, protection and immobilisation of the affected joint followed by a period of rehabilitation.
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Affiliation(s)
- Robin Chatterjee
- Sports & Exercise Medicine, Charing Cross Hospital, London, UK Sports & Exercise Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Jay Vyas
- General Practice, Schopwick Surgery Elstree, Elstree, Hertfordshire, UK
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Christiaanse E, Jager T, Lenchik L, Buls N, Van Hedent E, De Maeseneer M. Thickness of extensor tendons at the proximal intersection: sonographic measurements in asymptomatic volunteers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2099-2103. [PMID: 25425365 DOI: 10.7863/ultra.33.12.2099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES An important sign of proximal intersection syndrome is thickening of the tendons at the area where the first extensor compartment tendons cross over the second compartment. Normal values for the thickness of the tendons have not been reported. Our purpose was to measure the thickness of the tendons with sonography at the level of the intersection in healthy volunteers and assess differences between men and women, dominant and nondominant sides, and different tendons. METHODS Forty-one asymptomatic volunteers (25 women and 16 men) were examined by 2 radiologists experienced in musculoskeletal sonography. The thickness of the tendons in the first and second compartments was measured at their intersection at standardized proximal and distal levels. Descriptive statistics were obtained. Differences between men and women, dominant and nondominant sides, and different tendons were evaluated by a Student t test. RESULTS The 95% confidence intervals for measurements of superimposed tendon groups varied between 0.30 and 0.40 cm in women and between 0.36 and 0.48 cm in men. There were no statistically significant differences in comparisons of the different tendon groups (P > .05). There were statistically significant differences (P < .05) between tendon thickness in men and women except for the right extensor carpi radialis longus + abductor pollicis longus (proximal measurement) and extensor carpi radialis brevis + extensor pollicis brevis (distal measurement). On comparison of dominant and nondominant sides, there were no statistically significant differences. CONCLUSIONS Normal tendon thickness should be between 0.30 and 0.40 cm in women and 0.36 and 0.48 cm in men. A comparison between asymptomatic and symptomatic sides and proximal and distal measurements is recommended.
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Affiliation(s)
- Ernst Christiaanse
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Tjeerd Jager
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Leon Lenchik
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Eddy Van Hedent
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.)
| | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium (E.C., N.B., M.D.M.); Department of Radiology, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium (E.C., T.J., E.V.H.); and Department of Radiology, Wake Forest University, Winston-Salem, North Carolina USA (L.L.).
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Lee BH, Han CH, Park HJ, Lee YJ, Hwang HS. A novel taping therapy for chronic insomnia: a report on two cases. Complement Ther Med 2013; 21:509-11. [PMID: 24050588 DOI: 10.1016/j.ctim.2013.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Here, we report two cases of chronic insomnia treated satisfactorily by re-using of patients' bioelectricity. PATIENTS First was a 46 years old male who had taken drugs for several years and depression drug for one year. He had heart beat and felt pressure pain on almost of chest. Second was a 64 years old male who had taken drugs for one year. In spite of the medication, he could not sleep at all and had glint eyes. INTERVENTIONS Method of treatment is to put the medical tape (Chimsband) on acupoints and pressure pain points in the chest, which can be traced down by finger pressing examination. RESULTS In the first case, the patient escaped from the medications after three weeks. Following seven weeks, depression was reduced remarkably. In the second case, the glint of eyes returned to normal after two treatments. After three treatments, the sleeping time was lengthened to 4h. CONCLUSIONS First, pressing chest can be used for tracing neurological symptoms; second, when the bioelectricity of the patient reacts to Chimsband, the symptoms could be ameliorated; third, there is a relationship between treating the neurological symptoms such as insomnia and attenuating pressure pain.
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Affiliation(s)
- Bong Hyo Lee
- Department of Acupuncture, Moxibustion and Acupoint, College of Oriental Medicine, Daegu Haany University, South Korea.
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