Massage & Bodywork

JANUARY | FEBRUARY 2021

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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 83 Intersection syndrome also involves two other tendons of the forearm that control the wrist: the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB). These two tendons are in the second dorsal compartment. Interestingly, the ECRB is also the forearm tendon most frequently affected in chronic lateral epicondylitis (tennis elbow). Epicondylitis affects the proximal end of ECRB near the elbow instead of the distal end in the forearm, which is affected in intersection syndrome. Intersection syndrome is also a friction problem but occurs farther up the forearm (proximal) than where de Quervain's tenosynovitis occurs in the wrist. The latter presents as the two tendons of the first dorsal compartment cross over those in the second (Image 3). Where these tendons cross is the intersection. Repetitive actions of the hand or fingers may cause these tendons to rub against each other and produce tenosynovitis as a result of the friction. Intersection syndrome is common in various sporting activities that involve repetitive wrist motions, such as rowing, canoeing, horseback riding, skiing, and racket sports. As a result of the shear forces and friction in the area, there may be resultant tendon thickening and inflammation between the tendon and surrounding synovial sheath. This can lead to further irritation and the resultant pain. ASSESSMENT Both de Quervain's tenosynovitis and intersection syndrome involve an inflammatory reaction between the tendon 2 Tendons of the anatomical snuff box. Image from 3D4Medical's Complete Anatomy application. The most common terms we hear related to overuse tendon pathology are tendinitis or tendinosis, which result from collagen degeneration in the tendon. and the surrounding synovial sheath. Tendon friction is the primary cause for this reaction. As with any good assessment of soft-tissue pathology, a thorough evaluation begins with a detailed client history. In both conditions, there will likely be some repetitive overuse activities involving the distal upper extremity. As noted earlier, this might be sporting activities such as rowing or racket sports. Certain occupations, such as massage therapy, are also likely to produce the chronic overuse tendon pathology in both conditions. The name tenosynovitis would indicate that there is active inflammation associated with these conditions. However, characteristic signs of inflammation may not always be evident. For example, visible or palpable swelling may be present, but not always. There are no other clearly visible indicators of either condition. Detailed palpatory examination is one of the most effective ways to identify both of these problems. Clients presenting with de Quervain's tenosynovitis will usually report localized pain very close to the radial styloid process when those tendons are palpated. If the tendon is palpated during movements of the thumb, the characteristic pain is usually aggravated. Crepitus (a grinding or grating sensation) may be also be evident if these tendons are lightly palpated during movements of the wrist or thumb. Tendon thickening resulting from the inflammatory reaction may also increase crepitus during movement. Pain near the radial styloid is likely with both active and passive ulnar deviation of the wrist (Image 4). The practitioner may be able to move the client's hand farther into ulnar deviation during passive movements, and that may increase discomfort further. The pain is also likely to be more pronounced during

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