Pain Several Centimetres Above the Wrist, and a Squeak You Can Feel
Rowers, lifters, skiers and people who’ve spent a weekend with a drill get this, and almost all of them get told they have De Quervain’s.
The two conditions involve the same tendons and are separated by location.
That’s it, and it’s enough.
De Quervain’s hurts at the wrist, over the bony bump on the thumb side. Intersection syndrome hurts four to eight centimetres higher, up the back of the forearm.
Put a finger on the sore spot and measure with your other hand. If it’s a hand’s width above the wrist crease, you’re in intersection territory.
Why that spot
There’s a place on the back of your forearm where two muscle groups cross over each other, like two roads meeting at an angle.
The muscles that pull your thumb out run diagonally across the top of the tendons that cock your wrist backwards. Every time you extend your wrist under load, those two groups rub against each other at the crossing point.
Do that a few thousand times in a weekend and the tissue there becomes inflamed and swollen.
Which is why it belongs to a specific list of activities:
- rowing and sculling,
- heavy weightlifting with the wrists cocked back,
- ski pole planting, racquet sports, and
- any job with repetitive drilling, sanding or screwing.
The sign that clinches it
Put your other hand flat over the sore area and slowly bend your wrist up and down.
In an active case you can feel a creaking or squeaking under your palm, like wet leather or crunching snow.
Sometimes you can audibly, physically, hear it.
A squeak you can feel through your hand is one of the few findings in the wrist that leaves almost no room for doubt.
There’s usually visible swelling there too, a soft fullness on the back of the forearm that you can see by comparing sides in good light.
Treatment
Good news: this is one of the more reliably treatable overuse problems in the forearm, provided the load actually changes.
- Stop the specific movement. Repeated wrist extension under load is the driver, so it’s the rowing stroke, the wrist position in your lifts, or the drill. Not general rest.
- Splint. A wrist splint holding the wrist slightly extended, often including the thumb, worn for a few weeks. This is one of the conditions where splinting earns its keep.
- Anti-inflammatories early, while it’s genuinely inflamed.
- A corticosteroid injection into the area for cases that don’t settle, which works well here.
- Then graded return, with the technique or setup reviewed. Rowers usually need the feathering motion looked at; lifters usually need the wrist straighter under the bar.
Most settle in 2 to 6 weeks once the aggravating movement stops. Stubborn ones run to about 3 months. Surgery to release the compartment exists and is rarely needed.
What else to consider
If the pain is right at the wrist rather than up the forearm, and lifting a kettle with the thumb up is what hurts, read the De Quervain’s article instead.
If it’s on the little-finger side rather than the thumb side, look at ECU problems or a TFCC injury.
And if the whole forearm pumps up and goes weak at a predictable point in every session rather than staying sore afterwards, that’s a different problem with a different diagnosis.
The short version
Sore, swollen, sometimes squeaking, a hand’s width above the wrist on the back of the forearm, in someone who rows, lifts, skis or drills.
Splint it, stop the movement that causes it, and fix the technique before you go back. This one responds well when the load genuinely changes and not at all when it doesn’t.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Tens of thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Forearm pain that isn’t clearly improving by day 7 needs assessing.