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Last year I had a thumb problem that turned out to be De Quervain syndrome. Now I have a new problem called intersection syndrome. It feels pretty much the same, so what's the difference? It might help you to know I work as a housekeeper at a large hotel chain.

Painful or tender areas of the thumb, wrist, and/or forearm are common hand problems. Usually, the affected person is diagnosed with one of three conditions: trigger fingers, De Quervain syndrome, or intersection syndrome. These three conditions all fall under the category of tenosynovitis (inflammation of the synovial lining around the tendons). But often, they aren't really inflammatory conditions. How do we know this? Scientists have examined cells taken from painful tendons, tendon sheaths, the synovial lining, and other supportive soft tissue structures. By looking at them under a microscope, they have been able to see that very few (sometimes no) inflammatory cells are even present. So what's going on? It's more likely that repetitive motions (using the finger or hand over and over) have caused the lining around the tendon (called the tendon sheath) to form extra fibers and then start to thicken. Thickening of the tendon sheath is referred to as hypertrophy. The fingers and hand are delicate structures and carefully put together. Every layer of tissue (tendon, sheath, synovium) and each layer of space between have just the right amount of room for smooth sliding and gliding of the tendons. Even a small amount of thickening can cause a problem called stenosis. Stenosis is a narrowing of the normal space allowed for the tendons to move through the tendon sheath. Intersection syndrome is more often seen in athletes such as tennis players (or other racquet sports), weight lifters, and rowers. De Quervain syndrome is seen more often in older women (40 years old and older), African Americans, and members of the military. Depending on which tendons are involved determines the location of the symptoms and thus the name of the condition. For example, De Quervain syndrome is more likely to cause pain close to the base of the thumb and wrist just above the thumb. Intersection syndrome causes pain or tenderness and swelling on the thumbside of the forearm above the wrist. You can see how housekeeping staff and others who use their hands performing repetitive tasks are at risk for any one of these conditions. Early treatment can help put a stop to the formation of fibrosis and hypertrophy. But conservative (nonoperative) care may require rest and a change in your work load (or at least how you perform your tasks). Splinting may help and a hand therapist may be able to offer you helpful tips for ways to modify your work if you can't take time off to rest. If you are able to take some time off, the therapist's advice will also help when you go back to your work tasks.

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