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Intersection Syndrome

Original Post
John Lombardi · · Fort Collins, CO · Joined Aug 2013 · Points: 995

I can't find a lot of info on the internet about intersection syndrome, so I figured I would post some more specific info for others. I am still recovering (can't climb) so there's a good chance I will update this in a couple weeks, hopefully with some good news.

I have had this injury for possibly a year. I say possibly as I was diagnosed as having De Quervain's originally, and I am still unsure if maybe I had that. For about a year I would have symptoms, e.g. thumb pain, typically after climbing. Taping and PT, and bouts of rest, seemed to be sufficient. This March I began training quite a bit and pushed myself too far. I was having trouble using my mouse at work. Sharp pain when I was just trying to mouse. I got a steroid shot in my thumb and that seemed to really help with the De Quervain's symptoms.

3 weeks after my steroid shot I started bouldering outside, typically on V0-V1. I now know that I was pushing myself too much after the steroid shot. When I was trying some V4s, 5.5 weeks after my steroid shot, I was pulling up on a sloped topout and felt my tendons roll over one another, or maybe over bone. I was able to complete the climb but I could tell that I had some serious inflammation. My wrist was visibly swollen and felt real out of wack. In retrospect I have felt my tendons roll over another before, but it has felt fine.

For about a month now I've been doing approx 1.5 hours of PT (stretches) every day and 1.5 hours worth of Heat + massage + heat. Every other day I do 15-30 mins of strengthening (3 weeks since the injury) which is mainly just playing with a tennis ball and a flex bar. I have accidentally used my wrist and it has felt like shit after. 1 month after the injury I changed my oil in my truck and just using a socket wrench proved to make my wrist really sore. I have a good chunk of scar tissue where my tendons cross, but do have reduced inflammation from a month ago. My PT has me doing some rotator cuff/shoulder strengthening. I guess my shoulders are fucked up and my technique likely sucks that I am probably relying too heavily on my forearms while climbing.

If anyone has other anecdotal evidence of what works that would be great. At my current rate I don't really see myself climbing for another month. At least if I tried to climb soon it would likely end up me just re injuring myself. I will update this hopefully in a month or so if I feel like I have any decent progress. If there is a single person interested I can write down my specific stretches, etc.

Henning Norén · · Unknown Hometown · Joined Mar 2022 · Points: 0

Hi John! 

You probably won't see this since it is 2 years later. However in case of the small chance that you stumble upon this, I have a similar injury for the past 1.5 years and have to this point not found anything that completely gets rid of the problem. I have went to numerous doctors, where they now say that there is nothing they can do surgically and I have to fix it myself in some manner (which I have yet been unable to do). I therefore wonder how you have managed with the injury, has it gotten better? If so, what have you done specifically each day in order for it to get better? There also seems to be a very minimal amount of information readily available and easy to apply regarding intersection syndrome which complicates matters.

WF WF51 · · Unknown Hometown · Joined Oct 2020 · Points: 0

From a reliable source: "Treatment includes rest, activity modification, bracing, and non-steroidal anti-inflammatory drugs. A glucocorticoid injection may be used in cases where more conservative treatments have not alleviated the symptoms."

There are a fair amount of open access articles on intersection syndrome that are available, e.g., 

Schmidt, E., et al. (2021). It's Not De Quervain Tenosynovitis - A Diagnosis to Consider in Persistent Wrist Pain.


jake w · · mammoth lakes, california · Joined Sep 2019 · Points: 574

Have you received a steroid injection? That completely cleared mine up. Though more burly big wall days seem to inflame the area slightly still. But I have no pain or swelling after "regular" climbing. 

John Lombardi · · Fort Collins, CO · Joined Aug 2013 · Points: 995

Hi Henning. My injury has progressed and gotten better and worse and better. Only recently has it gotten to a more stable place where I can see very slow improvement. To echo Jake's sentiment: I think a steroid injection is a good place to start if it has been long term (I am not a doctor). I should have seen a PT to get some more specific info after my steroid shot though as I did make my injury worse before it got better after my steroid shot. But it definitely helped. 

My injury used to 'feel' like more of intersection syndrome as I could feel the actual tendons in my wrist roll over one another, both visually and physically, and I would get inflammation and pain after. That hasn't happened in a long time, even on the same holds that used to really aggravate my injury. My pain has progressed to specifically in the thumb area, which may be something else entirely.

Although "WF WF51" linked an article which is helpful it's not very climbing specific. The activity modification part for me consisted of finding the most basic wrist strengthening (and shoulder) that I could start at and progress from there. I do these 3x a week. It is pretty slow going, but I am at the point where I can climb more dynamically and certain holds like slopers or small crimps are not a problem. Additionally, the worst part was things like opening a jar would just instantly make my wrist mad. That is much better if not a problem no more now. I don't really stretch my wrist specifically day to day, but do some forearm stretches here and there. 

My exercises

  1. Starting out with no-weight and using rubber bands or 'power fingers' to do antagonist training. Ex: start with a closed hand and open while a rubber band is on the fingers.
  2. Progressing to weighted exercises but very very incrementally add. The emphasis was on making my rated perceived effort at a max of 7/10 (where 10 is failing, 9 is close to failing). My exercises consist of: wrist flexion, radial deviation, and extension. Additionally, I do a 'hammer rotation' with a pvc pipe. For my specific injury, I also do a pinch block exercise with a wide pinch block to strengthen my wrist and that grip.
  3. Slowly incrementally add weight to those exercises. Also do shoulder strengthening stuff as you may have gotten this injury in the first place by over compensating elsewhere (who knows, but that was part of my injury). 
  4. Hangboarding and finger strength exercises seemed to help also.

But the best and most useful thing I did was go to physical therapists that are climbers. That was how I got good feedback and a good path in order to get better. MP and the internet is an absolute shitshow for good advice anyways, so spending the money on a PT that is a climber, or has worked with climbers, makes a huge difference. Good luck! 

Henning Norén · · Unknown Hometown · Joined Mar 2022 · Points: 0

Yes Jake, I have recieved one cortisone injection which helped for a few weeks albeit the pain resurfaced quite quickly after those initial weeks. Docotr also did not want to give more injections in case of side effects. John, thanks for the reply. How much do you think you have been able to rest your hand in the midst of doing exercises? A big problem I have is even if I do not climb, my wrist will be active doing a lot of small repititive movements (studying primarily). I've tried different ergonomical adjustments and even using my other hand although I have not had much success with that. I will probably try to find a PT that has experience with climbers per your suggestion. I feel as though over the course of my injury the most difficult thing has been not increasing the inflammation by over-doing exercises and not allowing (and not really being able) adequate rest. How have you navigated the rest to exercise conundrum? (I'm aware this differs immensely depending on daily routine, your type of work or study and so forth). Thanks again for helpful answers everyone!

Arjun Dongre · · Newton, NC · Joined May 2008 · Points: 0

Hey dude, hope the new job is good. I have no idea about the specifics of your condition but I used to have crazy wrist/carpal tunnel pain from the combination of climbing and mouse clicking. I got one of these a number of years ago: google.com/search?q=wow+joy…;oq=joy+pen+wow 

and switched the left and right click functionalities. I "left click" now with my middle and ring fingers just as you would use them as the primary fingers in climbing. Been pain free in my wrists and forearms for years.

John Lombardi · · Fort Collins, CO · Joined Aug 2013 · Points: 995
Henning Norén wrote:

Yes Jake, I have recieved one cortisone injection which helped for a few weeks albeit the pain resurfaced quite quickly after those initial weeks. Docotr also did not want to give more injections in case of side effects. John, thanks for the reply. How much do you think you have been able to rest your hand in the midst of doing exercises? A big problem I have is even if I do not climb, my wrist will be active doing a lot of small repititive movements (studying primarily). I've tried different ergonomical adjustments and even using my other hand although I have not had much success with that. I will probably try to find a PT that has experience with climbers per your suggestion. I feel as though over the course of my injury the most difficult thing has been not increasing the inflammation by over-doing exercises and not allowing (and not really being able) adequate rest. How have you navigated the rest to exercise conundrum? (I'm aware this differs immensely depending on daily routine, your type of work or study and so forth). Thanks again for helpful answers everyone!

Hi Henning - I am not sure your job but my friend Arjun did remind me about one thing that did help day to day for my job which was to get an ergonomic mouse. Additionally, I switched my mousing hand from right to left, and spent some time trying to get my work ergonomic posture better. I work from home now, so I felt comfortable splurging on that sort of thing. I am at a computer "programming" 40 hrs a week so it does make a difference. 

For other day to day things: cooking, picking up bags, tying my shoes, or even sometimes zipping something on my jacket at a weird angle, those have definitely aggravated my wrist. When it is really bad, but I have to do ordinary things, I do wear a brace like https://www.amazon.com/Therapists-Choice%C2%AE-Wrist-Support-Universal/dp/B07BZQBSVG Could be a placebo, but it helped when I reinjured it a couple months ago.

For over-doing exercises, which essentially is what has caused almost all my injuries in the past 3 years, I had to do a bit of trial and error to have a good framework. I keep a workout log where for all PT related crap I track my workouts and make sure my rating of perceived effort is always around 6-7/10. Additionally, I make sure any pain I have is around a 4/10 and back down in weight until I am about a 4/10 in pain. Some pain is good. Always defer to doing less at first. 

I have found that finding other hobbies to take more time off climbing has helped. This winter I spent way more time skiing than I have ever done in my life, and the gripping of ski poles has actually helped my wrist, in addition to climbing less (for the time being). If you are a surgeon or a mechanic or work more intensely with hands than my day to day then even more reason to seek a PT that is really hands on. The current PT I have now, and the past 2 or 3, did a good job of making good goals in climbing in order to gage how I feel. A good PT would be able to help with "How do I help everyday functionality AND climb what I want". From the past couple of months, I was able to get better day to day comfort AND start to feel comfortable climbing on less ergonomic holds from strength training exercises I mentioned in my previous post. So it's great that I can open jars or even shake peoples hands and not get pain while also progressing back to 'normal' climbing for me. But I really needed a PT to bounce back ideas or help better characterize what is good pain vs bad pain in order to get there.

Guideline #1: Don't be a jerk.

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