Injury reduction and management information for rowers
Intersection Syndrome
by The Rowing Physio, 18 January 2020
Intersection syndrome refers to an injury in your wrist usually sustained from rowing. It is sometimes known as “Oarsman’s Wrist”. It was previously categorised as a tenosynovitis which is inflammation of the coating of a tendon, but has recently been classified as a tendinitis (inflammation of the tendon itself).
When you have Intersection Syndrome, the pain is on the side your wrist closest to your thumb (radial side). It can be anywhere from 3-8cm up your forearm from your wrist crease and can range in severity from mild discomfort to a loss of power in your wrist.
As a result, it is important to get wrist pain assessed and treated, do not ignore it! You don’t want this stopping you from holding the oar during a race. You can’t put any power through the oar if you can’t grip it!
Signs of Intersection Syndrome
- Swelling
- Pain along the side of your wrist or forearm (same side as the thumb)
- Crepitus (grinding feeling or sound)
What causes Intersection Syndrome?
There are two tendons in this region that cross each other (think of a driving intersection). When both these tendons are in use, they glide over each other. If this happens frequently or continuously, the friction can cause inflammation and pain.
The muscles affected are the extensor carpi radialis brevis and extensor carpi radialis longus going in a straight direction towards your index finger, and the abductor pollicis longus and extensor pollicis brevis which veer off towards your thumb (as pictured below). These are the muscles that are used to feather whilst rowing.
What are the risk factors?
Technical faults are a common cause. Some factors may include:
- Increased wrist extension at the finish (pulling knuckles back towards you)
- Knuckles pointed outwards relative to the forearm at the finish (ulnar deviation)
- Choppy water - holding the handle stronger
- Poor grip due to water on the oar or change in handle diameter
- Inappropriate increase in rowing loads
- Lots of Square blade drills (increased grip force to sit the boat up)
What can I do about it?
- Ice and Rest initially. Stop rowing until you get an assessment by a medical practitioner that has experience with rowing injuries
- Continue cross training on bike or running. Ergos may be recommended with a light grip as there is minimal strain without the need to feather.
- Massage of forearm muscle bulk
- Anti-inflammatory medication* - should be discussed with your medical practitioner first
- Cortisone Injection (a very concentrated anti-inflammatory) may be recommended by your health practitioner to help settle the pain
- Surgery – reserved for cases that are persistent and stubborn. There has been a recent break through in making the recovery time from these surgeries minimal however (5-8days). Surgery may be considered earlier for elite level rowers (Hoy, Trease & Braybon 2019).
Does wrist or forearm pain mean that I have intersection syndrome? Not necessarily. There are a number of other issues that can cause wrist pain, although it is a common overuse injury in rowing. It is important to get it assessed so that you have a plan and know whether you can continue rowing with peace of mind!
*The Rowing Physio is not able to give advice on the use of medication and is not liable for incorrect use of medication including side effects. Speak to your doctor first.
References
Hoy, G., Trease, L., & Braybon (Deceased), W. (2019). Intersection syndrome: an acute surgical disease in elite rowers. BMJ Open Sport & Exercise Medicine, 5 (1), e000535. doi: 10.1136/bmjsem-2019-000535.
Thornton, J., Vinther, A., Wilson, F., Lebrun, C., Wilkinson, M., & Di Ciacca, S. et al. (2016). Rowing Injuries: An Updated Review. Sports Medicine, 47(4), 641-661. doi: 10.1007/s40279-016-0613-y