Fluoroscopic-guided quadrilateral space block for the treatment of quadrilateral space syndrome - A case report

Bourget-Murray, Jonathan; Davison, Erin M; Frizzell, Bevan; LeBlanc, Justin

doi:10.1016/j.jcot.2019.03.011

Cited by 5 publications

(4 citation statements)

References 7 publications

(11 reference statements)

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“…The common causes include a history of shoulder trauma, tumors of humerus, tumors of surrounding soft tissue, glenoid lip cyst, thickened and edematous fibrous band, muscle enlargement. [ 5 – 12 ] QSS sometimes have less typical clinical symptoms, making the diagnosis of the disease more difficult, [ 13 ] so most of the previous reports applied imaging, angiography, and EMG techniques to diagnose the disease. When shoulder pain occurs, the preferred clinical imaging test is MRI, which can detect muscle atrophy around quadrilateral space, and helps exclude shoulder tumors and occupying lesions.…”

Section: Discussionmentioning

confidence: 99%

Musculoskeletal ultrasound diagnosis of quadrilateral space syndrome

Zhang¹,

Tian²,

Wang³

et al. 2021

Medicine

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Introduction: Quadrilateral space syndrome (QSS) is a peripheral nerve entrapment disease, which can be misdiagnosed in clinic. In the past, QSS was mainly diagnosed by clinical symptoms combined with magnetic resonance imaging (MRI), electromyography (EMG), and arterial angiography. There are few reports on the diagnosis of QSS by musculoskeletal ultrasound (MSKUS) combined with clinical symptoms. Patient concerns: A middle-aged female patient had posterolateral pain and numbness in her right shoulder for 2 months. Diagnoses: At first, she was diagnosed as suprascapular nerve entrapment, while EMG of suprascapular nerve and axillary nerve indicated that nerve conduction was normal. Then, MRI was performed, showing the shoulder had no abnormalities, and EMG and arterial angiography of upper limb showed no abnormalities too. Finally, she was diagnosed as QSS according to MSKUS and lidocaine block test. Interventions: Two sealing treatments of axillary nerve block in quadrilateral space under the guidance of MSKUS were performed. Outcomes: After 2 treatments, the pain and numbness in her shoulder disappeared, and her shoulder could move normally. There was no recurrence after 3 months of follow-up. Conclusion: MSKUS is an effective method to diagnose QSS. It is fast, convenient and inexpensive, and is worth popularizing in clinic.

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Section: Discussionmentioning

confidence: 99%

Musculoskeletal ultrasound diagnosis of quadrilateral space syndrome

Zhang¹,

Tian²,

Wang³

et al. 2021

Medicine

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“…Throwing mechanics are also addressed in the rehabilitation period. An ultrasound‐guided injection of anti‐inflammatory medication into the quadrilateral space can also be employed for pain relief although literature on this topic is limited 75,76,80 . Only case reports and series have been published as randomized controlled trials have not been performed at this time.…”

Section: Peripheral Neuropathies In Throwing Athletesmentioning

confidence: 99%

“…An ultrasound-guided injection of antiinflammatory medication into the quadrilateral space can also be employed for pain relief although literature on this topic is limited. 75,76,80 Only case reports and series have been published as randomized controlled trials have not been performed at this time. Indications for surgery include space occupying lesions and cases with a positive diagnostic injection that are refractory to 3-6 months of nonoperative management.…”

Section: Axillary Nerve/quadrilateral Space Syndromementioning

confidence: 99%

A review of upper extremity peripheral nerve injuries in throwing athletes

Bowers

Cherian

Zaremski

2022

PM&R

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Peripheral nerve injuries in the upper extremities may be common in throwing athletes as the throwing motion places extreme stress on the dominant arm. The combination of extreme stress along with repetitive microtrauma from throwing uniquely places the throwing athlete at elevated risk of upper extremity peripheral nerve injury. However, because symptoms can be nonspecific and frequently coexist with pathology in the upper extremity, the diagnosis of peripheral nerve injury is often delayed. Diagnosis of peripheral nerve injuries may require a combination of history and physical examination, diagnostic imaging, electrodiagnostic testing, and diagnostic ultrasound-guided injections. The primary management should include physical therapy focusing on throwing mechanics and kinetic chain evaluation. However, some athletes require surgical intervention if symptoms do not improve with conservative management. The purpose of this focused narrative review is to highlight upper extremity peripheral neuropathies reported in throwing athletes and to provide an overview of the appropriate clinical diagnosis and management of the throwing athlete with a peripheral nerve injury.

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“…Lidocaine block, with or without fluoroscopic guidance can be done to assess whether the quadrilateral space is the source of pain. Steroid injection may similarly be performed for longer term therapeutic benefit (12,13).…”

Section: Treatmentmentioning

confidence: 99%

Quadrilateral space syndrome

Zurkiya¹

2021

Cardiovasc Diagn Ther

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The quadrilateral space is a confined area through which the axillary nerve and posterior circumflex humeral artery (PCHA) travel in the shoulder. Both structures are susceptible to impingement and compression as they travel though this space resulting in a constellation of symptoms known as quadrilateral space syndrome (QSS). Patients may experience paresthesias, loss of motor function, pain and vascular complications. Individuals who perform repetitive overhead arm movements such as elite athletes are at greater risk of developing QSS. The diagnosis can be difficult, but in the setting of clinical suspicion, physical exam and imaging studies can provide specific findings. On MRI, patients may have atrophy of the deltoid or teres minor muscles and angiography may show aneurysm or vascular occlusion of the PCHA.Treatment is initially conservative, with physiotherapy. Surgical decompression is effective in patients with severe or progressive symptoms. Causes of external compression such as fibrous bands, scarring, or other space occupying lesion may be addressed at that time. Neurolysis and aneurysm resection may also be performed. In some cases, emboli from the PCHA can cause ischemia in the involved upper extremity resulting in an acute presentation. Catheter directed therapy such as thrombolysis or thrombectomy may performed emergently in these cases. Though rare, in patients presenting with arm weakness, paresthesia, pain and/or arterial thrombosis in the arm, QSS is an important entity to consider.

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Fluoroscopic-guided quadrilateral space block for the treatment of quadrilateral space syndrome - A case report

Cited by 5 publications

References 7 publications

Musculoskeletal ultrasound diagnosis of quadrilateral space syndrome

Musculoskeletal ultrasound diagnosis of quadrilateral space syndrome

A review of upper extremity peripheral nerve injuries in throwing athletes

Quadrilateral space syndrome

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