Quadrilateral space syndrome: a rare cause of shoulder pain.

Cormier, Philippe; Matalon, Terence A.S.; Wolin, Preston M.

doi:10.1148/radiology.167.3.3363143

Cited by 62 publications

(32 citation statements)

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“…Surgical exploration and possible nerve grafting are generally recommended if no return of function has occurred by 4-6 months after injury. 1,3,9,11,27 In our series, all patients who were deemed to be appropriate surgical candidates did not show adequate signs of spontaneous recovery (greater than LSUHSC Grade 2) even after 6-8 months of conservative therapy. Thus, surgical intervention was believed to be a reasonable treatment option.…”

Section: Treatmentmentioning

confidence: 63%

“…27 Chronic axillary nerve compression in quadrilateral space syndrome generally responds to conservative management, including changing pitching mechanics, which has been reported to be successful in 75%-90% of patients. 9,11 Surgical intervention for quadrilateral space syndrome is indicated if conservative management fails and involves release of fibrous bands of the teres minor muscle and any aberrant bands crossing the quadrilateral space. 9,28 Timing of surgery, however, remains controversial.…”

Section: Treatmentmentioning

confidence: 99%

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Axillary nerve injury associated with sports

Lee

Saetia

Saha

et al. 2011

FOC

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Object The aim of this retrospective study was to present and investigate axillary nerve injuries associated with sports. Methods This study retrospectively reviewed 26 axillary nerve injuries associated with sports between the years 1985 and 2010. Preoperative status of the axillary nerve was evaluated by using the Louisiana State University Health Science Center (LSUHSC) grading system published by the senior authors. Intraoperative nerve action potential recordings were performed to check nerve conduction and assess the possibility of resection. Neurolysis, suture, and nerve grafts were used for the surgical repair of the injured nerves. In 9 patients with partial loss of function and 3 with complete loss, neurolysis based on nerve action potential recordings was the primary treatment. Two patients with complete loss of function were treated with resection and suturing and 12 with resection and nerve grafting. The minimum follow-up period was 16 months (mean 20 months). Results The injuries were associated with the following sports: skiing (12 cases), football (5), rugby (2), baseball (2), ice hockey (2), soccer (1), weightlifting (1), and wrestling (1). Functional recovery was excellent. Neurolysis was performed in 9 cases, resulting in an average functional recovery of LSUHSC Grade 4.2. Recovery with graft repairs averaged LSUHSC Grade 3 or better in 11 of 12 cases Conclusions Surgical repair can restore useful deltoid function in patients with sports-associated axillary nerve injuries, even in cases of severe stretch–contusion injury.

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Section: Treatmentmentioning

confidence: 63%

Section: Treatmentmentioning

confidence: 99%

Axillary nerve injury associated with sports

Lee

Saetia

Saha

et al. 2011

FOC

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“…Clinically, it is postulated that this manoeuvre stresses the vasculature to accurately reproduce the signs (e.g., radial pulse disappearance) and symptoms (e.g., ischaemic pain, paraesthesia, anaesthesia, heaviness) of vascular compromise. Published case studies have used advanced imaging techniques (i.e., arteriograms, angiograms, ultrasound) to confirm suspected vascular compromise of the axillary artery and its branches, with patency of the arteries in a neutral upper limb position compared to a stenosed or occluded vessel in the hyperabducted position (Arko et al, 2001;Cormier, Matalon, & Wolin, 1988;Fields et al, 1986;Ishitobi et al, 2001;Kee et al, 1995;Nijhuis & MullerWiefel, 1991;Redler, Ruland, & McCue, 1986;Reekers, den Hartog, Kuyper, Kromhout, & Peeters, 1993;Rohrer et al, 1990;Schneider, Kasparyan, Altchek, Fantini, & Weiland, 1999;Todd et al, 1998;Vlychou et al, 2001). Imaging results influence the management of the condition which, in many cases, results in surgery.…”

Section: Introductionmentioning

confidence: 99%

Sonographic evaluation of the axillary artery during simulated overhead throwing arm positions

Stapleton

Herrington

George

2008

Physical Therapy in Sport

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Objectives: The aim of this study was to determine changes in axillary artery diameter and peak systolic velocity in asymptomatic individuals during upper limb positioning commonly used to assess vascular pathology in athletes. Design: Repeated measures observational study. Setting: Physiology laboratory. Participants: Subjective and objective screening excluded individuals with past, or present, conditions related to neurovascular compression syndromes. Thirty-one subjects (21 females, 10 males; mean age: 2574 years) were included in the final analysis. Main outcome measures: Sonographically determined axillary artery diameter and peak systolic velocity, as well as symptom production, were recorded for a series of 12 randomised arm positions, incorporating varying degrees of abduction, external rotation, and horizontal flexion/extension. Results: The majority of arm positions revealed no change in artery diameter and peak systolic velocity. However, at the extreme of abduction, and arm positions incorporating 1201 abduction, significant (po0.0005) reductions in axillary artery diameter were noted. All mean results masked wide heterogeneity: 13% demonstrating a greater than 50% reduction in diameter, 10%, a doubling of peak systolic velocity, and 42%, reporting symptoms. Conclusions: The number of individual clinically ''positive'' responses questions the specificity of individual diagnostic tests, such as the hyperabduction manoeuvre, and highlights the need to interpret test results in conjunction with the subjective assessment and other physical findings from the objective assessment. r

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“…QUADRILATERAL space syndrome (QSS) is a uncommon condition that has been reported to affect athletes who perform overhead movement patterns, such as baseball players, [1][2][3][4] tennis players, 5 and volleyball players. 6 Cahill and Palmer 7 described it as a rare condition that involves compression of the posterior humeral circumflex artery (PHCA) and the axillary nerve within the quadrilateral space, which produces pain over the posterior aspect of the shoulder that may radiate into the arm and forearm with a non-dermatomal distribution.…”

mentioning

confidence: 99%