Quadrilateral Space Syndrome

synonyms: quadrilateral space syndrome

Quadrilateral Space Syndrome ICD-9

Quadrilateral Space Syndrome Etiology / Epidemiology / Natural History

• Compression of the Axillary nerve and posterior humeral circumflex artery as they run through the quadrilateral space.
• Often associated with a history of trauma to the posterior shoulder.

Quadrilateral Space Syndrome Anatomy

• Borders of Quadrilateral space: teres minor superiorly, humeral shaft laterally, teres major inferiorly, long head of triceps medially.
• Contents of Quadrilateral space: Axillary nerve, posterior humeral circumflex artery.
• Compression is generally from fibrotic bands in the quadrilateral space.
• See also Shoulder Anatomy.

Quadrilateral Space Syndrome Clinical Evaluation

• Complain of vague posterior shoulder pain just under the region of the teres minor. Pain is exacerbated in the late cocking phase in throwing athletes.
• Symptoms exacerbated by forward flexion and/or abduction and external rotation.
• Discrete joint tenderness posteriorly in the quadrilateral space.
• May have paresthesia ove rhte lateral shoulder and upper posterior arm.
• May have deltoid weakness associated with decreased shoulder abduction.

Quadrilateral Space Syndrome Xray / Diagnositc Tests

• AP, scapular lateral and axillary views generally normal.
• Subclavian arteriogram done by the Seldinger technique demonstrates occlusion of the posterior humeral circumfelx artery with the arm in abduction and external rotation.
• MRI: may demonstrate teres minor atrophy / paralabral cysts.

Quadrilateral Space Syndrome Classification / Treatment

• Non-operative: physical therapy focused on posterior capsule and teres minor stretching.
• Operative: indicated only after failure of prolonged non-operative treatment. Treatment - open decompression of the quadrilateral space via a posterior approach. (Cahill BR, J Hand Surg, 1983;8:65), (Francel TJ, Plast Reconstr Surg 1991;87:911).

Quadrilateral Space Syndrome Associated Injuries / Differential Diagnosis

• SLAP Lesion:
• Posterior Capsular Contracture:
• RTC Tear: usually partial-thickness articular sided supraspinatus tears.
• Anterior Shoulder Instability:
• Acromioclavicular Arthritis:
• Distal Clavicle Osteolysis:
• Suprascapular Neuropathy
• Thoracic Outlet Syndrome
• Quadrilateral Space Syndrome
• Aneursyms: subclavian, axillary, posterior humeral circumflex arteries

Quadrilateral Space Syndrome Complications

Quadrilateral Space Syndrome Follow-up Care

• See also Shoulder Outcome Measures.

Quadrilateral Space Syndrome Review References

• Cahill B, J Hand Surg 1983;8:65
• Lester K, Am J Orthop 1999;28:718