We report a case of a 48-year-old female who presented four months following a low-energy trauma with symptoms most consistent with adhesive capsulitis. An MRI demonstrated extensive patchy areas of intramuscular edema-like signal involving the lateral head of the deltoid with associated muscle atrophy, in keeping with a subacute denervation injury. She was diagnosed with quadrilateral space syndrome (QSS) and successfully treated with an fluoroscopic-guided corticosteroid injection. At her two-year follow-up, the patient had regained full function and had no lasting symptoms. Non-specific symptoms like ill-defined shoulder pain, decreased motor function, and weakness can delay the diagnosis and management of QSS. As there is a lack of a good diagnostic study, fluoroscopic-guided quadrilateral space block should be considered should the diagnosis fit a patient's clinical profile, as this has the potential to be both diagnostic and therapeutic.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612044 | PMC |
| http://dx.doi.org/10.1016/j.jcot.2019.03.011 | DOI Listing |
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Background: Quadrilateral space syndrome is a painful disorder of the shoulder caused by static or dynamic entrapment of the axillary nerve and the posterior humeral circumflex artery. It was first described in 1983; however, it is an uncommon syndrome that initially presents with nonspecific shoulder pain or selective deltoid atrophy, and diagnosis is often delayed owing to its rarity. Young athletes of overhead sports are more commonly affected by this syndrome.
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Article Synopsis
- * Accurate diagnosis relies on understanding clinical signs and utilizing imaging techniques like ultrasound, CT angiography, and MRI, with an emphasis on dynamic imaging due to the positional nature of these syndromes.
- * Treatment often combines conservative methods and surgery focused on decompressing the affected areas, and this overview aims to help radiologists better recognize and manage these conditions for effective patient care.
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