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What is Quadrilateral Space Syndrome/Axillary Nerve Palsy?

Quadrilateral space syndrome describes patients suffering from nerve compression of the axillary nerve from a mechanical or compression-style injury. This condition is uncommon, but when found presents generally in the dominant shoulder.

Quadrilateral space syndrome is found in athletes participating in sports such as baseball, volleyball, or even swimming, due to the overhead nature of sport-specific movements.

Characteristics and Clinical Presentation of Quadrilateral Space Syndrome

Quadrilateral space syndrome is an uncommon cause of paresthesia in the lateral shoulder. Additionally, it’s an underdiagnosed cause of deltoid weakness and shoulder pain in overhead athletes. Patients with quadrilateral space syndrome frequently report neuropathic pain, weakness, and numbness in the posterior or lateral shoulder.

Symptoms of quadrilateral space syndrome include:

  • Shoulder pain
  • Numbness
  • Weakness
  • Tenderness
  • Dull ache in the shoulder

Getting a Diagnosis for Quadrilateral Space Syndrome

Your surgeon will conduct a physical examination of your arm and shoulder. Quadrilateral space syndrome can be misdiagnosed due to the overlap of symptoms with other conditions.

Subluxation of the glenohumeral joint is a symptom that may be found during diagnosis.

Sometimes there is wasting to specific muscle groups supplied by the axillary nerve.

MRI angiography at the side and overhead arm positions is beneficial in visualizing compression of the artery that accompanies the axillary nerve throughout the space.

Treatment Options for Quadrilateral Space Syndrome

Quadrilateral space syndrome will often improve without surgical intervention. However, there are varying degrees of severity to this injury. Minor damage to the axillary nerve is the most common and milder form of the injury, called neuropraxia. It’s important to seek medical supervision as soon as you notice a pattern of pain following an injury while engaging in athletic activities.

Conservative Treatments

Often, over the counter anti-inflammatories are sufficient in reducing discomfort. Stretching, sports techniques correction, conditioning and rest help patients recover. Cold packs may also br beneficial in reducing pain temporarily. Additionally, physical therapy is strongly recommended in order to maintain range of motion and flexibility in the shoulder, supervised to avoid additional nerve damage.

Surgical Treatments

Some patients may require surgery to maximize recovery. In these cases, the axillary nerve is decompressed, removing or incising thickened tissues touching the nerve in all shoulder positions.

Preventing Quadrilateral Space Syndrome

Because this injury is typically sustained during overhead throws, and due to its uncommon nature, patients are advised to warm up before engaging in sports activities. Maintaining proper body mechanics while throwing or reaching their arms overhead is important to improve overall health during athletic activities.

If you notice any pain in the arm or shoulder area when competing or practicing, you should stop immediately and seek medical attention.

Prognosis for Quadrilateral Space Syndrome

After a brief rest period, patients will begin a physical therapy program to prudently maximize range of motion and strength in the arm. Patients requiring surgical intervention will also attend rehab under their hand surgeon’s supervision, Athletic activities should be ceased during this time to reduce the possibility of causing further injury. Patients should seek to improve their sport-specific posture to avoid unnecessary stress to the shoulder area from muscles strain.

If You Believe You Have Quadrilateral Space Syndrome, Contact HandSport Surgery Institute.

Please contact us as soon as possible to schedule an appointment with our talented team. People who have been hurt should be evaluated to try and prevent further injury and mobility issues.

If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.

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