Quadrilateral Space Syndrome

Description

Quadrilateral space syndrome is a rare nerve condition in the shoulder that causes pain and occasionally weakness in the back of the shoulder. It involves compression of the axillary nerve at the back of the shoulder, usually by a band of ligament-like (fibrous) tissue or between the teres major and teres minor muscles in the back of the shoulder. The axillary nerve supplies the deltoid muscle, the main muscle to the shoulder. The quadrilateral space is a space in the back of the shoulder formed by three muscles: 1) the teres minor above, 2) the teres major below, and 3) the triceps on one side. The axillary nerve and posterior circumflex humeral artery run through this space, which can be narrowed, compressing the nerve and artery when the arm is in the throwing position. It can also be constricted by fibrous bands.

Common signs and symptoms

• Pain and discomfort that is often described as a burning or dull ache that is poorly localized, often in the back of the shoulder and occasionally in the front of the shoulder and arm

• Heaviness or fatigue of the arm

• Pain made worse by putting the arm in the thrower’s position

• Sometimes, tingling, numbness, or burning in the back of the shoulder and occasionally in the arm and forearm

• Tenderness in the back of the shoulder

• Atrophy (shrinkage) of the deltoid muscle or teres minor muscle

Causes

• Pressure on the axillary nerve at the back of the shoulder, often by a fibrous band

• Compression of the axillary nerve between the teres minor and teres major muscles

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