Neuromuscular Ultrasound Application to the Electrodiagnostic Evaluation of Quadrilateral Space Syndrome

Chen, Hamilton; Onishi, Kentaro; Zhao, Xing; Chang, Eric Y.

doi:10.1016/j.pmrj.2014.01.017

Cited by 14 publications

(15 citation statements)

References 20 publications

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“…26 Patients with QSS manifest with various symptoms (Figure 1). Neurogenic manifestations may include nondermatomal neuropathic pain, numbness, and weakness in the shoulder (usually posterior 27 ), often radiating down the arm. Vascular manifestations may include thrombosis, microembolism or macroembolism, digital or hand ischemia, and the full spectrum of signs and symptoms associated with acute ischemia such as pain, pallor, and absent pulses ( Figure 1).…”

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confidence: 99%

Quadrilateral Space Syndrome

Brown

Doolittle

Bohanon

et al. 2015

Mayo Clinic Proceedings

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Quadrilateral space syndrome (QSS) arises from compression or mechanical injury to the axillary nerve or the posterior circumflex humeral artery (PCHA) as they pass through the quadrilateral space (QS). Quadrilateral space syndrome is an uncommon cause of paresthesia and an underdiagnosed cause of digital ischemia in overhead athletes. Quadrilateral space syndrome can present with neurogenic symptoms (pain and weakness) secondary to axillary nerve compression. In addition, repeated abduction and external rotation of the arm is felt to lead to injury of the PCHA within the QSS. This often results in PCHA thrombosis and aneurysm formation, with distal emboli. Because of relative infrequency, QSS is rarely diagnosed on evaluation of athletes with such symptoms. We report on 9 patients who presented at Mayo Clinic with QSS. Differential diagnosis, a new classification system, and the management of QSS are discussed, with a comprehensive literature review. The following search terms were used on PubMed: axillary nerve, posterior circumflex humeral artery, quadrilateral space, and quadrangular space. Articles were selected if they described patients with symptoms from axillary nerve entrapment or PCHA thrombosis, or if related screening or imaging methods were assessed. References available within the obtained articles were also pursued. There was no date or language restriction for article inclusion; 5 studies in languages besides English were reported in German, French, Spanish, Turkish, and Chinese.

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confidence: 99%

Quadrilateral Space Syndrome

Brown

Doolittle

Bohanon

et al. 2015

Mayo Clinic Proceedings

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“…Most studies have used set protocols based on the anatomical landmarks (Delagi and Perotto, ) to study EMG activity in the rotator cuff (Maffet et al, ; Rokito et al, ; Reddy et al, ; Brown et al, ; Waite et al, ; Chen et al, ). However, as described previously, the accuracy of electrode placement in the teres minor muscle without using RTUS guidance is questionable in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies have used set protocols based on the anatomical landmarks (Delagi and Perotto, 2005) to study EMG activity in the rotator cuff (Maffet et al, 1997;Rokito et al, 1998;Reddy et al, 2000;Brown et al, 2010;Waite et al, 2010;Chen et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

“…Most articles reporting intramuscular EMG data from the teres minor have involved insertion of the electrode using guidelines published by Delagi and Perotto (2005) (Maffet et al, 1997;Rokito, 1998;Reddy et al, 2000;Brown et al, 2010;Waite et al, 2010;Chen et al, 2014). The participant is placed prone with the shoulder abducted to 908 and the elbow flexed to 908 over the edge of the plinth.…”

Section: Introductionmentioning

confidence: 99%

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Verification of a standardized method for inserting intramuscular electromyography electrodes into teres minor using ultrasound

2015

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The close proximity of the infraspinatus to the teres minor and their functional similarity in producing external rotation of the glenohumeral joint make accurate insertion of electromyographic (EMG) electrodes into the teres minor difficult and questionable even when published guidelines are followed. The primary aim of this study was to examine the anatomical support for the current guidelines for inserting intramuscular EMG electrodes into the teres minor muscle. The secondary aim was to provide a technical description for ultrasound-guided electrode insertion into the teres minor. Intramuscular electrodes were inserted into four cadaveric shoulders using markings based on the current guidelines. EMG electrodes were also inserted into the teres minor of four healthy male participants using real-time ultrasound (RTUS) guidance. Systematic dissections of the cadaver specimens revealed that the electrode had been successfully inserted into the teres minor muscle in only one out of the four. In the remaining three specimens, the needle lodged in the infraspinatus muscle belly at distances ranging from 3 to 17 mm medial to the teres minor. Using RTUS guidance, the electrodes were successfully inserted into the teres minor in all participants, as confirmed by visual inspection with RTUS. This study confirms that the current EMG electrode insertion guidelines for the teres minor are not accurate and RTUS ensures the placement of electrodes into the teres minor rather than the adjacent infraspinatus muscle.

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“…Tanıda yeri olan incelemeler, vKAS dü-şünülen olgularda arteriyogram ve nKAS olgularda elektromiyografidir. [19] Şekil 1. Supraskapular sinir sıkışmasında tedavi algoritması.…”

Section: Anatomi Ve Patofizyolojiunclassified