Ultrasound-Guided Quadrilateral Space Block for the Diagnosis of Quadrilateral Syndrome

Abstract

Quadrilateral space syndrome (QSS) is a rare nerve entrapment disorder that occurs when the axillary nerve and posterior circumflex humeral artery (PCHA) become compressed in the quadrilateral space. QSS presents as vague posterolateral shoulder pain that is exacerbated upon the abduction and external rotation of the shoulder. Diagnosis of QSS is difficult because of the vague presentation of QSS. In addition, even though MRI and MR angiography can be used in QSS diagnosis, there is currently no “gold standard” diagnostic imaging studies for QSS. In this case report, we describe a novel ultrasound-guided technique for a diagnostic quadrilateral space block and present a case where the diagnostic block was used to diagnose QSS. We believe that a diagnostic block of the quadrilateral space is a useful adjunct in the evaluation of patients with suspected QSS, especially in cases where examination findings and other diagnostic modalities are indeterminate.

Musculoskeletal ultrasound diagnosis of quadrilateral space syndrome

“…Arteriography of upper limb is also of high diagnostic value for the diagnosis of pressure in PCA. Although it had been reported in the literature that the specificity of QSS diagnosis by arterial angiography arteriography is relatively low, [ 14 , 15 ] EMG can detect latency and amplitude of axillary nerve to determine the degree of nerve damage, and can detect denervation potential of the muscles around the quadrilateral space. [ 16 , 17 ] However, in a study of EMG detection of axillary nerve in QSS showed high false-negative rates.…”

Ultrasound-guided anterior approach to the axillary and intercostobrachial nerves in the axillary fossa: an anatomical investigation

“…Fifty-two bodies donated to science [all Caucasian type; 21 male, 25 female; 68 (standard deviation, 14) kg, 167 (9) cm, 79 (11) yr], which were donated to the Department of Anatomy of the Medical University Graz, were investigated. They were under the approval and the strict rules of the Anatomical Donation Program of the University of Graz and according to Austrian law.…”

Quadrilateral Space Syndrome: Diagnosis and Clinical Management

“…Digital subtraction angiography, computed tomography angiography, and magnetic resonance angiography have all been used to visualize PHCA occlusion [ 2 , 31 ]. While there is no “gold standard” diagnostic test for QSS, magnetic resonance imaging (MRI) is typically the first choice of imaging [ 32 ]. MRI often demonstrates focal fatty atrophy of the teres minor muscle and can exclude pathological causes of shoulder pain ( Figure 2 ) [ 1 , 7 , 32 ].…”

“…While there is no “gold standard” diagnostic test for QSS, magnetic resonance imaging (MRI) is typically the first choice of imaging [ 32 ]. MRI often demonstrates focal fatty atrophy of the teres minor muscle and can exclude pathological causes of shoulder pain ( Figure 2 ) [ 1 , 7 , 32 ]. Arteriography has been described as the cornerstone of diagnosis in QSS; it is used to reveal compression of the PHCA while the patient’s arm is in abduction and external rotation [ 3 ] ( Figure 3 ).…”