LATERAL AXILLARY HIATUS SYNDROME

(QUADRANGULAR SPACE SYNDROME)

• axillary nerve compression while passing through quadrilateral space of shoulder region

Anatomy

https://www.orthodnb.com/2018/05/lateral-axillary-hiatus-syndrome.html

• Quadrilateral space
  • proximal – lower margin of Teres minor, shoulder jt capsule, Subscapularis
  • distal – upper margin of Teres major
  • medial – long head of triceps
  • lateral – humerus
• Contents
  • axillary N ( supplies deltoid and teres minor)
  • Posterior circumflex humeral artery
• Nerve tethered in the space by – muscular fascia, jt capsule, periosteum
• space narrowed in adduction by scissor like effect of triceps and teres major – distally tension
• full forward flexion – subscapularis, teres major, triceps contracts – humeral head impinges on nerve

Clinical features

• diffuse and anterior pain – increased in extreme movements of shoulder involving abduction and ER – posterior space tender
• rarely weakening of deltoid or sensory deficits

Arteriography

• posterior circumflex patent arm in side – occluded in Abd and ER

Diagnostic

• diagnostic nerve block
• electromyography

Treatment

• avoid aggravating movements
• NSAIDS
• Steroid injections
• ROM exercises
• Decompression of axillary nerve

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