Presentation, management, etc
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- Skiiers, footballers, rugby, baseball, hockey, soccer, weight lifting, wrestling
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- Chronic compression occurs in young adults who are overhead throwers
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- Carrying a heavy backpack/ misuse of crutches
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- Overdeveloped or hypertrophic muscles forming quadrangular space
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- Ganglion/paralabral cyst
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- More common in the dominant shoulder
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- Brachial Neuritis (Parsonage-Turner Syndrome)
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- Rare in isolation
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- Older people with GH dislocation more predisposed
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- Dull, poorly localises shoulder ache
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- Can be after sporting event or blunt force to the shoulder (shoulder dislocation can be related to AN)
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- Vague deltoid numbness or parasthesia
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- Sensory symptoms often worse at night
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- Deltoid weakness may be present ( rapid fatigue with overhead throwing)
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- Excaerbated by arm abduction and external rotation
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- Point tenderness of quadrangular space
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- Weakness in abduction, external rotation
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- Deltoid atrophy if chronic
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- Assess for changes in limb (cyanosis, pallor, splinter haemorrhages) for lesions pressing on posterior circumflex artery as it exits the quadrangular space (Quadrangular space syndrome (QSS)
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- Assess ipsilateral neck and upper extremity
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- Assess other nerves (Spinal accessory, suprascapular, long thoracic, musculocutaneous, radial)
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- Cx radiculopathy
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- TOS
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- Rotator cuff tear
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- Brachial plexopathy
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- QSS
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- Brachial neuritis
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- GH f#/dislocation
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- Subacromial impingement syndrome
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- Herpes Zoster
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Selective rest and modifications
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ROM exercises
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Cross friction massage / myofascial release to muscles of quadrangular space
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- GH mobilisation
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- Cross body and posterior capsule stretching
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- Rotator cuff strengthening
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- Avoidance of positions that place axillary nerve in traction
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- NSAIDs
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- If failure to restore function in 3-6 months , consider surgical referral
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- Traumatic cases can be managed non-surgically (reduction, immobilised for 4-6 weeks in the young and 7-10 days in the elderly then a rehab program - muscle strength and shoulder mobility) but there is a risk of permanent paralysis
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-Neuropraxic patients expect recovery within 6-12 months
- Axonotmesis recovery is high, but can take many months, if no signs of recovery within 6-9 months, consider surgery - Neurotmesis patients should have surgery |
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- Low grade + GH dislocation recovery within 7 months
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Complications: Permanent numbness to the lateral shoulder region, atrophy of the deltoid and teres minor muscles and chronic neuropathic pain
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