Quadrilateral (Quadrangular) Space Syndrome

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quadrangular spaceRecently I had a client seeking treatment for a condition that “you’ve probably never heard of“. As he describes an intermittent pain around the back of his shoulder, I begin to scroll through my mental rolodex of rotator cuff pain patterns and secondary muscles that affect this area. He continues to share information from his previous visits with an orthopedic specialist and physical therapist, and says that he was finally diagnosed with “quadrilateral space syndrome”. At this point any other thoughts stop and I come up empty on the mental rolodex of musculoskeletal pathologies. “Yep…I’ve certainly never encountered that one before” I tell him. Fortunately for my ego, it is a somewhat rare condition and this was only the second case encountered by the orthopedic specialist in over 20 years.

Quadrilateral (or quadrangular) space syndrome is a situation where the axillary nerve in the posterior shoulder becomes compressed. Symptoms often include a dull shoulder ache and numbness or tingling down the arm, and can worsen when the arm is raised in the abducted position. This can be especially problematic for athletes that play sports where the arm is frequently and repeatedly abducted. Pitching a baseball, shooting a basketball, and a tennis serve are all great examples.  Treatment usually consists of enlarging the quadrilateral space through manual soft tissue therapy performed by a physical therapist or medical massage therapist. Surgical decompression may be necessary in severe cases.

The teres minor, teres major, and triceps (long head) are three muscles that come together to create three of the four sides of the quadrilateral space, with the fourth side being the humerus bone. These three muscles are of primary importance when treating for quadrilateral space syndrome. The other rotator cuff muscles (supraspinatus, infraspinatus, subscapularis), posterior deltoid, and possibly the latissimus dorsi should be treated as well. It is important to remember that the quadrilateral space may be tender and sensitive to the touch, so treatment should be performed carefully to avoid further irritation of the axillary nerve.

Disclaimer: The information provided above is for educational purposes only and should not be considered professional medical advice. Please consult your doctor before making any decisions about your care.
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