Surgical decompression of the quadrilateral space in overhead athletes.
BACKGROUND
Quadrilateral space syndrome is an uncommon condition that can disable the overhead athlete. The authors describe 4 cases of quadrilateral space syndrome that may assist clinicians in recognition of this problem in patients with posterior shoulder pain.


OBJECTIVE
Quadrilateral space syndrome can present as posterior shoulder pain in the overhead athlete, and surgical decompression can relieve symptoms and allow full return to activity.


METHODS
Case series; Level of evidence, 4.


METHODS
Between 2004 and 2006, the authors performed surgical decompression of the quadrilateral space in 4 overhead athletes (4 shoulders; mean age, 24 years). They evaluated the clinical presentations, diagnostic tests, surgical procedures, and results of treatment. Mean follow-up was 24.5 months.


RESULTS
All 4 patients underwent surgical decompression of the quadrilateral space. Fibrous bands entrapped the axillary nerve in 3 shoulders, and venous dilation was found in the fourth shoulder. All patients returned to full activity without pain or limitation of overhead function 12 weeks after surgery.


CONCLUSIONS
Quadrilateral space syndrome is an uncommon cause of posterior shoulder pain that is easily overlooked and can severely limit overhead function in the athlete. Surgical decompression can predictably relieve pain and improve function in patients who do not respond to nonoperative regimens.
McAdams
Timothy R
TR
Department of Orthopaedic Surgery, Stanford University, 1000 Welch Road, Suite 100, Palo Alto, CA 94304, USA. tmcadams@stanford.edu
Dillingham
Michael F
MF
D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D009408:Nerve Compression Syndromes / Q000473:pathology / Q000601:surgery*; D020127:Recovery of Function; D012785:Shoulder Joint / Q000294:innervation* / Q000473:pathology / Q000601:surgery; D020069:Shoulder Pain / Q000473:pathology / Q000601:surgery*