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Drossopoulos PN, Ruiz C, Mengistu J, Smith CB, Pascarella L. Upper-limb neurovascular compression, pectoralis minor and quadrilateral space syndromes: A narrative review of current literature. Semin Vasc Surg 2024; 37:26-34. [PMID: 38704180 DOI: 10.1053/j.semvascsurg.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 05/06/2024]
Abstract
Pectoralis minor syndrome (PMS) and quadrilateral space syndrome (QSS) are uncommon neurovascular compression disorders affecting the upper extremity. PMS involves compression under the pectoralis minor muscle, and QSS results from compression in the quadrilateral space-both are classically observed in overhead-motion athletes. Diagnosing PMS and QSS may be challenging due to variable presentations and similarities with other, more common, upper-limb pathologies. Although there is no gold standard diagnostic, local analgesic muscle-block response in a patient with the appropriate clinical context is often all that is required for an accurate diagnosis after excluding more common etiologies. Treatment ranges from conservative physical therapy to decompressive surgery, which is reserved for refractory cases or severe, acute vascular presentations. Decompression generally yields favorable outcomes, with most patients experiencing significant relief and restored baseline function. In conclusion, PMS and QSS, although rare, can cause debilitating upper-extremity symptoms; accurate diagnosis and appropriate treatment offer excellent outcomes, alleviating pain and disability.
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Affiliation(s)
- Peter N Drossopoulos
- University of North Carolina at Chapel Hill School of Medicine, 321 S Columbia Street, Chapel Hill, NC, 27599
| | - Colby Ruiz
- University of North Carolina at Chapel Hill School of Medicine, 321 S Columbia Street, Chapel Hill, NC, 27599; Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill School of Medicine, Burnett-Womack Building, 160 Dental Circle, Chapel Hill, NC, 27514
| | - Jonathan Mengistu
- University of North Carolina at Chapel Hill School of Medicine, 321 S Columbia Street, Chapel Hill, NC, 27599
| | - Charlotte B Smith
- University of North Carolina at Chapel Hill School of Medicine, 321 S Columbia Street, Chapel Hill, NC, 27599
| | - Luigi Pascarella
- University of North Carolina at Chapel Hill School of Medicine, 321 S Columbia Street, Chapel Hill, NC, 27599; Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill School of Medicine, Burnett-Womack Building, 160 Dental Circle, Chapel Hill, NC, 27514.
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2
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Beecher G, Dyck PJB, Zochodne DW. Axillary and musculocutaneous neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:135-148. [PMID: 38697736 DOI: 10.1016/b978-0-323-90108-6.00004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
This chapter covers axillary and musculocutaneous neuropathies, with a focus on clinically relevant anatomy, electrodiagnostic approaches, etiologic considerations, and management principles. Disorders of the lateral antebrachial cutaneous nerve, a derivative of the musculocutaneous nerve, are also reviewed. We emphasize the importance of objective findings, including the physical examination and electrodiagnostic evaluation in confirming the isolated involvement of each nerve which, along with the clinical history, informs etiologic considerations. Axillary and musculocutaneous neuropathies are both rare in isolation and most frequently occur in the setting of trauma. Less commonly encountered etiologies include external compression or entrapment, neoplastic involvement, or immune-mediated disorders including neuralgic amyotrophy, postsurgical inflammatory neuropathy, multifocal motor neuropathy, vasculitic neuropathy, and multifocal chronic inflammatory demyelinating polyradiculoneuropathy.
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Affiliation(s)
- Grayson Beecher
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, United States; Neuroscience and Mental Health Institute and Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - P James B Dyck
- Division of Neuromuscular Medicine, Department of Neurology, Mayo Clinic, Rochester, MN, United States; Peripheral Neuropathy Research Laboratory, Mayo Clinic, Rochester, MN, United States
| | - Douglas W Zochodne
- Neuroscience and Mental Health Institute and Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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3
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Akkus G, Karagun B, Çetinalp NE, Açıkalın A, Evran M, Sengöz S, Sert M, Zorludemir S, Tetiker T. Clinical Relevance and Immunohistochemical Patterns of Silent Pituitary Adenomas: 10 Years of Single-centre Experience. Curr Med Imaging 2021; 17:310-317. [PMID: 33357196 DOI: 10.2174/1573405616666201223125642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Silent pituitary adenomas are clinically non-functional (i.e., without clinically evident pituitary hormone production). INTRODUCTION The aim of this study was to investigate subjects with silent pituitary adenomas for possible variations in their clinical status. METHODS A total of 102 patients who had undergone surgery for pituitary adenoma and had been diagnosed with silent pituitary adenoma was included in the study. The patients' preoperative and postoperative hormonal parameters and magnetic resonance imaging (MRI) features were collected, and pathological specimens were re-evaluated. RESULTS Immunohistochemistry results of the 102 patients were as follows: hormone-negative adenomas (n=35) 35.5%; FSH+LH-positivity (n=32) 31.3%; ACTH-positivity (n=11) 10.7%; α-subunit- positivity (n= 9) 8.8%; prolactin-positivity (n=8) 7.8%; GH-positivity (n=6) 5.4%; and plurihormonal adenoma (n=1). The mean sizes of SGA, SGHA, and SCA were 28.0±12.7, 30.0±16.0, and 27.7±8.9mm (p>0.05), respectively. With the exception of silent gonadotroph adenomas (SGAs), female gender dominance was shown in patients with silent growth hormone adenoma (SGHA) and silent corticotroph adenoma (SCA). Although no clinical relevance was observed in relation to hormonal excess, preoperative GH (4.21±4.6, vs. 0.27±0.36 p=0.00) was slightly more elevated in SGHA than in GH-negative adenomas. Additionally, preoperative basal ACTH values (47.3±28.7 vs. 23.9±14.4, p=0.003) were also higher in SCA compared to the other types. Our findings revealed SCAs to be of more aggressive behaviour than SGHAs and SGAs due to invasiveness in radiological imaging, their elevated re-operation, and postoperative ACTH values. CONCLUSION Silent pituitary adenomas represent a challenging diagnostic tumour group. Careful initial evaluation of patients with pituitary adenomas should consider any mild signs and symptoms of functionality, particularly in cases of GH- and ACTH-secreting adenomas.
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Affiliation(s)
- Gamze Akkus
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Barış Karagun
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Nuri E Çetinalp
- Cukurova University, Faculty of Medicine, Division of Neurosurgery, Adana, Turkey
| | - Arbil Açıkalın
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Mehtap Evran
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Sinem Sengöz
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Murat Sert
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
| | - Suzan Zorludemir
- Cukurova University, Faculty of Medicine, Divison of Pathology, Adana, Turkey
| | - Tamer Tetiker
- Cukurova University, Faculty of Medicine, Division of Endocrinology, Adana, Turkey
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Zhang J, Zhang T, Wang R, Wang T. Musculoskeletal ultrasound diagnosis of quadrilateral space syndrome: A case report. Medicine (Baltimore) 2021; 100:e24976. [PMID: 33725866 PMCID: PMC7969238 DOI: 10.1097/md.0000000000024976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Quadrilateral space syndrome (QSS) is a peripheral nerve entrapment disease, which can be misdiagnosed in clinic. In the past, QSS was mainly diagnosed by clinical symptoms combined with magnetic resonance imaging (MRI), electromyography (EMG), and arterial angiography. There are few reports on the diagnosis of QSS by musculoskeletal ultrasound (MSKUS) combined with clinical symptoms. PATIENT CONCERNS A middle-aged female patient had posterolateral pain and numbness in her right shoulder for 2 months. DIAGNOSES At first, she was diagnosed as suprascapular nerve entrapment, while EMG of suprascapular nerve and axillary nerve indicated that nerve conduction was normal. Then, MRI was performed, showing the shoulder had no abnormalities, and EMG and arterial angiography of upper limb showed no abnormalities too. Finally, she was diagnosed as QSS according to MSKUS and lidocaine block test. INTERVENTIONS Two sealing treatments of axillary nerve block in quadrilateral space under the guidance of MSKUS were performed. OUTCOMES After 2 treatments, the pain and numbness in her shoulder disappeared, and her shoulder could move normally. There was no recurrence after 3 months of follow-up. CONCLUSION MSKUS is an effective method to diagnose QSS. It is fast, convenient and inexpensive, and is worth popularizing in clinic.
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 1 upper limb. Eur J Radiol 2020; 131:109234. [PMID: 32949858 DOI: 10.1016/j.ejrad.2020.109234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/21/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This article aims to review the pertinent anatomy, etiopathogenesis, current clinical and radiological concepts and principles of management in case of upper limb entrapment neuropathies. METHODS The review is based on critical analysis of the existing literature as well as our experience in dealing with entrapment neuropathies. RESULTS Entrapment neuropathies of the upper limb peripheral nerves are common conditions that are often misdiagnosed because of their varying clinical presentations and lack of standardized diagnostic methods. Clinical assessment and electrodiagnostic studies have been the mainstay; however, imaging techniques have provided newer insights into the pathophysiology of these entities, leading to a paradigm shift in their diagnosis and management. The current best practice protocols for entrapment syndromes are constantly evolving with increasing emphasis on the role high-resolution ultrasound and magnetic resonance imaging. Many imaging criteria are described and we have tried to present the most validated measurements for diagnosing entrapment neuropathies. CONCLUSION It is imperative for a clinical radiologist to be familiar with the etiopathogenesis and clinical features of these conditions, in addition to being thorough with the anatomy and the latest imaging strategies.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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6
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Hong CC, Thambiah MD, Manohara R. Quadrilateral space syndrome: The forgotten differential. J Orthop Surg (Hong Kong) 2020; 27:2309499019847145. [PMID: 31079528 DOI: 10.1177/2309499019847145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The quadrilateral space is bounded by the teres minor superiorly, the teres major inferiorly, the long head of the triceps medially and the shaft of the humerus laterally. The axillary nerve and posterior circumflex humeral artery pass through this space to enter the posterior compartment of the upper arm. Quadrilateral space syndrome (QSS) is caused by entrapment of the axillary nerve or its main branches and/or the posterior circumflex humeral artery in the quadrilateral space by internal or external compression. QSS can often be difficult to diagnose, given that patients may present with non-specific symptoms. As such, patients may be misdiagnosed with more common disorders of the shoulder. We report a case of QSS masquerading initially as rotator cuff pathology with positive impingement signs.
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Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Matthew Dhanaraj Thambiah
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Ruben Manohara
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
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7
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Quadrilateral Space Syndrome: Diagnosis and Clinical Management. J Clin Med 2018; 7:jcm7040086. [PMID: 29690525 PMCID: PMC5920460 DOI: 10.3390/jcm7040086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 11/17/2022] Open
Abstract
Quadrilateral space syndrome (QSS) is a rare disorder characterized by axillary nerve and posterior humeral circumflex artery (PHCA) compression within the quadrilateral space. Impingement is most frequently due to trauma, fibrous bands, or hypertrophy of one of the muscular borders. Diagnosis can be complicated by the presence of concurrent traumatic injuries, particularly in athletes. Since many other conditions can mimic QSS, it is often a diagnosis of exclusion. Conservative treatment is often first trialed, including physical exercise modification, physical therapy, and therapeutic massage. In patients unrelieved by conservative measures, surgical decompression of the quadrilateral space may be indicated.
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Brown SAN, Doolittle DA, Bohanon CJ, Jayaraj A, Naidu SG, Huettl EA, Renfree KJ, Oderich GS, Bjarnason H, Gloviczki P, Wysokinski WE, McPhail IR. Quadrilateral space syndrome: the Mayo Clinic experience with a new classification system and case series. Mayo Clin Proc 2015; 90:382-94. [PMID: 25649966 DOI: 10.1016/j.mayocp.2014.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/19/2014] [Accepted: 12/15/2014] [Indexed: 11/25/2022]
Abstract
Quadrilateral space syndrome (QSS) arises from compression or mechanical injury to the axillary nerve or the posterior circumflex humeral artery (PCHA) as they pass through the quadrilateral space (QS). Quadrilateral space syndrome is an uncommon cause of paresthesia and an underdiagnosed cause of digital ischemia in overhead athletes. Quadrilateral space syndrome can present with neurogenic symptoms (pain and weakness) secondary to axillary nerve compression. In addition, repeated abduction and external rotation of the arm is felt to lead to injury of the PCHA within the QSS. This often results in PCHA thrombosis and aneurysm formation, with distal emboli. Because of relative infrequency, QSS is rarely diagnosed on evaluation of athletes with such symptoms. We report on 9 patients who presented at Mayo Clinic with QSS. Differential diagnosis, a new classification system, and the management of QSS are discussed, with a comprehensive literature review. The following search terms were used on PubMed: axillary nerve, posterior circumflex humeral artery, quadrilateral space, and quadrangular space. Articles were selected if they described patients with symptoms from axillary nerve entrapment or PCHA thrombosis, or if related screening or imaging methods were assessed. References available within the obtained articles were also pursued. There was no date or language restriction for article inclusion; 5 studies in languages besides English were reported in German, French, Spanish, Turkish, and Chinese.
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Affiliation(s)
| | | | | | - Arjun Jayaraj
- Division of Vascular Surgery, Mayo Clinic, Rochester, MN
| | - Sailendra G Naidu
- Division of Vascular and Interventional Radiology, Mayo Clinic, Scottsdale, AZ
| | - Eric A Huettl
- Division of Vascular and Interventional Radiology, Mayo Clinic, Scottsdale, AZ
| | - Kevin J Renfree
- Department of Orthopedic Surgery, Mayo Clinic, Scottsdale, AZ
| | | | - Haraldur Bjarnason
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN
| | | | | | - Ian R McPhail
- Division of Vascular Medicine, Mayo Clinic, Rochester, MN; Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN.
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9
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Agneskirchner JD, Haag M, Lafosse L. [Arthroscopic nerve release and decompression of ganglion cysts around the shoulder joint]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2014; 26:277-87. [PMID: 24924508 DOI: 10.1007/s00064-013-0278-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Arthroscopic visualisation and release of nerves around the shoulder, decompression of ganglion cysts. INDICATIONS Arthroscopic treatment of nerve entrapment syndromes around the shoulder (suprascapular nerve, axillary nerve). Arthroscopic visualisation and release of osseous or ligamentous structures causing nerve entrapment. Arthroscopic decompression and resection of periglenoid ganglion cysts. Arthroscopic release of concomitant lesions (labrum, rotator cuff, biceps). CONTRAINDICATIONS No clinical or neurological evidence for nerve entrapment syndrome. Lack of conditions for a complex arthroscopic procedure (technique of visualisation, instrumentation, knowledge of specific neuroanatomy). SURGICAL TECHNIQUE Diagnostic arthroscopy, decompression/resection of ganglion cyst. Visualisation and decompression of nerve. Detection and fixation of concomitant pathologies. POSTOPERATIVE TREATMENT Immobilisation in sling during the day after the operation. Actively assisted and active mobilisation of shoulder controlled by discomfort level. Manual lymph drainage starting on postoperative day 1. Sling and further rehabilitation according to treatment of concomitant lesions.
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Affiliation(s)
- J D Agneskirchner
- Sportclinic Germany, Uhlemeyerstr. 16, 30175, Hannover, Deutschland,
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10
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Sonoelastography for the evaluation of an axillary schwannoma in a case of quadrilateral space syndrome. Clin Imaging 2014; 38:360-3. [DOI: 10.1016/j.clinimag.2013.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/01/2013] [Accepted: 12/26/2013] [Indexed: 02/07/2023]
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11
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The deltoid, a forgotten muscle of the shoulder. Skeletal Radiol 2013; 42:1361-75. [PMID: 23784480 DOI: 10.1007/s00256-013-1667-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 02/02/2023]
Abstract
The deltoid is a fascinating muscle with a significant role in shoulder function. It is comprised of three distinct portions (anterior or clavicular, middle or acromial, and posterior or spinal) and acts mainly as an abductor of the shoulder and stabilizer of the humeral head. Deltoid tears are not infrequently associated with large or massive rotator cuff tears and may further jeopardize shoulder function. A variety of other pathologies may affect the deltoid muscle including enthesitis, calcific tendinitis, myositis, infection, tumors, and chronic avulsion injury. Contracture of the deltoid following repeated intramuscular injections could present with progressive abduction deformity and winging of the scapula. The deltoid muscle and its innervating axillary nerve may be injured during shoulder surgery, which may have disastrous functional consequences. Axillary neuropathies leading to deltoid muscle dysfunction include traumatic injuries, quadrilateral space and Parsonage-Turner syndromes, and cause denervation of the deltoid muscle. Finally, abnormalities of the deltoid may originate from nearby pathologies of subdeltoid bursa, acromion, and distal clavicle.
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12
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Millett PJ, Schoenahl JY, Allen MJ, Motta T, Gaskill TR. An association between the inferior humeral head osteophyte and teres minor fatty infiltration: evidence for axillary nerve entrapment in glenohumeral osteoarthritis. J Shoulder Elbow Surg 2013; 22:215-21. [PMID: 22939404 DOI: 10.1016/j.jse.2012.05.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/11/2012] [Accepted: 05/15/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenohumeral osteoarthritis often results in inferior humeral osteophytes. Anatomic studies suggest that the axillary neurovascular bundle is in close proximity to the glenohumeral capsule. We therefore hypothesize that an inferior humeral osteophyte of sufficient magnitude could encroach on the axillary nerve and result in measurable fatty infiltration of the teres minor muscle. MATERIALS AND METHODS Preoperative magnetic resonance imaging studies of 91 consecutive arthritic shoulders were retrospectively reviewed. Two cohorts were established based on the presence of a humeral osteophyte. The distances from the axillary neurovascular bundle to various osseous structures were measured using calibrated software. Objective quantitative measurements of the degree of fatty infiltration of the teres minor muscles were obtained with image analysis software. Results were compared between cohorts. RESULTS The distance between the inferior humerus and axillary neurovascular bundle was inversely correlated to the size of the inferior humeral osteophyte (ρ = -0.631, P < .001). Fatty infiltration of the teres minor was greater when an inferior osteophyte was present (11.9%) than when an osteophyte was not present (4.4%) (P = .004). A statistically significant correlation between the size of the humeral head spur and quantity of fat in the teres minor muscle belly (ρ = 0.297, P = .005) was identified. CONCLUSION These data are consistent with our hypothesis that the axillary nerve may be entrapped by the inferior humeral osteophyte often presenting with glenohumeral osteoarthritis. Entrapment may affect axillary nerve function and lead to changes in the teres minor muscle. Axillary neuropathy from an inferior humeral osteophyte may represent a contributing and treatable cause of pain in patients with glenohumeral osteoarthritis.
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13
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Abstract
Peripheral nerve entrapments are frequent. They usually appear in anatomical tunnels such as the carpal tunnel. Nerve compressions may be due to external pressure such as the fibular nerve at the fibular head. Malignant or benign tumors may also damage the nerve. For each nerve from the upper and lower limbs, detailed clinical, electrophysiological, imaging, and therapeutic aspects are described. In the upper limbs, carpal tunnel syndrome and ulnar neuropathy at the elbow are the most frequent manifestations; the radial nerve is less frequently involved. Other nerves may occasionally be damaged and these are described also. In the lower limbs, the fibular nerve is most frequently involved, usually at the fibular head by external compression. Other nerves may also be involved and are therefore described. The clinical and electrophysiological examination are very important for the diagnosis, but imaging is also of great use. Treatments available for each nerve disease are discussed.
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Affiliation(s)
- P Bouche
- Department of Clinical Neurophysiology Salpêtrière Hospital, Paris, France.
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14
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Blum A, Lecocq S, Louis M, Wassel J, Moisei A, Teixeira P. The nerves around the shoulder. Eur J Radiol 2013; 82:2-16. [DOI: 10.1016/j.ejrad.2011.04.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/29/2011] [Indexed: 11/27/2022]
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15
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Chafik D, Galatz LM, Keener JD, Kim HM, Yamaguchi K. Teres minor muscle and related anatomy. J Shoulder Elbow Surg 2013; 22:108-14. [PMID: 22521388 DOI: 10.1016/j.jse.2011.12.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/07/2011] [Accepted: 12/19/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to describe the complex anatomy surrounding the teres minor muscle. METHODS Thirty-one cadaveric human shoulders were dissected. Qualitative fascial and neurovascular anatomy were described. Location of motor nerves to teres minor were measured in reference to local anatomy. RESULTS Fascial anatomy of the posterior shoulder had 2 distinct and equally common variants, 1 of which demonstrated a stout, inflexible fascial compartment enveloping the teres minor muscle. The other had a continuous fascia enveloping both the infraspinatus and teres minor muscles. In both variants, the primary nerve to teres minor traveled around a fascial sling, becoming sub-fascial at an average of 44 mm (range, 25-68) medial to the teres minor's insertion. The nerve took its most angulated course as it entered the fascial sling. Smaller accessory innervation of teres minor began, on average, 30 mm (range, 15-48) medial to the muscle's lateral insertion. None of the accessory motor nerves coursed deep to the fascial sling nor to the distinct teres minor fascial compartment. CONCLUSION A stout fascial sling may be the potential site of greatest compression and tethering of the primary motor nerve to teres minor. Additional lateral accessory motor nerves to teres minor remained extra-fascial and took a less angulated path. Half of the shoulders demonstrated a separate teres minor fascial compartment. An improved understanding of the fascial anatomy and innervation pattern of the teres minor muscle may help clinicians who treat patients with symptomatic isolated teres minor muscle atrophy.
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Affiliation(s)
- Dara Chafik
- Southwest Shoulder, Elbow and Hand Center, Tucson, AZ, USA
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16
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Eliahou R, Sosna J, Bloom AI. Between a rock and a hard place: clinical and imaging features of vascular compression syndromes. Radiographics 2012; 32:E33-49. [PMID: 22236908 DOI: 10.1148/rg.321115011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vascular compression syndromes are caused by the entrapment of vessels between rigid or semirigid surfaces in a confined anatomic space. Chronic entrapment may lead to arterial ischemia and embolism, venous stasis and thrombosis, and hematuria. These syndromes are usually seen in otherwise healthy young patients, among whom underdiagnosis is common. Most occurrences of vascular compression are associated with an underlying anatomic abnormality. In a small percentage of cases, other contributing factors, including repetitive microtrauma, may cause pathologic changes leading to the onset of pain and other symptoms of vascular and neural compression. Hence, the diagnosis must be based on both clinical and radiologic findings. Because some cases of vascular entrapment become symptomatic only when specific physical maneuvers are performed, dynamic diagnostic imaging methods are especially useful. Digital subtraction angiography has been the mainstay of imaging-based diagnosis for most vascular compression syndromes, but other methods (eg, color Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) are used with increasing frequency for initial diagnostic evaluation. Because vascular compression syndromes are caused by the external compression of vessels, endoluminal treatment alone is rarely adequate and surgical decompression is likely to be required for optimal and durable clinical benefit. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.321115011/-/DC1.
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Affiliation(s)
- Ruth Eliahou
- Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel
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17
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Arthroscopic trans-capsular axillary nerve decompression: indication and surgical technique. Arthroscopy 2011; 27:1444-8. [PMID: 21831569 DOI: 10.1016/j.arthro.2011.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 04/25/2011] [Accepted: 05/05/2011] [Indexed: 02/02/2023]
Abstract
Symptomatic axillary nerve compression is rare yet results in debilitating pain, weakness, and decreased athletic performance in some patients. If nonoperative modalities fail, surgical intervention is necessary to reduce symptoms and avoid functional decline. Traditionally, open techniques have been described to decompress the axillary nerve and are reported to provide satisfactory results. Similar to suprascapular nerve decompression, recent advances have provided the opportunity to develop all-arthroscopic axillary nerve decompression techniques. Although direct comparisons between open and arthroscopic techniques do not exist, arthroscopic axillary nerve decompression may provide some benefits over open techniques. Therefore we present a technique and early results for all-arthroscopic trans-capsular axillary nerve decompression.
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Arthroskopische Therapie von Nervenentrapmentläsionen und periglenoidalen Ganglien am Schultergelenk. ARTHROSKOPIE 2010. [DOI: 10.1007/s00142-010-0582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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de Lecluse J. Syndromes canalaires des nerfs axillaire, musculo-cutané et radial au coude. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.jts.2010.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality Imaging of Peripheral Neuropathies of the Upper Limb and Brachial Plexus. Radiographics 2010; 30:1373-400. [DOI: 10.1148/rg.305095169] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Síndrome del espacio cuadrilateral con denervación completa de los músculos deltoides y redondo menor. RADIOLOGIA 2010; 52:373-4. [DOI: 10.1016/j.rx.2010.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 03/14/2010] [Accepted: 03/17/2010] [Indexed: 11/19/2022]
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Nishida Y, Koh S, Fukuyama Y, Hirata H, Ishiguro N. Nodular fasciitis causing axillary nerve palsy: a case report. J Shoulder Elbow Surg 2010; 19:e1-4. [PMID: 20189836 DOI: 10.1016/j.jse.2009.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 10/26/2009] [Accepted: 10/27/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Yoshihiro Nishida
- Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Showa, Nagoya, Japan.
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McClelland D, Hoy G. A case of quadrilateral space syndrome with involvement of the long head of the triceps. Am J Sports Med 2008; 36:1615-7. [PMID: 18658023 DOI: 10.1177/0363546508321476] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
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. HYPOTHESIS 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. STUDY DESIGN 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. CONCLUSION 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.
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Affiliation(s)
- Timothy R McAdams
- Department of Orthopaedic Surgery, Stanford University, 1000 Welch Road, Suite 100, Palo Alto, CA 94304, USA.
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McClelland D, Paxinos A. The anatomy of the quadrilateral space with reference to quadrilateral space syndrome. J Shoulder Elbow Surg 2007; 17:162-4. [PMID: 17993281 DOI: 10.1016/j.jse.2007.05.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Accepted: 05/07/2007] [Indexed: 02/01/2023]
Abstract
Quadrilateral space syndrome is a rare condition in which the contents of the quadrilateral space, the axillary nerve and the posterior circumflex humeral artery, are compressed, leading to vague symptoms of shoulder pain, tenderness over the quadrilateral space on palpation, and teres minor and deltoid denervation. Fibrous bands within the quadrilateral space are often cited in the literature as a cause of compression in quadrilateral space syndrome; however, Cahill and Palmer did not see these bands in cadaveric dissection. These are postulated to cause compression of the quadrilateral space contents in abduction and external rotation of the shoulder. To clarify the anatomic features that may predispose the development of quadrilateral space syndrome, 16 cadaveric shoulders were studied. Dissection revealed that fibrous bands are a common finding in the quadrilateral space, being present in 14 of 16 shoulders. The most common site for a fibrous band was between the teres major and the long head of the triceps. Where the bands were present, both internal and external rotation of the shoulder caused a reduction in the cross-sectional area of the quadrilateral space.
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Affiliation(s)
- Damian McClelland
- University Hospital of North Staffordshire, Staffordshire, United Kingdom
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Fogelson MH, Craig WD, Mcphee JR, Lenert JT, Henry LR. Glenohumeral Joint Ganglion Cyst and Other Rare Cysts of the Axilla. Am Surg 2007. [DOI: 10.1177/000313480707300918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although ganglion cysts have been reported to arise from almost any joint, those arising from the glenohumeral joint producing an axillary mass are extremely rare. We report what we believe to be the eighth such case and describe its management. The unusual differential diagnosis and aids to diagnosis of axillary cysts are reviewed. Specific issues regarding axillary space ganglions are emphasized.
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Affiliation(s)
- Marc H. Fogelson
- Department of Orthopedic Surgery, United States Military Hospital, Kuwait Naval Hospital, Camp Pendleton, California
| | - William D. Craig
- Department of Radiology, United States Military Hospital, Kuwait National Naval Medical Center, Bethesda, Maryland
| | - Joseph R. Mcphee
- Department of General Surgery, United States Military Hospital, Kuwait Naval Hospital, Jacksonville, Florida
| | - Jeffrey T. Lenert
- Department of General Surgery, National Naval Medical Center, Bethesda, Maryland
| | - Leonard R. Henry
- Department of General Surgery, United States Military Hospital, Kuwait National Naval Medical Center, Bethesda, Maryland
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Abstract
Athletes are at particular risk of compromise of the neurovascular structures of the shoulder-specifically, neurovascular conditions distal to the brachial plexus. These conditions include thoracic outlet syndrome, axillary artery occlusion, effort thrombosis, suprascapular nerve entrapment, quadrilateral space syndrome, and complex regional pain syndrome. When diagnosed properly and in a timely fashion, function of the limb can be preserved. To accomplish this, the physician must possess a detailed understanding of the various clinical presentations, diagnostic techniques, and treatment options.
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Abstract
Peripheral nerve entrapment syndromes involve the compression of a short segment of a nerve at a specific site, as a result of the vulnerability of that nerve as it passes through a fibroosseous tunnel or an opening in fibrous or muscular tissue. Injury of the nerve may occur as a result of compression by the overlying structures. Another mechanism of injury is traction of the nerve, with or without friction of the nerve, as it travels and sharply changes direction around critical points. Imaging can be particularly helpful for the diagnosis of these uncommon injuries. Percutaneous decompression of a ganglion cyst or perineural injection for therapeutic purposes with the aid of fluoroscopy, CT, or ultrasound guidance can be performed in specific areas.
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Affiliation(s)
- E Pessis
- Service de Radiologie, Centre Cardiologique du Nord, 32, rue des Moulins Gémeaux, 93200 Saint-Denis.
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Amin MF, Berst M, el-Khoury GY. An unusual cause of the quadrilateral space impingement syndrome by a bone spike. Skeletal Radiol 2006; 35:956-8. [PMID: 16552605 DOI: 10.1007/s00256-006-0092-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 01/04/2006] [Accepted: 01/11/2006] [Indexed: 02/02/2023]
Abstract
The quadrilateral space impingement syndrome is a clinical syndrome resulting from compression of the axillary nerve and the posterior circumflex humeral artery, with subsequent focal atrophy of the teres minor, with or without involvement of portions of the deltoid muscle. This entity has many etiologies. We are reporting a case of this syndrome caused by a bone spike from a malunited old scapular fracture following a motor vehicle accident. The bone spike impinged on the axillary nerve as it passes through the quadrilateral space, causing focal atrophy of the teres minor muscle. The abnormality was well demonstrated by MD-CT.
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Affiliation(s)
- Mohammed F Amin
- University of Iowa Hospitals and Clinics, Radiology, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Cirpar M, Gudemez E, Cetik O, Uslu M, Eksioglu F. Quadrilateral space syndrome caused by a humeral osteochondroma: a case report and review of literature. HSS J 2006; 2:154-6. [PMID: 18751829 PMCID: PMC2488174 DOI: 10.1007/s11420-006-9019-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Quadrilateral space syndrome (QSS) is a rare condition in which the posterior humeral circumflex artery and the axillary nerve are entrapped within the quadrilateral space. The main causes of the entrapment are abnormal fibrous bands and hypertrophy of the muscular boundaries. Many other space-occupying causes such as a glenoidal labral cyst or fracture hematoma have been reported in the literature. However, we could not find a report on classical QSS caused by an osteochondroma. The aim of this case report is to attract attention to an unusual etiology of shoulder pain, and to emphasize the importance of physical examination and x-ray imaging before performing more complex attempts for differential diagnosing.
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Affiliation(s)
- Meric Cirpar
- Department of Orthopaedics and Traumatology, Kirikkale University Medical Faculty, Kirikkale, Turkey
- ODTU Saglik ve Rehberlik Merkezi, 71100 Kirikkale, Turkey
| | - Eftal Gudemez
- Department of Hand Surgery and Microsurgery, VKV American Hospital, Istanbul, Turkey
| | - Ozgur Cetik
- Department of Orthopaedics and Traumatology, Kirikkale University Medical Faculty, Kirikkale, Turkey
| | - Murad Uslu
- Department of Orthopaedics and Traumatology, Kirikkale University Medical Faculty, Kirikkale, Turkey
| | - Fatih Eksioglu
- Department of Orthopaedics and Traumatology, Kirikkale University Medical Faculty, Kirikkale, Turkey
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Brestas PS, Tsouroulas M, Nikolakopoulou Z, Malagari K, Drossos C. Ultrasound findings of teres minor denervation in suspected quadrilateral space syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:343-7. [PMID: 16869012 DOI: 10.1002/jcu.20239] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Isolated teres minor denervation is an uncommon finding on sonographic examination. We present a case of a 64-year-old man with increased echogenity of the teres minor muscle and a slight reduction in muscle bulk. Investigation of a suspected axillary nerve lesion included a detailed sonographic examination of the posterior shoulder and the axillary space, followed by MR imaging and electrophysiologic testing. This case demonstrates the potential importance of examining rotator cuff muscles when performing sonographic examination of the shoulder in patients with persistent symptoms, no history of trauma, and absence of tendon tears.
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Affiliation(s)
- Paraskevas S Brestas
- Department of Radiology, G. Gennimatas General Hospital of Athens, 154 Mesogeion Av., Athens, 11527, Greece
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Spinner RJ, Amrami KK, Kliot M, Johnston SP, Casañas J. Suprascapular intraneural ganglia and glenohumeral joint connections. J Neurosurg 2006; 104:551-7. [PMID: 16619659 DOI: 10.3171/jns.2006.104.4.551] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Unlike the more commonly noted paralabral cysts (extraneural ganglia), which are well known to result in suprascapular nerve compression, only four cases of suprascapular intraneural ganglia have been reported. Because of their rarity, the pathogenesis of suprascapular intraneural ganglia has been poorly understood and a pathoanatomical explanation has not been provided. In view of the growing literature demonstrating strong associations between paralabral cysts and labral (capsular) pathology, joint connections, and joint communications, the authors retrospectively reviewed the magnetic resonance (MR) imaging studies and postoperative results in the two featured patients to test a hypothesis that suprascapular intraneural ganglia would have analogous findings. METHODS Two patients who presented with suprascapular neuropathy were found to have intraneural ganglia. Connections to the glenohumeral joint could be established in both patients through posterior labrocapsular complex tears. In neither patient was the joint connection identified preoperatively or intraoperatively, and cyst decompression was performed by itself without attention to the labral tear. The suprascapular intraneural ganglia extended from the glenohumeral joint as far proximally as the level of the nerves' origin from the upper trunk in the supraclavicular fossa. Although both patients experienced symptomatic improvement after surgery, neurological recovery was incomplete. In both cases, postoperative MR images revealed cyst persistence. In addition, previously unrecognized superior labral anteroposterior (SLAP) Type II lesions (tears of the superior labrum extending anteroposterior and involving the biceps anchor at the labrum without actual extension into the tendon) were visualized. In one patient with a persistent cyst, an MR arthrogram was obtained and demonstrated a communication between the joint and the cyst. CONCLUSIONS The findings in these two patients support the synovial theory for intraneural ganglia. Based on their experience with intraneural ganglia at other sites, the authors believe that suprascapular intraneural ganglia arise from the glenohumeral joint, egress through a superior (posterior) labral tear, and dissect within the epineurium along an articular branch into the main nerve, following the path of least resistance. Furthermore, these two cases of intraneural ganglia with SLAP lesions are directly analogous to the many cases of paralabral cysts associated with these types of labral tears. By better understanding the origin of this unusual type of ganglia and drawing analogies to the more common extraneural cysts, surgical strategies can be formulated to address the underlying pathoanatomy, improve operative outcomes, and prevent recurrences.
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Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Ollat D, Martin M, Desmoineaux P, Beaufils P, Versier G. Kystes para-glénoïdiens gléno-huméraux. ACTA ACUST UNITED AC 2006; 92:214-22. [PMID: 16910603 DOI: 10.1016/s0035-1040(06)75728-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Paraglenoid glenohumeral cysts can be observed in 2-4% of the general population, particularly in men during the third and fourth decade. On average, these cysts measure 10-20 mm in diameter and are located preferentially on the posterosuperior aspect of the glenoid. An articular origin (rim injury) is generally accepted. The pathogenesis is similar to that of meniscal cysts. Depending on the exact localization, there is generally little clinical expression. The most frequent complication involves compression of the suprascapular nerve leading to suffering of the supra and/or infraspinatus. Amyotrophy can occur without clinical expression. An attentive examination is necessary to identify the cyst. EMG is often falsely negative. MRI is currently gold standard diagnostic tool but will probably be improved with arthro-MRI. Ultrasonography and computed tomography can visualize with difficulty small cysts located very close to the bone. The best treatment is arthroscopy which enables complete cure (emptying the cyst and resection or suture of the rim). We present a review of the pertinent literature together with a retrospective series of six cases of paraglenoid glenohumeral ganglion cysts.
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Affiliation(s)
- D Ollat
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital d'Instruction des Armées Bégin, Saint-Mandé
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Kim S, Choi JY, Huh YM, Song HT, Lee SA, Kim SM, Suh JS. Role of magnetic resonance imaging in entrapment and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity. Eur Radiol 2006; 17:509-22. [PMID: 16572333 DOI: 10.1007/s00330-006-0180-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 01/10/2006] [Accepted: 01/26/2006] [Indexed: 10/24/2022]
Abstract
The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging.
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Affiliation(s)
- Sungjun Kim
- Department of Diagnostic Radiology, College of Medicine, Yonsei University, 134, Shinchondong, Seodaemun-ku, 120-752 Seoul, South Korea
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Cothran RL, Helms C. Quadrilateral Space Syndrome: Incidence of Imaging Findings in a Population Referred for MRI of the Shoulder. AJR Am J Roentgenol 2005; 184:989-92. [PMID: 15728630 DOI: 10.2214/ajr.184.3.01840989] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the incidence of MRI findings suggesting quadrilateral space syndrome in a population referred for shoulder MRI. CONCLUSION Focal teres minor atrophy or abnormal signal suggesting quadrilateral space syndrome is an uncommon, although not rare, finding on MRI of the shoulder in our referral population and is rarely an isolated abnormality.
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Affiliation(s)
- R Lee Cothran
- Department of Radiology, Duke University Health System, Erwin Rd., Box 3808, DUMC, Durham, NC 27710, USA
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Affiliation(s)
- Thomas R McCauley
- Radiology Consultants, PC, 40 Temple Street, Suite 2B, New Haven, CT 06520, USA.
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Abstract
Nerve injuries about the shoulder in athletes are being recognized with increasing frequency. Prompt and correct diagnosis of these injuries is important to treat the patient and to understand the potential complications and natural history so as to appropriately counsel athletes. This 2-part article is a review and an overview of the current state of knowledge regarding some of the more common nerve injuries seen about the shoulder in athletes.
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Affiliation(s)
- Marc R Safran
- Department of Orthopaedic Surgery, University of California, San Francisco, California 94143-0728, USA.
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