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Surgical Decompression of the Quadrilateral Space in Overhead Athletes

Timothy R. McAdams, MD^,* and Michael F. Dillingham, MD

From the Department of Orthopaedic Surgery, Stanford University, Palo Alto, California, and SOAR Clinic, Redwood City, California

^* Address correspondence to Timothy R. McAdams, MD, Department of Orthopaedic Surgery, Stanford University, 1000 Welch Road, Suite 100, Palo Alto, CA 94304 (e-mail: tmcadams{at}stanford.edu).

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.

Key Words: quadrilateral space syndrome (QSS) • athlete • axillary nerve • computed tomography (CT) angiogram • surgery