Sensory disturbances and functional limitations on the lateral shoulder and arm

Introduction Quadrilateral space syndrome is a series of clinical syndromes caused by compression of the posterior circumflex artery and phrenic nerve at the four-sided hole. Its main manifestation is the sensory disturbance of the lateral arm of the sacral nerve and the limitation of deltoid function. The deltoid muscle may have atrophy, other muscles may have limited shoulder abduction, or the abduction force may be slow or disappeared on the lateral side of the shoulder and on the outside of the arm.

Cause

When the shoulder joint is abducted and externally rotated, the muscles that make up the four-sided hole are pulled, and the four sides are squeezed from three directions to cause the disease. Can be secondary to trauma to the shoulder or secondary to excessive movement of the upper limbs. Occurs in young adults aged 20-35, characterized by pain in the anterior and lateral sides of the shoulder joint, but the positioning is poor, and there is tenderness near the attachment area of the small round muscle. Some will have a deltoid or small round muscle atrophy.

an examination

Related inspection

Triceps reflex kinesthetic position

Symptoms: mainly occur in dominant limbs, or in bilateral limbs that begin with interstitial pain and numbness of the upper extremities, spreading to the forearm and palm of the upper arm. In the case of shoulder flexion, abduction, and external rotation, some cases have a history of nocturnal pain, and the symptoms of most cases are unconsciously aggravated. Trauma is a common cause. Johnson believes that injecting drugs after the sputum may cause sacral nerve damage. Cormier and Redier reported that one case of baseball pitcher suffered from this disease. The main manifestation was progressive shoulder pain. The pain was not fixed in front of the shoulder. One of them was radiated to the arm and hand. The symptoms of abduction and external rotation of the affected limb were all There is aggravation.

Signs: Neurological examinations are often found without abnormalities. The deltoid muscle may have atrophy, other muscles may have limited shoulder abduction, or the abduction force may be slow or disappeared on the lateral side of the shoulder and on the outside of the arm. Pressing the four holes from the back has a significant localized tenderness area. The tender area may be biased toward the outside of the hole. The affected limb is placed in the abduction external rotation for 1 min, which may induce symptoms.

Differential diagnosis

Pain in the shoulder: due to visceral disease, causing shoulder pain, or hyperalgesia, known as suffering. Symptoms appear to be slow, dull, or uncomfortable. They do not completely conform to the nerve direction, the area is blurred, and the pain is blurred.

Neck and shoulder pain: The main pain point is around the shoulder joint, so it is called the shoulder joint inflammation, referred to as shoulder inflammation, commonly known as condensed shoulder, leaking shoulder wind or frozen shoulder. The onset of the disease is mostly caused by freezing, trauma, and infection of tissues around the shoulder joints, such as tendons and bursae. Many patients are caused by rheumatism. The main symptoms are continuous pain in the neck and shoulders. The upper limbs of the affected side are elevated, rotated, and the swinging is limited. The feeling of cold in the wind is heavy and painful. If not treated in time, prolonged prolongation can cause joint adhesion, the upper limbs of the affected side become thin, weak and even form a disuse atrophy.

Pain in the shoulder or shoulder area and deep discomfort: one of the symptoms caused by cervical spondylosis.

Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

Limited shoulder activity: more common and inflammation around the shoulder joint and shoulder dislocation.

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