Localized tenderness at quadrilateral foramen

Introduction The physical examination of the four-sided hole syndrome showed localized tenderness at the four-sided hole. 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. Can be secondary to trauma to the shoulder or secondary to excessive movement of the upper limbs. In 1980, Cahill first described the four-hole syndrome. In 1983, Cahill et al reported the clinical manifestations, diagnosis, surgical methods and good surgical results of 18 cases of quadrilateral hole syndrome.

Cause

(1) Causes of the disease

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.

(two) pathogenesis

The four-sided hole is an anatomical gap composed of the small round muscle, the large round muscle, the triceps, and the medial edge of the surgical neck of the humerus. There is a layer of fascia between the large and small round muscles. The phrenic nerve is slanted backwards from the posterior side of the sacral nerve. The upper edge of the four-sided hole passes through the hole and continues to move outward and forward along the deep layer of the deltoid muscle, tying the shoulder arm. The skin branch of the lateral skin feels through the muscles and enters the skin. The large round muscle starts from the back of the lower scapula and the inferior fascia. It stops at the humerus nodules and causes the humerus to retract. The small round muscle starts from the back of the scapula and ends in the lower part of the greater humerus, allowing the humerus to adduct and rotate. The triceps long head starts from the scapula under the scapula, and merges with the other two ends to stop at the olecranon. When the shoulder joint is abducted and externally rotated, the three muscles are pulled, and the four holes are pressed from above, below and inside.

an examination

Related inspection

Electromyography CT examination

1. Symptoms: mainly occur in dominant limbs, and can also occur in both limbs. Beginning with interstitial pain and numbness in the upper extremities, spread to the upper arm, forearm and hand. Symptoms worsen when the shoulder joint is flexed, abducted, and externally rotated. 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 radial 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.

2. Signs: Neurological examinations are often found without abnormalities. The deltoid muscle may have atrophy and the other muscles are normal. Shoulder abduction may be limited, or absorptive strength may decrease. The lateral side of the shoulder and the outside of the arm feel dull or disappear. Pressing the four side holes from the rear has a significant localized tenderness zone, and the tenderness zone may be biased toward the outside of the hole. The affected limb was placed in the abduction external rotation for 1 min, which can induce symptoms.

The diagnosis relies mainly on the results of the physical examination, namely: localized tenderness at the four-sided hole, numbness of the lateral shoulder and shoulder abduction weakness or limitation. Electrophysiological examination revealed that the deltoid muscle had a denervation potential and the phrenic nerve conduction velocity slowed down.

Differential diagnosis

Arm pain refers to the symptoms of pain in the entire upper limb, that is, below the shoulder, above the sputum (excluding the palm, finger). As early as in the "Lingshu. Meridian", there are records such as "pre-treatment of pain in the armpits", "pain in front of the shoulders" and "pain in the shoulders and elbows". There have been many explanations in the medical books of the past dynasties, but there is always no stagnation of the qi and blood running through the parts of the hand sputum yin and the hand yang yang meridians discussed in the "Lingshu. Meridian". The mechanism of general pain. Arm pain can also occur in certain visceral lesions. For example, "Su Wen. The Theory of Dirty Gas Law": "The heart disease...the pain in both arms" is the radiation pain of the shoulder arm caused by the heart and pulse.

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.

Stretching arm and shaking hands: Rotating with tendonitis, for the early stage of the disease, the pain only occurs when the upper arm is lifted high and the force is abducted. Later, when the arm is shaken, it will also appear. Normally, the pain attacks when pushing forward, and there is no or only slight pain when pulling things.

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