Spontaneous resolution of quadrilateral space syndrome: a case report.

American journal of physical medicine & rehabilitation (2014-10-31)
Thomas Gregory, Harpreet Sangha, Robert Bleakney
ABSTRACT

A case of quadrilateral space syndrome is presented, where a large near-circumferential glenoid labrum tear led to a paralabral cyst that dissected into the quadrilateral space and caused a compressive neuropathy of the axillary nerve. This led to a 6-mo history of left shoulder pain, parasthesias, marked weakness to abduction, and marked denervation in both the deltoid and teres minor on electro-diagnostics. This is a presentation of interest as it is the only case report in the literature, to the authors' knowledge, where spontaneous resolution of entrapment occurred. This normally requires intervention for definitive management. It resolved through nonsurgical management with pregabalin, oxycodon, and naproxen medications, leading to good functional return, as well as pain and presumed muscle edema dissipation, while awaiting interventional consultation. It also illustrates that quadrilateral space syndrome is a difficult clinical diagnosis owing to the nonspecific symptom presentation, as well as weakness.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
γ-Aminobutyric acid, ≥99%
Supelco
Naproxen, Pharmaceutical Secondary Standard; Certified Reference Material
Supelco
γ-Aminobutyric acid, analytical standard
Sigma-Aldrich
Naproxen, meets USP testing specifications
Supelco
Oxycodone solution, 1.0 mg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®
Sigma-Aldrich
γ-Aminobutyric acid, BioXtra, ≥99%
Supelco
Oxycodone hydrochloride, analytical standard
Sigma-Aldrich
(S)-(+)-6-Methoxy-α-methyl-2-naphthaleneacetic acid, 98%
Supelco
Naproxen, VETRANAL®, analytical standard
USP
Naproxen, United States Pharmacopeia (USP) Reference Standard
Supelco
Naproxen solution, 1.0 mg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®
Vigabatrin impurity D, European Pharmacopoeia (EP) Reference Standard
Naproxen, European Pharmacopoeia (EP) Reference Standard