Quadrangular space syndrome

Case contributed by Dr Piyush P Siwach

Presentation

Known tear of right supraspinatus, ? extent.

Patient Data

Age: 60 years
Gender: Female
MRI

Severe fatty atrophy of teres minor muscle.

Varices, but no mass in the quadrangular space.

Unrelated to the other pathology, superior labral degeneration and tear, supraspinatus and infraspinatus tendinosis with a 10mm full thickness transverse tear in anterior to mid-supraspinatus tendon, and mild subacromial-subdeltoid bursitis.

MRI

Annotated images from the MRI highlighting the atrophied Teres minor muscle and varices in quadrangular space.

Case Discussion

The pattern of atrophy is consistent with chronic denervation of teres minor muscle. Teres minor tendon is intact, and tears of this tendon are uncommon even in large rotator cuff tears. Prominent veins are seen, but no mass or fibrosis is evident, in the quadrangular space, the site most likely to cause axillary nerve impingement resulting in this abnormality. A higher lesion is excluded as the deltoid muscle is normal in volume and signal intensity. Venous varicosities have not been described as a cause of this syndrome, so their significance in this case is indeterminate. In any case the atrophy of the muscle is terminal and beyond the stage of surgical decompression of the space. 

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Case information

rID: 53549
Case created: 23rd May 2017
Last edited: 21st Jun 2017
Inclusion in quiz mode: Included

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