Quadrilateral hole syndrome
Introduction
Introduction to the four-sided hole syndrome Quadrilateral space syndrome (quadrilateral spacesyndrome) is a series of clinical syndromes caused by compression of the posterior circumflex artery and phrenic nerve at the four-sided hole. The main manifestations are 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. basic knowledge The proportion of illness: 0.06% Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
Cause of quadrilateral hole syndrome
(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 space 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 obliquely posterior to the posterior tract. The upper edge of the four-sided hole passes through the hole and continues along the deep layer of the deltoid muscle, and walks forward. The skin branch that dominates the skin on the outer side of the shoulder arm penetrates the muscle into the skin. The large round muscle starts from the back of the lower scapula and the infraorbital fascia. Stop at the humerus nodules, so that the humerus adducts the internal rotation, the small round muscle starts from the back of the scapula, ends in the lower part of the humerus, makes the humerus adduct and external rotation, the triceps long head starts from the scapula The underarm trochanter, combined with the other two ends, ends 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.
Prevention
Prevention of quadrilateral hole syndrome
No special precautions.
Complication
Complications of quadrilateral hole syndrome Complication
No complications.
Symptom
Symptoms of quadrilateral hole syndrome Common symptoms Inability to limit the pain at the four sides of the hole
1. Symptoms mainly occur in the dominant limbs, and can also occur in the bilateral limbs, beginning with interstitial pain and numbness of the upper extremities, spreading to the upper arm, forearm and hand, flexing the abductor during abduction, abduction, and external rotation. In some cases, there is a history of nocturnal pain. In most cases, the symptoms are aggravated unconsciously. Trauma is a common cause. Johnson believes that injecting drugs after sputum may cause sacral nerve injury. Cormier and Redier reported 1 case of baseball pitcher. The main manifestation of this disease is progressive shoulder pain. The pain is not fixed in front of the shoulder. One of them is radiated to the arm and hand. The limb is abducted and the symptoms are aggravated when the external rotation occurs.
2. Signs of neurological examination are often found without abnormalities. The deltoid muscle may have atrophy, other muscles are normal, shoulder abduction may be limited, or abduction strength may be reduced, and the lateral side of the shoulder and the lateral side of the arm may be dull or disappear, and the four sides of the hole are pressed from the back. There is an obvious localized tenderness area. The tender area may be biased to the outside of the hole, and the affected limb is placed in the abduction external rotation for 1 min, which may induce symptoms.
Examine
Examination of quadrilateral hole syndrome
1. Electrophysiological examination revealed that the deltoid muscle has a denervation potential and the phrenic nerve conduction velocity is slowed down.
2. Angiography is to understand whether the phrenic nerve is under pressure by developing the artery after the rotator.
Diagnosis
Diagnosis and diagnosis of quadrilateral hole syndrome
The diagnosis mainly depends on the physical examination results, namely: localized tenderness at the four sides of the hole, numbness of the lateral shoulder and shoulder abduction weakness or limitation, electrophysiological examination, it can be found that the deltoid muscle has denervation potential, and the phrenic nerve conduction velocity is slowed down.
