Axillary nerve decompression for quadrangular syndrome
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Axillary nerve exposure and decompression may be required for primary entrapment neuropathy known as the “quadrangular space syndrome”, for evaluation of an axillary nerve injury and optimisation of the environment for recovery from more proximal injury or for poor regeneration following C5 spinal nerve root decompression.The symptoms and functional loss will be defined by the underlying pathology.
Quadrangular space syndrome was reported in throwing athletes and those engaged in overhead activity. In this condition there is usually posterior shoulder pain with sensory disturbance in the upper lateral cutaneous nerve territory, weakness of the deltoid and often paralysis of the teres minor resulting in impaired shoulder external rotation in the elevated and abducted shoulder position. There is often occlusion of the posterior circumflex humeral artery on shoulder abduction and external rotation (the ABER position). Placing the patient’s arm in this position may induce symptom onset and is a clinical examination test supporting the diagnosis.
Decompression is performed using a posterior approach and the axillary nerve can be evaluated with nerve stimulation. Compression points can be released using this approach, however the full course of the axillary nerve from its take-off from the posterior cord cannot be visualised and in trauma presenting early an anterior approach is to be preferred to facilitate access for reconstruction of a ruptured nerve. In late presenting cases, the posterior approach is more useful because if there is no functional continuity of the axillary nerve, a nerve transfer from the triceps motor branches can be performed close to the axillary nerve motor points, allowing late salvage of a complete lesion of the axillary nerve.
The modified Somsak nerve transfer technique is described as a separate operative technique in OrthOracle https://www.orthoracle.com/library/modified-somsak-nerve-transfer-medial-head-triceps-nerve-transfer-anterior-division-axillary-nerve-posterior-approach/
Author:Dominic Power FRCS Tr & Orth, Consultant Hand and Peripheral Nerve Surgeon.
Institution: West Midlands Peripheral Nerve Injury Service, Birmingham Hand Centre, UK.
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Question 1 of 15
Quadrangular space syndrome is commonly associated with which one of the following sports?CorrectIncorrect
Question 2 of 15
Which one of the following is the nerve root innervation of the teres minor muscle?CorrectIncorrect
Question 3 of 15
Which one of the following best describes the innervation of the deltoid muscle?CorrectIncorrect
Question 4 of 15
Which one of the following forms the inferior boundary of the quadrangular space when viewed from posteriorly?CorrectIncorrect
Question 5 of 15
Which one of the following passes through the quadrangular space with the axillary nerve?CorrectIncorrect
Question 6 of 15
Which one of the following is the most proximal branch to the triceps muscle?CorrectIncorrect
Question 7 of 15
Which one of the following is the nerve supply of teres majorCorrectIncorrect
Question 8 of 15
Which one of the following structures forms the medial border of the quadrangular space?CorrectIncorrect
Question 9 of 15
Viewed from anteriorly, which one of the following structures forms the inferior border of the quadrilateral space?CorrectIncorrect
Question 10 of 15
Which one of the following structures can be released to decompress the axillary nerve in the quadrangular space?CorrectIncorrect
Question 11 of 15
Which one of the following is not a branch from the posterior division of the axillary nerve?CorrectIncorrect
Question 12 of 15
Which one of the following branches was described by Somsak Leechavengvongs as a donor nerve for nerve transfer to the axillary nerve?CorrectIncorrect
Question 13 of 15
Which one of the following is the approximate distance that the anterior division of the axillary nerve lies distal to the lateral border of the acromion?CorrectIncorrect
Question 14 of 15
Which one of the following structures does not pass through the lateral triangular space?CorrectIncorrect
Question 15 of 15
Which one of the following structures passes through the medial triangular space between teres minor and trees major?CorrectIncorrect