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Introduction: Quadrangular space syndrome includes compression of the axillary nerve and posterior circumflex humeral artery and its administration in couple of cases, requires careful decompression.
Aim: To compare the anterior and posterior surgical decompression approaches and to determine the scoring for both the approaches in QSS.
Materials and methods: A pilot study was conducted from January 2020 to August 2021 academic session of the first-year medical students in the Department of Anatomy in which four human cadavers were dissected in the Axillae and the Scapular region by the senior residents of the Department of Anatomy and Department of Orthopedics, who dissected quadrangular space in the eight upper limbs, using anterior and posterior surgical approaches.
Results: Posterior approach to identify the quadrangular space and secure its contents was recognized as the easier and much quicker method by both the Anatomy and Orthopedic residents, but the incision/reflection of deltoid muscle in this approach results in increased postoperative morbidity. Whereas the anterior (Delto-pectoral) approach involves more skill but reduces post operative morbidity.
Conclusions: Anterior (Delto-pectoral) approach with suggested modifications can prove as an effective method in surgical decompression of quadrangular space syndrome. The authors suggest more cadaveric studies to facilitate anatomists and surgeons with the opportunities to practice and evaluate older and newer surgical approaches.
1. Robert H. Miller, Frederick M Azar, Thomas W. Throckmorton. Campbell’s Operative Orthopaedics. Twelfth edition. Volume 3. Part 13. Sports Medicine. Chapter 46. Shoulder and Elbow injuries. Page: 2238.
2. Van de Pol D, Kuijer PP, Langenhorst T, Maas M. High prevalence of self-reported symptoms of digital ischemia in elite male volleyball players in the Netherlands: a cross-sectional national survey. Am J Sports Med. 2012;40(10):2296-2302.
3. Cormier PJ, Matalon TA, Wolin PM. Quadrilateral space syndrome: a rare cause of shoulder pain. Radiology. 1988;167(3):797-798.
4. McClelland D, Hoy G. A case of quadrilateral space syndromewith involvement of the long head of the triceps. Am J SportsMed. 2008;36(8):1615-1617.
5. Reutter D, Hunziker R, Husmann M. Computed angiogram ofthe upper extremities for diagnosing a rare cause of brachialarterial embolism: the “Pitcher Syndrome”. Eur Heart J. 2010;31(22):2782.
6. Chautems RC, Glauser T, Waeber-Fey MC, Ros tanO,Barraud GE. Quadrilateral space syndrome: case report and reviewof the literature. Ann Vasc Surg. 2000;14(6):673-676.
7. Brown, S.A.; Doolittle, D.A.; Bohanon, C.J., et al. Quadrilateral space syndrome: The mayo clinic experience with a new classification system and case series. Mayo Clin. Proc. 2015, 90, 382–394.
8. Brown, D.L.; Chung, K.C. Quadrangular space syndrome associated with superficial radial sensoryneuropathy. Ann. Plast. Surg. 1999, 43, 207–210.
9. Jackson, M.R. Upper extremity arterial injuries in athletes. Semin. Vasc. Surg. 2003, 16, 232–239.
10. Snell Richard S. Clinical Anatomy by Regions. 9th edition. Chapter 9. The Upper Limb. Quadrangu lar space. 359.
11. Manske R.C, Sumler A., Runge J. Quadrilateral space syndrome. Hum. Kinet. 2009; 14:45–47.
12. Jonas Andermahr, Michael McKee, Diane Nam. AO Surgery Reference. First edition. 2015. Delto pectoral approach. https://surgeryreference.ao foundation.org/orthopedic-trauma/adult-trauma/ clavicle/additional-credits.
13. Cahill BR, Palmer RE. Quadrangular space syndrome. J Hand Surg Am. 1983. Jan;8(1):65-9.
14. Paul Rea. Essential Clinically Applied Anatomy of the Peripheral Nervous System in the Head and Neck. ScienceDirect. Neck. 3.15.1 Axillary Nerve. 2016.
15. Juneja P, Hubbard JB. StatPearls [Internet]. Stat Pearls Publishing; Treasure Island (FL): Aug 22, 2020. Anatomy, Shoulder and Upper Limb, Arm Teres Minor Muscle.
16. Elzanie A, Varacallo M. StatPearls [Internet]. Stat Pearls Publishing; Treasure Island (FL): Aug 22, 2020. Anatomy, Shoulder and Upper Limb, Deltoid Muscle.
17. Jon J.P. Warner, Joseph P. Iannotti, Evan L. Flatow. Complex and Revision Problems in Shoulder Surgery. Second edition. Chapter 34. Deltoid Injuries. 650.
18. Francel Thomas J. M.D.; Dellon, A Lee M.D.; Campbell, James N. M.D. Quadrilateral Space Syndrome: Diagnosis and Operative Decompression Technique, Plastic and Reconstructive Surgery. 1991; 87: (5) : 911-916.
19. Feigl G, Aichner E, Mattersberger C, Zahn PK, Avila Gonzalez C, Litz R. Ultrasound-guided anterior approach to the axillary and intercostobrachial nerves in the axillary fossa: an anatomical investigation. Br J Anaesth. 2018;121(4):883-889.
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