You’ve heard the old cliché. “If it walks like a duck, talks like a duck–it’s a duck.”
Is it always a duck? Or an amazing imitator? Take Quadrilateral Space Syndrome for instance.
“The typical presentation of a patient with QSS is slow onset, intermittent, and poorly localized shoulder pain without trauma. Pain has been described as posterior as well as over the lateral shoulder and arm. Paresthesias of the affected upper extremity in a non-dermatomal distribution, usually over the posterior or lateral aspect of the shoulder and arm, or both, without diminished sensation to light touch are commonly seen. These symptoms are typically aggravated by abduction and external rotation of the affected shoulder. Throwing athletes may describe pain with the late cocking phase of throwing and shoulder fatigue in the overhead position.”
This duck looks exactly like a rotator cuff or labral problem. While diagnosis can be tricky, remember there are orthopedic testing clusters to help rule in/out pathology with the rotator cuff and labrum. If these tests don’t indicate their involvement, than some good old fashion palpation may be helpful.
“Point tenderness over the QS is almost always seen and can help distinguish QSS from rotator cuff or labral pathology. Palpation of the QS sometimes causes lateral shoulder pain or paresthesias. Holding the arm in ﬂexion, abduction, and external rotation for 1 to 2 minutes has been described as a method to recreate the patient’s symptoms.”
You’ll be happy to know, conservative management of this has shown success. Enjoy the article!
In the article below, the authors from the University of Florida, Gainesville conduct a Narrative Review of the published research involving Quadrilateral Space Syndrome.