Department of Ultrasound, Baoji High-tech Hospital, Baoji, Shaanxi, China.
Medicine (Baltimore). 2021 Mar 12;100(10):e24976. doi: 10.1097/MD.0000000000024976.
Quadrilateral space syndrome (QSS) is a peripheral nerve entrapment disease, which can be misdiagnosed in clinic. In the past, QSS was mainly diagnosed by clinical symptoms combined with magnetic resonance imaging (MRI), electromyography (EMG), and arterial angiography. There are few reports on the diagnosis of QSS by musculoskeletal ultrasound (MSKUS) combined with clinical symptoms.
A middle-aged female patient had posterolateral pain and numbness in her right shoulder for 2 months.
At first, she was diagnosed as suprascapular nerve entrapment, while EMG of suprascapular nerve and axillary nerve indicated that nerve conduction was normal. Then, MRI was performed, showing the shoulder had no abnormalities, and EMG and arterial angiography of upper limb showed no abnormalities too. Finally, she was diagnosed as QSS according to MSKUS and lidocaine block test.
Two sealing treatments of axillary nerve block in quadrilateral space under the guidance of MSKUS were performed.
After 2 treatments, the pain and numbness in her shoulder disappeared, and her shoulder could move normally. There was no recurrence after 3 months of follow-up.
MSKUS is an effective method to diagnose QSS. It is fast, convenient and inexpensive, and is worth popularizing in clinic.
四边孔综合征（QSS）是一种周围神经卡压性疾病，临床上易误诊。既往 QSS 主要依靠临床症状结合磁共振成像（MRI）、肌电图（EMG）、动脉造影等来诊断，少见 MSKUS 联合临床症状诊断 QSS 的报道。
一位中年女性患者，右肩部后外侧疼痛伴麻木 2 个月。
起初诊断为肩胛上神经卡压，而行肩胛上神经及腋神经 EMG 检查提示神经传导正常。进一步行 MRI 检查未见肩关节异常，上肢 EMG 和动脉造影未见异常。最后根据 MSKUS 和利多卡因阻滞试验诊断为 QSS。
在 MSKUS 引导下行腋神经四边孔封闭治疗 2 次。
2 次治疗后，患者肩部疼痛、麻木感消失，肩部活动恢复正常，随访 3 个月无复发。
MSKUS 是诊断 QSS 的有效方法，具有快速、便捷、经济的优点，值得在临床上推广应用。
