Poster 250 Pain Relief for Plantar Fasciitis after Hydrodissection of Plantar Fascia from Pseudofascia: A Case Report

Abstract

Disclosures: T. P. DeWald, No Disclosures: I Have No Relevant Financial Relationships to Disclose. Case Description: A right-hand-dominant 23-year-old male swimmer presented with persistent right shoulder pain, numbness, and paresthesia with radiation down the medial aspect of the right upper extremity. Patient stated that symptoms started gradually over a week and would only present during distances over 1,000 meters. Symptoms resolved when the athlete ceased activity. Setting: University Sports Medicine Clinic. Results or Clinical Course: Patient was treated conservatively with observation. Patient demonstrated normal physical examination. However, patient’s symptoms were reproduced with his right arm fully abducted and externally rotated and equivocal Adson’s test. Venous and arterial ultrasounds of the right upper extremity were obtained with no evidence of vessel obstruction. IR angiogram was then performed and did not show venous or arterial thoracic outlet syndrome. However, during provocative maneuver of extreme abduction and external rotation patient exhibited compression of the bilateral axillary arteries and circumflex humeral arteries. MRI of the right shoulder was negative for fat atrophy of teres minor and infraspinatus mucles. Electrodiagnostic studies did not demonstrate abnormalities in the axillary, ulnar, or median nerves with normal EMG of corresponding muscles. Patient resumed activity and continued to swim competitively with modification in training duration and regimen, demonstrating improvement in symptoms. The athlete will be evaluated for possible surgical decompression in the offseason. Discussion: Quadrilateral space syndrome is a rare condition arising from the compression of the axillary nerve and posterior circumflex humeral artery within the quadrilateral space. Ours is a unique case in which an athlete is demonstrating transient, ischemic quadrilateral space syndrome after long distance swimming. Muscle hypertrophy or fibrotic band formation have been implicated in pathology. Surgical decompression has proven to be successful in alleviating symptoms. Conclusions: Quadrilateral space syndrome should be considered as a differential diagnosis in young athletes with persistent shoulder pain and neuromuscular compromise as it can be missed.