Quadrilateral space syndrome caused by a ganglion

Abstract

A 44-year-old man, a sheet metal worker, sustained a bruise to his right shoulder after striking it against a cart at work in April 1994. The pain in his right shoulder did not subside, and he visited our hospital 4 days after the accident. One year before the accident this same worker had dislocated his right shoulder in a severe fall. The patient reported pain throughout the posterior region of his shoulder. It was exacerbated by external rotation and flexion. Tenderness was present in the quadrilateral space. There were no limitations in the range of motion of the shoulder joint, muscle weakness, tendon reflex deficits, or perception loss. X-ray films depicted no abnormalities. Therefore nonsteroidal antiinflammatory drugs were prescribed, and the course was observed. The patient returned to the hospital 5 days after the initial visit with persistent pain. He was unable to return to work because of the pain, which also interfered with his sleep. Because the symptoms were atypical for a simple bruise, the patient was examined with magnetic resonance imaging on the eleventh day. Both the Tland T2-weighted magnetic resonance images depicted an image compatible with a cyst in the lower region of his right axilla, indicating either a synovial hernia or a ganglion (Figures 1 and 2). Resection of the cyst was attempted on the twenty-fifth day after the injury. The patient was