Quadrilateral space syndrome| Kemble Wang Orthopaedics

Quadrilateral (Quadrangular) space syndrome

You have just undergone surgery for quadrilateral space syndrome with Kemble. This is a rare condition where one of the nerves (axillary nerve) or its branches at the back of the shoulder is compressed. This condition typically causes a burning feeling at the back of the shoulder. It is quite difficult to diagnose and it is not uncommon for patients to have suffered with symptoms for many months/years prior to diagnosis and treatment. The problem can arise out of the blue, or be secondary to trauma or other shoulder pathologies.

During the surgery, Kemble would have made an incision at the back of your shoulder, traced the nerve and all its branches, and made sure it is no longer compressed by any fibrous bands, cysts, or other abnormal tissue. Often, improvements in symptoms does not occur immediately. Just like a garden hose that has been trapped under the garage door for a long time, even when the garage door is lifted, often the water flow is not normal for a long time due to the kinking and damage done to the hose. Similarly, your burning pain may take weeks or months to slowly improve.

The following is a schematic diagram of the nerve and anatomy involved in quadrilateral (quandrangular space syndrome). This view is taken of the muscles and nerves from the back of the shoulder

Post operative recovery

0-2 weeks

When you wake up from the surgery, Kemble would have placed your arm in a sling. This is to rest the arm while your wound/skin/muscles heal. You may come out of the sling 3x a day to keep your elbow/wrist mobile. You may also come out of the sling to gently swing your shoulder (pendular motion exercises).

There will be a water resistant dressing at the back of your shoulder. This is water resistant but not waterproof - so you can briefly run it under water in the shower but do not submerge or run it under water for too long. This dressing stays intact until your first postoperative visit 10-14 days following surgery.

2-6 weeks

After your first post operative visit, you can come out of your sling to begin gentle shoulder range of motion exercises to regain your flexibility. You will be seeing a physiotherapist for this.

Allow all passive/gentle active shoulder ROM, but do not push past point of pain
However, limit active shoulder ER (to avoid contraction of teres minor), and avoid resisted triceps exercises. These two muscles border the quadrilateral space and over-stimulation in the early postoperative phase should be avoided.

6+ weeks

After 6 weeks following surgery, can work on shoulder strengthening exercises to regain your previous level of shoulder strength.
Can now also work on teres minor/triceps strengthening as these may have been affected by nerve compression, particularly teres minor.