b'ComplianceLEGAL NUTRITIONCouncilANJC Leadership ANJC Leadership LEGAL EASE NUTRITION Impersonating Rotator CuffREHAB Council Impingement: Quadrangular Space Syndrome By Dr. Tim BertelsmanThe axillary nerve lies anterior to thedeltoid numbness or paresthesia.Overhead athletes may benefit from LEGAL Q&A CHIROASSISTsubscapularis muscle, then descendsHowever, pain is not always prominent.selective rest and activity modification. Executive Directors UPDATE inferiorly, exiting the axilla posteriorlySensory symptoms, when present, areAlteration of throwing mechanics is a through the quadrangular space-often worse at night. Patients maysuccessful management tool in 75-90 bounded superiorly by the teres minor,complain of deltoid weakness, includingpercent of patients. Range of motion inferiorly by the teres major, mediallyrapid fatigue with overhead activity orexercises may be implemented to by the long head of the triceps, andoverhead lifting. Compressive symptomsprevent joint contracture. Conservative laterally by the humerus. After exitingare exacerbated during activity,care may include cross-friction massage the quadrangular space, the nerveespecially those involving arm abductionor myofascial release techniques to the Legislative Update and external rotation, i.e. late cockingmuscles of the quadrangular space, supplies a motor branch to the teres INSURANCE Update INSURANCE Update minor and another to the deltoid. A sensory branch supplies cutaneous innervation to the inferior deltoid region.TECHNIQUE CouncilAxillary nerve injury may result in loss of shoulder abduction (deltoid) or external rotation (teres minor).Axillary neuropathy may begin from blunt trauma to the anterior shoulder, MedicareQ&Aparticularly in sports such as skiing, football, rugby, baseball, hockey, soccer,OUR HEALTHweight lifting, and wrestling.Axillary nerve injuries accompany 9-18 percent of shoulder dislocations.Traumatic axillary nerve injuries may present as part of a more substantial brachial plexus injury. Chronic compression or traction is a more common mechanism of axillary neuropathy termed quadrangular space syndrome, aka, quadrilateral spacephase of throwing. QSS is difficult toglenohumeral mobilization, cross syndrome (QSS). QSS is more commondiagnosis and is frequently misidentifiedbody and posterior capsule/internal in young active adults, particularlyas shoulder impingement syndrome. rotation stretching, and rotator cuff overhead athletes, i.e., throwers andstrengthening. Clinicians should be swimmers. QSS is often caused by nerveClinical evaluation demonstrates compression from fibrous bands withinpoint tenderness at the quadrangularcautious to avoid positions that place the quadrangular space, particularly atspace (QSS sign). Symptoms may bethe axillary nerve in a state of sustained the inferior margin of the teres minor.exacerbated by placing the arm in a latetraction (i.e., late cocking). EMS, This presentation is common in throwingcocking position while resisting internalincluding Russian stim, has been utilized athletes. QSS may also result fromrotation. Resisted muscle testing mayin an attempt to minimize deltoid carrying a heavy backpack, the misuse ofdemonstrate weakness in abductionmuscle wasting. Axillary nerve injuries crutches, overdevelopment/hypertrophy(deltoid) or external rotation (teresheal slowly, and surgical intervention is of the muscles forming the quadrangularminor). Clinicians should be cognizantgenerally not considered until conserva-space, or ganglion/paralabral cyst.that weakness may be masked bytive management fails to restore muscle The condition is more common in thecompensatory muscle recruitment.function in three to six months. dominant shoulder. Long-standing compression may result The clinical presentation typicallyin deltoid atrophy. Tim Bertelsman, DC, CCSP, DACO, is a consists of dull, poorly localizedConservative management affords goodpast president of the Illinois Chiropractic shoulder aching with possible vagueoutcomes for the majority of patients.Society and co-founder of ChiroUp.com.16 I Spring2019 www.anjc.info'