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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
TERMINOLOGY
Synonyms
- Parsonage-Turner syndrome, acute brachial neuritis, neuralgic amyotrophy, acute brachial radiculitis, quadrilateral space syndrome, idiopathic teres minor edema, neurogenic edema, denervation edema
Definitions
- Edema within rotator cuff muscle(s) from motor nerve abnormality
- May also involve deltoid muscle
- Parsonage-Turner syndrome (viral neuritis)
- Usually involves suprascapular nerve
- ~ 90% have denervation edema in supraspinatus and infraspinatus muscles
- 2/3 have ≥ 3 muscles involved
- Deltoid is 3rd most commonly involved muscle
- Can have deltoid edema without teres minor edema if neuritis only involves 6th cervical nerve portion of axillary nerve
- Quadrilateral space syndrome
- Axillary nerve compression/injury, most commonly due to fibrous band or paralabral cyst
- Teres minor and deltoid muscle denervation edema or atrophy, depending on chronicity
- Compression of posterior humeral circumflex artery
- Other
- Idiopathic teres minor atrophy
- Older patients with cuff tears or degenerative joint disease (DJD) and chronic irritation of axillary nerve branch
- Younger patients with inflexible fascial compartment
- Spinoglenoid or suprascapular notch paralabral ganglion cyst
- Brachial plexus injury or mass
- Idiopathic teres minor atrophy
- Edema within rotator cuff muscle(s) from motor nerve abnormality
IMAGING
General Features
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Hong CC et al: Quadrilateral space syndrome: the forgotten differential. J Orthop Surg (Hong Kong). 27(2):2309499019847145, 2019
- Ahlawat S et al: Spectrum of suprascapular nerve lesions: normal and abnormal neuromuscular imaging appearances on 3-T MR neurography. AJR Am J Roentgenol. 204(3):589-601, 2015
- Brown SA et al: Quadrilateral space syndrome: the Mayo Clinic experience with a new classification system and case series. Mayo Clin Proc. 90(3):382-94, 2015
- Gregory T et al: Spontaneous resolution of quadrilateral space syndrome: a case report. Am J Phys Med Rehabil. 94(1):e1-5, 2015
- Kruse LM et al: Clinical outcomes after decompression of the nerve to the teres minor in patients with idiopathic isolated teres minor fatty atrophy. J Shoulder Elbow Surg. 24(4):628-33, 2015
- Gupta A et al: Neuralgic amyotrophy (Parsonage Turner syndrome). Orthopedics. 37(2):75, 130-33, 2014
- Zurkiya O et al: Quadrilateral space syndrome. J Vasc Interv Radiol. 25(2):229, 2014
- Apaydin N et al: Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury. Surg Radiol Anat. 32(3):193-201, 2010
- Friend J et al: Teres minor innervation in the context of isolated muscle atrophy. Surg Radiol Anat. 32(3):243-9, 2010
- Cummins CA et al: Peripheral nerve injuries in baseball players. Phys Med Rehabil Clin N Am. 20(1):175-93, x, 2009
- Ligh CA et al: Case reports: unusual cause of shoulder pain in a collegiate baseball player. Clin Orthop Relat Res. 467(10):2744-8, 2009
- Scalf RE et al: MRI findings of 26 patients with Parsonage-Turner syndrome. AJR Am J Roentgenol. 189(1):W39-44, 2007
- Amin MF et al: An unusual cause of the quadrilateral space impingement syndrome by a bone spike. Skeletal Radiol. 35(12):956-8, 2006
- Bencardino JT et al: Entrapment neuropathies of the shoulder and elbow in the athlete. Clin Sports Med. 25(3):465-87, vi-vii, 2006
- Brestas PS et al: Ultrasound findings of teres minor denervation in suspected quadrilateral space syndrome. J Clin Ultrasound. 34(7):343-7, 2006
- Gaskin CM et al: Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients. Radiology. 240(2):501-7, 2006
- Wilson L et al: Isolated teres minor atrophy: manifestation of quadrilateral space syndrome or traction injury to the axillary nerve? Orthopedics. 29(5):447-50, 2006
- Cothran RL Jr et al: Quadrilateral space syndrome: incidence of imaging findings in a population referred for MRI of the shoulder. AJR Am J Roentgenol. 184(3):989-92, 2005
- Elsayes KM et al: Value of magnetic resonance imaging for muscle denervation syndromes of the shoulder girdle. J Comput Assist Tomogr. 29(3):326-9, 2005
- Ryan M et al: Whole body magnetic resonance imaging in the diagnosis of Parsonage Turner syndrome. Acta Radiol. 45(5):534-9, 2004
- Sofka CM et al: Teres minor denervation on routine magnetic resonance imaging of the shoulder. Skeletal Radiol. 33(9):514-8, 2004
- Robinson P et al: Quadrilateral space syndrome caused by glenoid labral cyst. AJR Am J Roentgenol. 175(4):1103-5, 2000
- Bredella MA et al: Denervation syndromes of the shoulder girdle: MR imaging with electrophysiologic correlation. Skeletal Radiol. 28(10):567-72, 1999
- Sanders TG et al: Paralabral cyst: an unusual cause of quadrilateral space syndrome. Arthroscopy. 15(6):632-7, 1999
- Helms CA et al: Acute brachial neuritis (Parsonage-Turner syndrome): MR imaging appearance--report of three cases. Radiology. 207(1):255-9, 1998
- Yu JS et al: Denervation atrophy caused by suprascapular nerve injury: MR findings. J Comput Assist Tomogr. 21(2):302-3, 1997
- Linker CS et al: Quadrilateral space syndrome: findings at MR imaging. Radiology. 188(3):675-6, 1993
- Cormier PJ et al: Quadrilateral space syndrome: a rare cause of shoulder pain. Radiology. 167(3):797-8, 1988
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
TERMINOLOGY
Synonyms
- Parsonage-Turner syndrome, acute brachial neuritis, neuralgic amyotrophy, acute brachial radiculitis, quadrilateral space syndrome, idiopathic teres minor edema, neurogenic edema, denervation edema
Definitions
- Edema within rotator cuff muscle(s) from motor nerve abnormality
- May also involve deltoid muscle
- Parsonage-Turner syndrome (viral neuritis)
- Usually involves suprascapular nerve
- ~ 90% have denervation edema in supraspinatus and infraspinatus muscles
- 2/3 have ≥ 3 muscles involved
- Deltoid is 3rd most commonly involved muscle
- Can have deltoid edema without teres minor edema if neuritis only involves 6th cervical nerve portion of axillary nerve
- Quadrilateral space syndrome
- Axillary nerve compression/injury, most commonly due to fibrous band or paralabral cyst
- Teres minor and deltoid muscle denervation edema or atrophy, depending on chronicity
- Compression of posterior humeral circumflex artery
- Other
- Idiopathic teres minor atrophy
- Older patients with cuff tears or degenerative joint disease (DJD) and chronic irritation of axillary nerve branch
- Younger patients with inflexible fascial compartment
- Spinoglenoid or suprascapular notch paralabral ganglion cyst
- Brachial plexus injury or mass
- Idiopathic teres minor atrophy
- Edema within rotator cuff muscle(s) from motor nerve abnormality
IMAGING
General Features
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Hong CC et al: Quadrilateral space syndrome: the forgotten differential. J Orthop Surg (Hong Kong). 27(2):2309499019847145, 2019
- Ahlawat S et al: Spectrum of suprascapular nerve lesions: normal and abnormal neuromuscular imaging appearances on 3-T MR neurography. AJR Am J Roentgenol. 204(3):589-601, 2015
- Brown SA et al: Quadrilateral space syndrome: the Mayo Clinic experience with a new classification system and case series. Mayo Clin Proc. 90(3):382-94, 2015
- Gregory T et al: Spontaneous resolution of quadrilateral space syndrome: a case report. Am J Phys Med Rehabil. 94(1):e1-5, 2015
- Kruse LM et al: Clinical outcomes after decompression of the nerve to the teres minor in patients with idiopathic isolated teres minor fatty atrophy. J Shoulder Elbow Surg. 24(4):628-33, 2015
- Gupta A et al: Neuralgic amyotrophy (Parsonage Turner syndrome). Orthopedics. 37(2):75, 130-33, 2014
- Zurkiya O et al: Quadrilateral space syndrome. J Vasc Interv Radiol. 25(2):229, 2014
- Apaydin N et al: Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury. Surg Radiol Anat. 32(3):193-201, 2010
- Friend J et al: Teres minor innervation in the context of isolated muscle atrophy. Surg Radiol Anat. 32(3):243-9, 2010
- Cummins CA et al: Peripheral nerve injuries in baseball players. Phys Med Rehabil Clin N Am. 20(1):175-93, x, 2009
- Ligh CA et al: Case reports: unusual cause of shoulder pain in a collegiate baseball player. Clin Orthop Relat Res. 467(10):2744-8, 2009
- Scalf RE et al: MRI findings of 26 patients with Parsonage-Turner syndrome. AJR Am J Roentgenol. 189(1):W39-44, 2007
- Amin MF et al: An unusual cause of the quadrilateral space impingement syndrome by a bone spike. Skeletal Radiol. 35(12):956-8, 2006
- Bencardino JT et al: Entrapment neuropathies of the shoulder and elbow in the athlete. Clin Sports Med. 25(3):465-87, vi-vii, 2006
- Brestas PS et al: Ultrasound findings of teres minor denervation in suspected quadrilateral space syndrome. J Clin Ultrasound. 34(7):343-7, 2006
- Gaskin CM et al: Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients. Radiology. 240(2):501-7, 2006
- Wilson L et al: Isolated teres minor atrophy: manifestation of quadrilateral space syndrome or traction injury to the axillary nerve? Orthopedics. 29(5):447-50, 2006
- Cothran RL Jr et al: Quadrilateral space syndrome: incidence of imaging findings in a population referred for MRI of the shoulder. AJR Am J Roentgenol. 184(3):989-92, 2005
- Elsayes KM et al: Value of magnetic resonance imaging for muscle denervation syndromes of the shoulder girdle. J Comput Assist Tomogr. 29(3):326-9, 2005
- Ryan M et al: Whole body magnetic resonance imaging in the diagnosis of Parsonage Turner syndrome. Acta Radiol. 45(5):534-9, 2004
- Sofka CM et al: Teres minor denervation on routine magnetic resonance imaging of the shoulder. Skeletal Radiol. 33(9):514-8, 2004
- Robinson P et al: Quadrilateral space syndrome caused by glenoid labral cyst. AJR Am J Roentgenol. 175(4):1103-5, 2000
- Bredella MA et al: Denervation syndromes of the shoulder girdle: MR imaging with electrophysiologic correlation. Skeletal Radiol. 28(10):567-72, 1999
- Sanders TG et al: Paralabral cyst: an unusual cause of quadrilateral space syndrome. Arthroscopy. 15(6):632-7, 1999
- Helms CA et al: Acute brachial neuritis (Parsonage-Turner syndrome): MR imaging appearance--report of three cases. Radiology. 207(1):255-9, 1998
- Yu JS et al: Denervation atrophy caused by suprascapular nerve injury: MR findings. J Comput Assist Tomogr. 21(2):302-3, 1997
- Linker CS et al: Quadrilateral space syndrome: findings at MR imaging. Radiology. 188(3):675-6, 1993
- Cormier PJ et al: Quadrilateral space syndrome: a rare cause of shoulder pain. Radiology. 167(3):797-8, 1988
