What is Quadrilateral Space Syndrome (QSS)?

Quadrilateral Space Syndrome (QSS) is a rare condition that occurs when the axillary nerve and/or the posterior circumflex humeral artery get squeezed or compressed as they pass through a small area in the back of your shoulder called the 'quadrilateral space.' This compression can lead to pain, numbness, tingling, and weakness in your arm.

QSS is often caused by repetitive overhead activities, common in athletes like throwers, swimmers, and tennis players. It can also result from repeated motions that narrow the space (overuse), extra bands of tissue that can form and compress the nerve or artery (fibrous bands), trauma or injury such as a shoulder dislocation or a direct blow to the shoulder which can cause swelling or scar tissue, or muscle enlargement if muscles in the area grow significantly (e.g., in bodybuilders), they can crowd the space.

What are the common symptoms of QSS?

Symptoms typically include vague pain or a dull ache in the back of the shoulder, sometimes radiating down the arm; numbness, tingling, or a 'pins and needles' sensation in the shoulder and upper arm; pain that worsens with overhead movements or when your arm is in a 'throwing' position; tenderness when pressure is applied over the back of the shoulder in the quadrilateral space; weakness or fatigue in the arm, especially when lifting or rotating it; and sometimes, shrinking (atrophy) of certain shoulder muscles like the teres minor or deltoid.

How is QSS diagnosed?

Diagnosing QSS can be challenging because its symptoms can be similar to other shoulder problems. Your doctor will ask about your symptoms, activities, and any past injuries; perform a physical examination to check your shoulder's range of motion, strength, sensation, and tenderness; may order imaging tests like MRI or ultrasound to look at the quadrilateral space, assess muscle size, and check for any abnormalities or scarring. In some cases, nerve conduction studies (NCS) or electromyography (EMG) might be performed to evaluate how well the axillary nerve is working. An injection of local anesthetic into the quadrilateral space that temporarily relieves your symptoms can also help confirm the diagnosis.

When is surgery considered for QSS?

Surgery is usually considered if non-surgical treatments haven't significantly improved your symptoms after about six weeks or more; symptoms are severe or progressively worsening; or there's clear evidence of nerve damage or significant compression.

What do I need to do before surgery?

Your healthcare team will provide specific instructions, but generally, you may need to undergo a pre-operative physical examination and blood tests; stop certain medications (e.g., blood thinners, some anti-inflammatory drugs) a week or two before surgery; arrange for someone to drive you home after surgery and help you during the first few days of recovery; and avoid eating or drinking for a certain period before the surgery.

What can I expect immediately after surgery?

You will likely have your arm in a sling to help it rest and heal. You may experience some pain, which will be managed with medication. Your surgical site will be covered with a dressing. Your surgeon will give you instructions on wound care and activity restrictions.

What does rehabilitation/physical therapy involve?

Physical therapy is crucial for a successful recovery. Your therapist will design a personalized program that may include pain and swelling management (using ice, gentle massage, or other techniques); range of motion exercises (to restore full movement in your shoulder); strengthening exercises (targeting the muscles around your shoulder, including the deltoid and teres minor, which may have been weakened); postural correction (to improve overall shoulder mechanics); and activity-specific training (gradually reintroducing movements related to your work, sports, or daily activities).

When can I expect to return to daily activities, work, driving, and sports?

This timeline varies greatly based on your recovery progress and the demands of your activities. Daily activities: Light daily activities can usually be resumed within a few days to weeks. Driving: You can typically drive once you are no longer taking strong pain medications and have sufficient control and range of motion in your shoulder to safely operate a vehicle (often a few weeks after surgery). Work: Return to work depends on the nature of your job. Light, desk-based work might be possible within a few weeks, while jobs requiring heavy lifting or repetitive overhead movements will take longer, potentially several months. Sports: A gradual return to sports, especially overhead activities, will be guided by your physical therapist and surgeon, often not for several months after surgery. Full return to competitive sports may take 3-6 months or longer.

What is the expected long-term outcome?

For many patients, surgical decompression of QSS provides significant relief from pain, numbness, and weakness, allowing them to return to their normal activities, including sports. Nerve healing can be slow, so improvement may continue for several months. While some mild symptoms may occasionally linger, the goal is to significantly improve your quality of life and shoulder function.

Shoulder Conditions

Subcoracoid Bursitis

Get Clear, Concise Answers to Your Top Questions About Subcoracoid Bursitis

Navigating a shoulder condition can be overwhelming. On this page, we've compiled the 15 most frequently asked questions about Subcoracoid Bursitis to give you straightforward, expert-backed answers. Understand your symptoms, diagnosis, and what comes next with insights from Dr. Christian Veillette's practice. Plus, explore trusted external resources for even more information.

Q1: What is Subcoracoid Bursitis?

A bursa is a small, fluid-filled sac that acts as a cushion between bones, tendons, and muscles around your joints. The subcoracoid bursa is located in your shoulder, beneath a bony projection called the coracoid process. Subcoracoid bursitis is when this bursa becomes inflamed, swollen, and irritated.

Q2: What causes Subcoracoid Bursitis?

Subcoracoid bursitis often develops from repetitive overhead arm movements or activities that put stress on the shoulder. It can also be caused by:

Overuse injuries (e.g., in sports, painting, or heavy lifting)
Direct trauma or injury to the shoulder
Underlying conditions like arthritis or gout
Poor posture
Bone spurs in the shoulder

Q3: What are the common symptoms of Subcoracoid Bursitis?

The most common symptoms include:

Pain in the front of your shoulder, which can sometimes spread down your arm.
Pain that worsens with overhead movements or reaching.
Tenderness when pressing on the front of your shoulder.
Difficulty sleeping, especially when lying on the affected side.
Sometimes, swelling or warmth in the shoulder area.
Reduced range of motion in the shoulder.

Q4: How is Subcoracoid Bursitis diagnosed?

Your doctor will usually diagnose subcoracoid bursitis based on:

A thorough discussion of your symptoms and medical history.
A physical examination of your shoulder, checking for pain, tenderness, and range of motion.
Sometimes, imaging tests like X-rays (to rule out other bone issues), ultrasound, or MRI may be used to confirm the diagnosis and assess the extent of inflammation or rule out other shoulder problems.

Q5: What are the non-surgical treatment options?

Most cases of subcoracoid bursitis improve with non-surgical treatments. These include:

Rest and Activity Modification: Avoiding activities that aggravate your pain.
Ice Application: Applying ice packs to the affected area for 15-20 minutes several times a day to reduce inflammation and pain.
Pain Medication: Over-the-counter anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and swelling. Your doctor may prescribe stronger medications if needed.
Corticosteroid Injections: Your doctor may inject a corticosteroid medication directly into the bursa to reduce inflammation quickly. These are generally not used frequently due to potential side effects.
Physical Therapy: This is a key part of recovery. A physical therapist will guide you through exercises to restore motion, strengthen shoulder muscles, and improve posture.

Q6: What does physical therapy involve?

Physical therapy for subcoracoid bursitis aims to reduce pain, improve range of motion, and strengthen the muscles around your shoulder. Your therapist may use:

Gentle stretching exercises to improve flexibility.
Strengthening exercises for your rotator cuff and other shoulder muscles.
Techniques to improve your posture and body mechanics.
Modalities like ultrasound or massage to help with pain and healing.

Q7: When is surgery considered for Subcoracoid Bursitis?

Surgery for subcoracoid bursitis is rare and typically considered only if non-surgical treatments have not provided relief after several months, or if there is an underlying issue like a bone spur or a significant rotator cuff tear contributing to the bursitis.

Q8: What does the surgical procedure involve (if applicable)?

If surgery is needed, it's usually performed using a minimally invasive technique called arthroscopy. Small incisions are made, and a tiny camera and instruments are used to remove the inflamed bursa (bursectomy) and, if necessary, address any bone spurs or rotator cuff issues. The goal is to create more space and reduce friction in the shoulder.

Q9: What are the potential risks of surgery (if applicable)?

While rare with arthroscopic surgery, potential risks include:

Infection
Bleeding
Nerve or blood vessel damage
Stiffness or ongoing pain
Reoccurrence of bursitis

Q10: What do I need to do to prepare for treatment/surgery?

Non-surgical: Follow your doctor's instructions regarding rest, medication, and ice. Attend all physical therapy appointments.
Surgical (if applicable): Your doctor will provide specific pre-operative instructions, which may include stopping certain medications, arranging for transportation home, and preparing your home for recovery.

Q11: What can I expect immediately after treatment/surgery?

Non-surgical: You should experience gradual pain reduction and improved shoulder movement as you follow your treatment plan.
Surgical: You may have some pain and swelling, managed with medication. You might wear a sling for a short period to protect your shoulder. Physical therapy usually begins shortly after.

Q12: How long is the typical recovery period?

Recovery time varies greatly depending on the severity of your condition and the treatment approach.

Non-surgical: Mild cases may resolve in a few weeks, while more chronic cases can take several months.
Surgical: Full recovery can take anywhere from 3 to 6 months, or sometimes longer, with consistent physical therapy.

Q13: How will pain be managed during my recovery?

Pain will be managed using a combination of methods, which may include:

Over-the-counter pain relievers (NSAIDs).
Prescription pain medication, if necessary.
Ice application.
Physical therapy techniques.
Your doctor will discuss a pain management plan tailored to your needs.

Q14: What signs or symptoms should I watch out for and report to my doctor immediately?

Contact your doctor immediately if you experience:

Increased pain that is not relieved by medication.
Signs of infection: fever, chills, increased redness, warmth, or pus around any incision sites (if applicable).
New or worsening numbness or tingling in your arm or hand.
Sudden, severe swelling or bruising.
Inability to move your arm at all.

Q15: What is the expected long-term outlook for Subcoracoid Bursitis?

With proper treatment and adherence to your rehabilitation program, most people with subcoracoid bursitis experience significant improvement in pain and function. Long-term outcomes are generally good, especially when addressing underlying causes and maintaining good shoulder mechanics.

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We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.

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