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Rate ePoster

Musculoskeletal and Sports Medicine

The Uncommon Cause of Posterior Shoulder Pain You Can’t Miss: A Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 3
Has Audio

    Poster Presenter(s)

  • Daniel Burke, Other

    OMS-IV
    Philadelphia College of Osteopathic Medicine - Georgia Campus
    Duluth, Georgia

    • Primary Author(s)

  • Clay Guynn, DO

    Physician
    Sports Medicine South of Gwinnett: A Northside Network Provider
    Lawrenceville, Georgia

Disclosure(s):
Daniel Burke, Other: No financial relationships to disclose
Clay Guynn, DO: No relevant disclosure to display
Case Diagnosis: 31-year-old male with chronic shoulder pain who had significant improvements after management for Quadrilateral Space Syndrome, avoiding surgical intervention.

Case Description or Program Description: •31-year-old male with right shoulder pain following MVA resulting in rib fracture and SLAP tear
•Pain completely resolved following SLAP repair but returned 1 year later with only mild improvement after subacromial and glenohumeral injections
•Deep aching shoulder pain remained and was exacerbated by abduction/external rotation persisted following injections.

Setting: Outpatient PM&R/Sports clinic

Assessment/Results: •Cardiopulmonary: RRR, CTAB
•Normal affect; CN 2-12 intact; no skin changes.
•NMSK: Negative Obrien, pain radiating into posterior latissimus; Positive Speeds; Positive cross arm test; Negative Spurling’s.
•No shoulder deformities, effusion, full ROM passive/active; 4+ strength on all ROM, but pain with abduction, ER, and palpation of R quadrilateral space

Imaging
•R paralabral cyst of shoulder on MRI arthrogram
•US showed R paralabral cyst, AC joint OA

Management
•Deep aching pain persisted following PT and injections for suspected subacromial bursitis and glenohumeral arthritis
•Quadrilateral space syndrome (QSS) suspected, and patient underwent QS steroid injection which resolved pain.

Outcome
•Shoulder pain reduction from 5/10 to 0/10, lasting 5 months
•Patient has not required surgery

Discussion (relevance): Quadrilateral Space Syndrome (QSS)
•Rare disorder presenting with 4 features: diffuse shoulder pain; paresthesia in non-dermatomal pattern; point tenderness over quadrilateral space; positive angiogram in provocative positioning
•Often caused by trauma, fibrosis, or muscular hypertrophy
•Conservative treatments include physical therapy, activity modifications, injections, and NSAIDs. Surgical decompression is reserved for patients who are unresponsive to conservative treatments

Conclusions: QSS may present with vague symptoms, leading to misdiagnosis and delay in proper treatment. Though physical therapy, NSAIDs, and activity modification are first line treatment, there is no consensus on alternative treatment prior to advancing to surgical intervention. This case shows evidence that glucocorticoid injections into the quadrilateral space may provide long-lasting symptom relief in these patients.