Axillary Nerve Entrapment

  • Christopher J. BurnettEmail author
  • Helen W. Karl


The long course of the axillary nerve and its proximity to the shoulder joint make it vulnerable to injuries: athletic, traumatic, and iatrogenic. It can become entrapped in the quadrilateral space and generate symptoms of shoulder pain and weakness.


Quadrilateral space Quadrangular space Shoulder pain Deltoid muscle Teres minor muscle 

Supplementary material

Video 31.1

Physical examination of the axillary nerve (MOV 28837 kb)

Video 31.2

Landmark-guided injection of the axillary nerve (MOV 30237 kb)


  1. 1.
    Cahill BR, Palmer RE. Quadrilateral space syndrome. J Hand Surg [Am]. 1983;8(1):65–9.CrossRefGoogle Scholar
  2. 2.
    Cothran Jr RL, Helms C. Quadrilateral space syndrome: incidence of imaging findings in a population referred for MRI of the shoulder. AJR Am J Roentgenol. 2005;184(3):989–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Neal S, Fields KB. Peripheral nerve entrapment and injury in the upper extremity. Am Fam Physician. 2010;81(2):147–55.PubMedGoogle Scholar
  4. 4.
    Ouchi N, Suzuki S. Lateral axillary nerve palsy as a complication of labor. J Matern Fetal Neonatal Med. 2008;21(3):217–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Safran MR. Nerve injury about the shoulder in athletes, part 1: suprascapular nerve and axillary nerve. Am J Sports Med. 2004;32(3):803–19.CrossRefPubMedGoogle Scholar
  6. 6.
    Perlmutter GS, Leffert RD, Zarins B. Direct injury to the axillary nerve in athletes playing contact sports. Am J Sports Med. 1997;25(1):65–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Apaydin N, Tubbs RS, Loukas M, Duparc F. Review of the surgical anatomy of the axillary nerve and the anatomic basis of its iatrogenic and traumatic injury. Surg Radiol Anat. 2010;32(3):193–201.CrossRefPubMedGoogle Scholar
  8. 8.
    Tubbs R, Tyler-Kabara E, Aikens A, Martin J, Weed L, Salter E, et al. Surgical anatomy of the axillary nerve within the quadrangular space. J Neurosurg. 2005;102(5):912–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Chautems RC, Glauser T, Waeber-Fey MC, Rostan O, Barraud GE. Quadrilateral space syndrome: case report and review of the literature. Ann Vasc Surg. 2000;14(6):673–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Budzik JF, Wavreille G, Pansini V, Moraux A, Demondion X, Cotten A. Entrapment neuropathies of the shoulder. Magn Reson Imaging Clin N Am. 2012;20(2):373–91, xii.CrossRefPubMedGoogle Scholar
  11. 11.
    McClelland D, Paxinos A. The anatomy of the quadrilateral space with reference to quadrilateral space syndrome. J Shoulder Elbow Surg. 2008;17(1):162–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Uz A, Apaydin N, Bozkurt M, Elhan A. The anatomic branch pattern of the axillary nerve. J Shoulder Elbow Surg. 2007;16(2):240–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Apaydin N, Uz A, Bozkurt M, Elhan A. The anatomic relationships of the axillary nerve and surgical landmarks for its localization from the anterior aspect of the shoulder. Clin Anat. 2007;20(3):273–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Price DJ. The shoulder block: a new alternative to interscalene brachial plexus blockade for the control of postoperative shoulder pain. Anaesth Intensive Care. 2007;35(4):575–81.PubMedGoogle Scholar
  15. 15.
    Lester B, Jeong GK, Weiland AJ, Wickiewicz TL. Quadrilateral space syndrome: diagnosis, pathology, and treatment. Am J Orthop (Belle Mead NJ). 1999;28(12):718–22, 25.Google Scholar
  16. 16.
    Francel TJ, Dellon AL, Campbell JN. Quadrilateral space syndrome: diagnosis and operative decompression technique. Plast Reconstr Surg. 1991;87(5):911–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Hoskins WT, Pollard HP, McDonald AJ. Quadrilateral space syndrome: a case study and review of the literature. Br J Sports Med. 2005;39(2), e9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hertel R, Lambert SM, Ballmer FT. The deltoid extension lag sign for diagnosis and grading of axillary nerve palsy. J Shoulder Elbow Surg. 1998;7(2):97–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Dong Q, Jacobson JA, Jamadar DA, Gandikota G, Brandon C, Morag Y, et al. Entrapment neuropathies in the upper and lower limbs: anatomy and MRI features. Radiol Res Pract. 2012;2012:230679.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Linker CS, Helms CA, Fritz RC. Quadrilateral space syndrome: findings at MR imaging. Radiology. 1993;188(3):675–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Mochizuki T, Isoda H, Masui T, Ohkawa Y, Takahashi M, Takehara Y, et al. Occlusion of the posterior humeral circumflex artery: detection with MR angiography in healthy volunteers and in a patient with quadrilateral space syndrome. AJR Am J Roentgenol. 1994;163(3):625–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus. Radiographics. 2010;30(5):1373–400.CrossRefPubMedGoogle Scholar
  23. 23.
    Kim YA, Yoon KB, Kwon TD, Kim DH, Yoon DM. Evaluation of anatomic landmarks for axillary nerve block in the quadrilateral space. Acta Anaesthesiol Scand. 2014;58(5):567–71.CrossRefPubMedGoogle Scholar
  24. 24.
    Checcucci G, Allegra A, Bigazzi P, Gianesello L, Ceruso M, Gritti G. A new technique for regional anesthesia for arthroscopic shoulder surgery based on a suprascapular nerve block and an axillary nerve block: an evaluation of the first results. Arthroscopy. 2008;24(6):689–96.CrossRefPubMedGoogle Scholar
  25. 25.
    Price D. Blockade of the axillary nerve. Acta Anaesthesiol Scand. 2011;55(8):1029–30.PubMedGoogle Scholar
  26. 26.
    Rothe C, Asghar S, Andersen HL, Christensen JK, Lange KH. Ultrasound-guided block of the axillary nerve: a volunteer study of a new method. Acta Anaesthesiol Scand. 2011;55(5):565–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Pain Management Division, Department of AnesthesiologyBaylor Scott and White Memorial HospitalTempleUSA
  2. 2.Department of Anesthesiology and Pain MedicineUniversity of Washington, Seattle Children’s HospitalSeattleUSA

Personalised recommendations