20/04/2022 at 11:54 am #36255Johannah PhamParticipant
I am an ultrasound trainee and wanted to share an interesting scan I did today.
Patient is a 40 year old male with previous history of working as a landscaper. Right-hand dominant.
Symptoms include focal pain at the posterior scapula region, a ‘clicky’ GH joint, and pain on movement.
He had a previous diagnosis of bursitis.
Teres minor muscle is reduced in volume with marked increase in echogenicity. Tendon was in tact. ?fatty atrophy ?quadrilateral space syndrome.
The remainder of the rotator cuff tendons and muscles appeared normal. No signs of bursitis.
Has anyone had any similar cases? How significant is this finding in isolation? How could I have extended the scan?
Patient is hopefully having an MRI which I will try to follow-up.
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20/04/2022 at 8:58 pm #36265Stephen BirdKeymaster
This is a great example, and lovely images.
It is indeed isolated wasting of teres minor. It most likely represents unilateral axillary nerve damage (quadrilateral space syndrome).
You sometimes see deltoid atrophy as well, however this is variable.
The common causes are a prior dislocation or surgery.
But there are other possibilities.
It might be a case of Parsonage Turner syndrome which is a brachial plexus neuritis which is usually self limiting and resolves. It loves the supra scapular nerve where you get wasting of supra and infra in a young person, but is can involve the axillary nerve.
I have also personally seen many cases of isolated teres minor wasting , both unilateral and bilateral in patients with no relevant symptoms with no history of trauma or surgery where I scratch my head and wonder why!
Speaking to my radiologists they also occasionally encounter it for no apparent reason.
I suspect the axillary nerve is sometimes a little unreliable with its work ethic !!!
Thanks so much for your lovely post and images,
Please enjoy the website,
21/04/2022 at 9:01 pm #36311Stephen BirdKeymaster
I am so pleased you are enjoying the material Jo,
Spread the word amongst your colleagues and contacts.
Have a great week scanning,
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