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Initial management with arthroscopic labral repair and cyst decompression provided partial relief; however, persistent neurological deficit required secondary open quadrilateral space decompression. The patient achieved complete recovery of range of motion and deltoid strength, with no cyst recurrence at the 2.5-year follow-up. This case underscores the importance of considering QSS in patients with unexplained posterior shoulder pain and weakness, highlights paralabral cysts as a rare but treatable cause, and demonstrates the value of staged management and long-term follow-up in preventing chronic axillary neuropathy.<\/jats:p>","DOI":"10.1136\/bcr-2025-269205","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:35:36Z","timestamp":1767180936000},"page":"e269205","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Complete deltoid muscle paralysis due to post-traumatic para-labral cyst, an unusual cause of quadrilateral space syndrome"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7352-5228","authenticated-orcid":false,"given":"Nitesh","family":"Gahlot","sequence":"first","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6957-7180","authenticated-orcid":false,"given":"Manveer","family":"Singh","sequence":"additional","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2080-2612","authenticated-orcid":false,"given":"Rajesh Kumar","family":"Rajnish","sequence":"additional","affiliation":[{"name":"Orthopaedics, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"2025123106151331000_18.12.e269205.1","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.jse.2017.10.024","article-title":"Quadrilateral space syndrome: a review","volume":"27","author":"Flynn","year":"2018","journal-title":"J Shoulder Elbow Surg"},{"key":"2025123106151331000_18.12.e269205.2","doi-asserted-by":"crossref","DOI":"10.3390\/jcm7040086","article-title":"Quadrilateral Space Syndrome: Diagnosis and Clinical Management","volume":"7","author":"Hangge","year":"2018","journal-title":"J Clin Med"},{"key":"2025123106151331000_18.12.e269205.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(83)80056-2"},{"key":"2025123106151331000_18.12.e269205.4","doi-asserted-by":"publisher","DOI":"10.1177\/0363546508321476"},{"key":"2025123106151331000_18.12.e269205.5","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.2214\/ajr.175.4.1751103","article-title":"Quadrilateral space syndrome caused by glenoid labral cyst","volume":"175","author":"Robinson","year":"2000","journal-title":"AJR Am J Roentgenol"},{"key":"2025123106151331000_18.12.e269205.6","doi-asserted-by":"publisher","DOI":"10.1067\/mse.2002.127096"},{"key":"2025123106151331000_18.12.e269205.7","doi-asserted-by":"crossref","unstructured":"Constant CR , Murley AH . 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