Tingling in the left arm and hand - Sign of a heart attack
by Dr. BB
Patient presents to the clinic w/ severe numbness and tingling to the left arm and hand that starts w/ pain in the upper thoracic region (T1-2) and left trapezius muscle. He says when he turns his head to the right that the numbness and tingling go away in his left hand and arm. Is this positive test for T.O.S. and a possible indicator for a heart attack?? Please reply back when U can. Sincerely, Dr. BB
Hello Dr BB, Thank you for your question. On it's own it doesn't confirm TOS. That's done with Adson's test, but it's a difficult and subjective test until one's done it many times. An alternative is do a doppler on the arm while performing the Adsons procedure; type Adsons into the Search function at Chiropractic Help. In my book the radial pulse must greatly diminish during the procedure, and return when head and neck return to neutral, and the patient exhales.
More likely, Spurling's test will be positive. Left rotation and simultaneously looking up provoking neck and probably arm pain. It's a sign of a probable disc injury. Conversely, right rotation is less painful, and may relieve the pain and tingling.
Does the arm pain and tingling follow a dermatomal pattern? TOS tends to be more vague though sometimes follows the C8 dermatome quite accurately as the lowermost trunk lies on the first rib.
Then, TOS causes increased tingling when raising the arm above the head, whereas a disc injury brings relief, the so called Shoulder abduction relief sign.
The Upper Limb Tension Test is very simple and is pathognomonic of a strongly irritated, pinched nerve root. Again, the Search function will tell you how it's done.
The triceps is the most commonly affected muscle, paresis of elbow extension is common. Less likely, but still quite common is finger abduction and adduction. Pads and Dabs muscles.
Look for sensory change too; hyper in the early stages turning to hypoalgesia to pin prick as the condition continues. Is it specifically dermatomal?
If these tests are positive, then I would order xrays, including obliques, looking for degeneration of the paravertebral joints of Luschka. An MRI of course is first choice. Only that would confirm a disc injury.
These cases can be stubborn, though usually they get relief from gentle and highly specific manipulation. I find less manipulation is better than repeated too frequently. Perhaps 2-3 manipulations and then soft tissue therapy, acupuncture, NSAIDs and then decide how to proceed after a week or so.
It doesn't sound like an MI to me, but are there other factors? Hypertension, DM, smoker?
I hope this contributes. I would suggest you call a local chiropractor and discuss the case.
1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.
2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.
3. Mrs T looked like the leaning tower of Pisa; she had a slipped disc at L5 making her lean towards the opposite side. It's called the postero lateral disc hernia; she's much better after two weeks of treatment and will go back to work next week, part time. Lateral discs are more difficult; both take a minimum of six weeks to heal. In my opinion, antalgic patients need what I call exercising bed rest. Sit and it won't get better.
4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months. He has a pincer deformity in the hip causing the groin pain, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.
5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.
6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your lower back is just as important as the pain.
7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.
8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.
9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.
10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.
11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.
12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.
13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback
since working above his head. Trapped nerve tests are negative but he
has advanced degenerative joints of Luschka; after just two treatments
he is 50 percent better. Can we reach 90?
And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.
Greetings, Dr B. You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.
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