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. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days.
2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.
3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously.
4. Mrs V too has two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again.
5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff.
6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.
7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.
8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.
9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine.
10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.
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. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.
13. Mrs B has had one of the nastiest of conditions; vertigo caused by a
disturbance in the inner ear. Falling repeatedly and vomiting she
consulted her doctor but medication didn't help. After two sessions of
the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.
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.
You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.
The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.
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