Tingling in the left arm and hand - Sign of a heart attack

by Dr. BB
(Georgia)

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.

Barrie Lewis DC

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Interesting challenges of the day

1. 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 she was 75 percent improved; no longer vomiting or falling. She's not enjoying the Brandt Daroff home exercises.

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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. 

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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.

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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. 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.



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