by Mike

Both the artery and particularly ulnar nerve are affected, hence your Tinel's sign, but what about Adson's?

Both the artery and particularly ulnar nerve are affected, hence your Tinel's sign, but what about Adson's?


I am 34 yo. The only condition worth referring that I have since I'm 22 is Diabetes Type 1. Doing insulin and trying to stay healthy and control it.
For about 7 years, I noticed a very mild weakness on my left arm, forearm. It was getting tired more easily. I am right handed. So I thought it would be normal.

But even doing biceps for example, I would feel burning faster on the left bicep and stop. I would also feel that other parts like shoulders etc.. would compensate to make up for that in order to lift the weight.
I left it like that for years because it wasn't really affecting my quality of life. I wasn't having any tingling, or numbness, just weakness.

I later started having some weird feeling in my legs, especially in my knee area and also the area before the foot. In my knee, Id feel constantly the feeling a person feels when a doc hits the patient with that rubber hammer and the leg moves. I don't know how that would be called.

If I am wearing sox for example and sitting on a wooden floor, I would see that my right leg , even though the surface is slippery clean, would hold my leg in place without effort. The left would slide a bit etc...

Many years past, and we come now, 2017. Here is a list of things that I am feeling and all are on the left side only.

- Weakness in the left hand. To the point that i do not feel confident with my left hand. If you tell me to throw a punch at a punching bag, I will do it, and it will have power, but it's like I will think of my grip and how to position my fist etc..

- Also, I have noticed that the skin on my left forearm is a bit more loose if that could be said. Of course the right arm is more developed etc. Although you cannot tell that my left side has a problem visually. But if I wear a watch for example on the left or on the right, the watch will leave a much more obvious mark on my skin on the left side. Also when touching my bones, I can feel them more on the left side than on the right. Although you can't really see a big difference visually.

- When I flex up my left bicep, there is a big shaking that starts. I am not referring to the shaking a normal bicep flex would have which is normal ( right side ). But when I flex the left, it's like my whole arm is shaking like it's coming from the shoulder or something. It's really weird.

- Lately ( past 2 months ) , I started having pain in my scalene muscle on the left side, along with left side chest pain , somewhere above the nipple, and if I touch it deep with my fingers, I can feel like a tendon or vein or artery who knows. And that specifically hurts. If I touch my scalene in the triangle, I get shooting electrical nerve pain all the way down my arm and fingers. A kind of heat feeling and nerve pain together.

Together with that, lately, i have found myself clenching my ring and pinky finger while sitting etc.. If i tap my ulnar nerve on my elbow , even slowly, i get shooting electricity to my ring and pinky. Always on the left side.

Along with that i have a feeling on my left cheek on the face. It's not numb, but it's like a goosebump constant effect on my cheek (left) and it gives you the feeling too that all muscles, tendons etc.. that are on the left side of my neck are somehow shorter and tighter kind of feeling.

So here you have it.

Now, I've done a EMG and nerve conduction test before 4 months, and they told me there is nothing wrong.

I went to see a chiropractor who saw me. After explaining all the above and few sessions, he told me that it might be TOS, but in such a form that it's subclinical, and won't show on an EMG etc...

After sessions, I feel better , but after days I keep getting symptoms,

Note also that I am lately ( past 2 years ) in a high stress situation with anxiety. I am not taking any pills constantly, but when I have crazy stress and take a benzo, it tends to relax all these feelings and I don't feel them a lot.

My speech, swallowing , walking, vision, appetite, etc.. all is fine. No crazy headaches. But I'm concerned it can be something serious. Maybe a pinched nerve? herniated disc? Maybe related to diabetes? Tumor or MS? It's weird it's only on the left side.

Thank you for taking the time to read all this among many emails you are receiving and I thank you in advance if you could send me a reply to let me know what you think.


Hello Mike,
Thank you for your in depth letter; it does make things easier for the clinicians treating you when you can set things out so accurately. I'd keep a copy of this on your computer, updating it periodically as need be for any new doctors you consult.

There are something you don't mention though. Firstly, how well your diabetes is controlled. What is your HbA1c? Does your blood glucose regularly go above 10, do you monitor it regularly, are you reasonably strict with your diet, and do you exercise daily. Those are all vital questions about the known T1DM.

If it's not well controlled, then I'd start looking for an experienced doctor who can tell you, and monitor your response, about the ketogenic diet; there are several variants, but what they all have in common is cutting our all refined carbohydrate diet, reducing the overall starch in your meal planning, and increasing the healthy fat in your diet, for example olive oil.

Diabetes is well known for attacking blood vessels, but what is less commonly understood is that it affects the nerves and tendons; and many of the symptoms to mention have to do with just that.

There an old medical saying, remember the patient can have two diseases. Are you symptoms just from the diabetes, or is there something else at play; I can't answer that, but you are right to have your concerns. I would certainly doubt cancer or MS after this prolonged time.

I think you chiropractor may well be right about TOS, much fits, but the question is whether you have a positive Adson's test or not. It's a difficult and subjective test, but if strongly positive, then the possibility of TOS is high. You can try it yourself, but it's not an easy test even for an experienced clinician. Using the site search function, you'll find it at chiropractic help.

Measuring the circumference of you arm at various levels, manually testing the muscle strength, checking the reflexes all tell a story. Ask your chiropractor, he should know how to do that.

One of the signs of TOS incidentally is that it is more difficult to work above your head; the arm tires more quickly, starved of blood and nerve impulses.

An x-ray of your neck to test for a cervical rib would be useful, and degenerative disc disease.

If your blood glucose is not well controlled, I'd start there; it's vitally important. Those who follow the rules with T1DM can lead a long and normal life, but it's very unforgiving if you cheat. One of the most important rules in my book is ALWAYS to take a short walk, say 10 mins, after any starchy meal. Don't just increase your insulin. Or cycle, swim, skip etc.

I wish I could add more; keep thinking, don't get overly anxious as far as you are able, and above all keep your BG under control. Walk every day. The ketogenic diet incidentally will enable you to immediately halve your insulin.

Thank you for your questions and I confess I am not able to give a comprehensive answer; keep me in the loop as you continue this journey, keeping to this thread.

Good luck and God bless, life is difficult,

Dr B

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