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.
Barrie Lewis DC