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The Pain Doctor: Left arm pain

By Femi Ogunyemi

“One good thing about music – when it hits you, you feel no pain”- Bob Marley

ON a recent transatlantic flight a commotion started two seats ahead of mine. The famous American gentleman I’d greeted on boarding had developed a sudden medical emergency. The desert trolley was rushed away and a crowd surrounded his seat. With calm trepidation, I left my seat to offer assistance.

Two Doctors had responded to the Purser’s call. One had ordered high dose aspirin and the other a device to check blood pressure, neither of which had arrived.

Apparently, this celebrity patient, whom, for privacy and confidentiality, I shall call “Mr X”, had complained of sudden onset left arm pain.

I introduced myself to the physicians then offered my US business card to the patient.

“What is this?” the first Doctor snapped. “I find this inappropriate to be giving your card to a man clearly having a heart attack!”

Even if Mr X was having a heart attack, he was alive enough to be accorded all necessary client protocol before thrusting your services on him at the behest of the flight attendant.

Ignoring my respected colleague’s comment, I asked Mr X for his permission to render my services.

“Thanks for the introduction, Doc.” he tapped my card and waved his headphones. “I was just listening to some music when it all started.”

I discovered two painful spots in Mr X’s left upper trapezius muscle between his shoulder and neck.

These are tight nodules called “trigger points”. They form within an affected muscle causing pain that radiates away from the source. Trigger points are often symptomatic of a common condition called Myofascial Pain Syndrome.

Unable to inject, I chose to massage the points. This worsened the pain. Mr X groaned.

My displeased colleague, the one who had ordered the double dose aspirin, whispered in my ear. “You are going to kill this man by dislodging the clot in his arm!”

“There is no clot in his arm”, I whispered back.

He complained to the Purser who simply ignored him. Within minutes, to the joyful relief of the patient, the pain subsided. I requested extra shoulder support for his chair and, jokingly, delegated two female flight attendants to massage his arm on a rotating shift. For a moment, the Purser believed me. Mr X chuckled.

Over the past 30 years I have had the fortune, or misfortune, of encountering many non-hospital situations such as this and even published an article “Fight or flight – The Good Samaritan”, in a UK journal back in 1996. I will occasionally share some of these sometimes humorous, sometimes chilling experiences in the life of this Column.

(Left) Arm Pain – Can be mild or unbearable, sudden or chronic (over 3 months), from the fingers to the shoulder, may be unilateral or bilateral, can be dull, sharp shooting, constant or episodic.

Causes can be divided into those due to trauma or injury, to individual behavior and to diseases.

An evolving heart attack is the most dangerous cause of left arm pain. However this is less common, and will likely be associated with other findings.

Trauma includes fractures, nerve injury, strains and sprains of muscles, ligaments and tendons in the shoulder, arm, elbow, forearm, wrist and hand.

Behavioural causes include stress, posture (sitting or sleeping), some medications and food. Spicy or peppery foods can cause gas distension in the gut which can cause left arm pain.

Diseases of the bones, muscles, tendons and the nerves themselves are very common causes. These include joint arthritis, spondylosis in the neck, radiculopathy, diabetic neuropathy, tumors in the thoracic outlet and tendinitis (tennis elbow, golfer’s elbow/shoulder).

Left arm pain can occur as a component of myofascial pain syndrome (Mr X), fibromyalgia or following a stroke.

Often causes are multiple.

Treatment of (left) arm pain depends on its cause(s).
Physical therapy (Mr X’s massage)
Relaxation therapy (Mr X)
Behavioural therapy (Mr X’s shoulder support)

Drugs – paracetamol, non steroidal anti-inflammatory drugs, local anaesthetics, and sometimes strong narcotic pain medicines may be needed.

Mr X’s had an acute exacerbation of a chronic problem. Pain medication must address both states.


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