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Dr. Hanson
Dr. Hanson, Doctor (MD)
Category: Health
Satisfied Customers: 935
Experience:  Diplomate, American Board of Quality Assurance & Utilization Review Physicians
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I have a constant pain in my upper left pectoral

Customer Question

I have a constant pain in my upper left pectoral muscle which is sensitive to the touch. I also have occasional tingling in my left & right pinky fingers and left toes. I also get occasional pain in my neck and left forearm. I get lightheaded after walking or moderate activity and my symptoms become more pronounced.

I have had a full workup on my heart to include EKG and angiogram with normal results.

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Male , Age: 57

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Submitted: 10 years ago.
Category: Health
Expert:  Dr. Hanson replied 10 years ago.
You have chronic myofascial pain due to thoracic outlet syndrome. Scalene muscles are a group of muscles (three on each side of your neck) that extend from your cervical vertebraes to your first and second ribs. Blood vessels supplying your left and right arms and pectoral muscles pass through your scalene muscles in your neck.

Trigger Points in your scalene muscles can cause a variety of symptoms including thoracic outlet syndrome. Thoracic outlet syndrome is caused by compression of your blood vessels. The thoracic outlet is the area of your body between your collarbone and your rib cage. Veins, nerves, and arteries come through this opening. When the blood vessels or nerves are compressed or squeezed it causes the symptoms of thoracic outlet syndrome.

Trigger points in your scalene muscles of your neck can cause chest pain similar to angina ("a constant pain in my upper left pectoral muscle. .EKG and angiogram with normal results . .").

Some other symptoms of thoracic outlet syndrome include shoulder pain that increases in certain positions, arm and hand pain especially in the ring finger and little finger, numbness or coldness in the arm, decreased movement of the shoulder and arm, tingling of arms, hands, shoulders, or neck, swelling of fingers and hands, dizziness, Raynaud's phenomenon indicated by pain, tingling, and color changes in the fingers and toes when exposed to cold ("occasional tingling in my left & right pinky fingers and left toes.". The location of your pain is not always the same location as the source of your pain.

Sometimes exercises can help to relieve chronic myofascial pain with thoracic outlet syndrome e.g. "scalene stretch": stand, holding your hand behind your back then lower your left shoulder, then tilt your head to the right. Slowly roll your head backwards until a stretch is felt. Hold for 10-15 seconds. Repeat for other side. Repeat cycle three times, at least three times daily.

Treatment includes: physical therapy, medications e.g. muscle relaxants (Flexeril, Soma, Robaxin, or Parafon forte) and anti-inflammatory drugs for pain (Relafen, Daypro, Celebrex).

I recommend that you be evaluated and treated by a "physiatrist". Ask your primary care physician for a referral to a "physiatrist". A physiatrist is certified by the American Board of Physical Medicine and Rehabilitation (ABPM&R) to treat acute and chronic pain and musculoskeletal disorders. Most patients with chronic myofascial pain and thoracic outlet syndrome can be helped to obtain relief from their symptoms.

I hope my information is helpful. If you have additional questions I will gladly answer them, otherwise please click "ACCEPT", "POSITIVE FEEDBACK" and a "BONUS" would be greatly appreciated.

Dr. H
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Customer: replied 10 years ago.
Reply to XXXXX XXXXXson's Post: Why do I get lightheaded? Am I suseptible to passing out? Also is anxiety a normally associated with the onset of symptons?
Expert:  Dr. Hanson replied 10 years ago.
Thoracic outlet syndromes are due to the compression of the neurovascular structures passing through the thoracic outlet. When a person has thoracic outlet syndrome their brachial plexus and subclavian vessels are compressed at the base of their neck toward their axillas and their arms. The subclavian arteries are major arteries of the upper thorax that supply oxygenated blood to the head and arms. When the subclavian artery is compressed then oxygenated blood flowing to the brain is decreased and consequently the person feels lightheaded, anxious, and susceptible to passing out. Here is a diagram of the brachial plexus so that you can specifically see the relation of the subclavian artery to the brachial plexus.

I hope this information is helpful. If you have additional questions I will gladly answer them. "POSITIVE FEEDBACK" and a "BONUS" would be greatly appreciated.

Dr. H