Right Upper Arm Pain in an Older Woman

​BY GREGORY M. TAYLOR, DO, & DAWN ZELENKA-JOSHOWITZ, DOAn 81-year-old woman with a past medical history of atrial fibrillation, three coronary artery bypass graft surgeries, and a prior cerebrovascular accident presented to the emergency department with right arm pain. Her symptoms had grown worse for two days, and she experienced paralysis about two hours before arrival.Her initial vital signs were a temperature of 97.7°F, a blood pressure of 196/43 mm Hg (left arm), a heart rate of 60 bpm, and a respiratory rate of 18 bpm. She had obvious pallor to her right upper arm with no brachial or radial pulses. She was unable to extend her fingers with 0/5 grip strength. Sensation was reduced below the elbow, with a capillary refill time of more than five seconds.The remaining neurovascular and neurological exam was unremarkable. Cardiopulmonary exam revealed an irregularly irregular rhythm and lungs that were clear to auscultation bilaterally. She underwent an emergent CT angiogram of the right upper extremity that revealed luminal narrowing (Photo A) followed by eventual complete thrombotic occlusion of the right axillary artery (Photo B) with no evidence of blood flow distally.Acute limb ischemia like this patient's must be recognized quickly to avoid the complications that arise from untreated limb hypoperfusion. The signs and symptoms of acute limb ischemia include pain, pallor, parasthesias (late finding), poikilothermia, pulselessness, and paralysis (late finding). Res...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research