Pain in left arm and then leg

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

There are a number of causes for this problem.

The first is something rare ...

Takayasu’s arteritis

Takayasu's arteritis is a chronic autoimmune disease where arteries are inflamed. It is also known as Takayasu's aortitis or pulseless disease.

In most cases, Takayasu's arteritis affects the aorta and its major branches, including arteries to the brain, arms and kidneys. The aorta pumps blood from the heart to the rest of the body.

This problem causes damage to the body's major organs, reduced pulses in the arms and legs, and symptoms of poor circulation, such as a cold arm or leg, muscle pains with use, or stroke if brain arteries are narrowed or blocked. The disease can be fatal.

The symptoms vary depending on the arteries affected. Early symptoms can include fever, fatigue, poor appetite, weight loss, night sweats, joint aches and chest pain. Later symptoms are related to narrowing of the arteries and a decrease in blood flow to certain organs. These later symptoms can include:

• High blood pressure and kidney failure resulting from poor blood flow to the kidneys
• Weak or absent pulses in the arms, neck or legs
• A significant difference in blood pressure between the right and left arms
• A significant difference in blood pressure between the arms and legs
• Angina
• Congestive heart failure
• Fainting, dizziness, changes in vision, or stroke, due to poor blood flow to the brain
• Abdominal pain, nausea and vomiting, due to poor blood flow to the abdomen
• Muscle weakness and pain in the arms or legs

A patient may have this disease if they meet at least three of the six criteria developed by the American College of Rheumatology to distinguish it from other forms of vasculitis:

• Symptoms beginning at age 40 or younger
• Muscle weakness and pain when you move your arms or legs
• A weak pulse in the brachial artery (major artery in the upper arm)
• A sound called a bruit, which indicates turbulent blood flow, when your doctor listens to your aorta or subclavian artery with a stethoscope
• Signs of damage to the aorta or other arteries on a test called an angiogram, which is a series of X-rays of arteries

A difference of at least a 10-mm Hg (millimeters of mercury) in the systolic blood pressure (the first number in your blood pressure reading) in your right and left arms

To identify areas where arteries are damaged, the doctor may order the following studies: standard angiography, magnetic resonance angiography, Doppler ultrasound, standard magnetic resonance imaging (MRI) or computed tomography (CT).

Damage to arteries may be permanent. Even when Takayasu's arteritis itself is no longer active, narrowed arteries may continue to disrupt blood flow to organs.

Doctors usually treat Takayasu's arteritis with glucocorticoid medications, such as prednisone. If these medications alone do not work well, then stronger immunosuppressive drugs may be added, including methotrexate, azathioprine or cyclophosphamide. Blood pressure medications also may be necessary to control high blood pressure.

If Takayasu's arteritis has caused significant narrowing of an artery, the narrowed segment may need to be widened. Depending on the artery affected, this can be done in one of three ways:

• Traditional (open) surgery

• Percutaneous transluminal balloon angioplasty, where a small balloon is inserted into the blood vessel, then inflated to open it

• Percutaneous placement of a stent, in which a small mesh device is placed in the artery to keep the blood vessel open

Overall, about 77 percent of patients with Takayasu's arteritis respond to some form of medical therapy.

Cervical spine disease

Neck pain is a common accompaniment of cervical spondylosis (arthritis). When cervical nerve irritation is present, the symptoms may suggest alternative conditions such as angina pectoris (C3 and C4 supplying the upper chest; C5 to C8 supplying the arm) or shoulder problems (C4 or C5). Sensory disturbance in the hand may occur. Arm pain may accompany the numbness.

Cervical myelopathy (pressure on the spinal cord in the neck) may lead to an unsteady, stiff legged, broad based gait, with hesitant, jerky, or shuffling movements. Spasticity in the legs is more common than weakness. Pain and numbness in the soles of the feet is a common presentation. Other unusual presentations of cervical disc degeneration include headache, paralysis of one side of the body, hemidiaphragm paralysis(paralysis of one side of the diaphragm, and Horner's syndrome because of involvement of the sympathetic chain of nerves. If spurs are present in the front of the cervical spine they can cause pressure on the esophagus and make swallowing difficult.

Lower back pain is common. Moreover, this symptom might be expected to occur more often in patients with cervical spine degeneration: about 20% of patients with cervical spondylosis have coexisting lumbar spinal stenosis. If the lumbosacral roots and cervical cord are simultaneously compressed, the resultant picture may be very confusing. Leg pain in the form of sciatica, is common.

Aortic dissection may also be a cause of vascular based pain in the arm and leg. This is a surgical emergency.

Strokes may cause pain to be felt in the arm and leg of the same side of the body. Generally pain is less common than paralysis. However, after recovery, patients may have pain in the limbs that were affected.

Migraine headaches can sometimes cause either paralysis or pain in the arm and leg. Since this is an unusual presentation, neurology consultation is advised.

Entrapment neuropathies affecting peripheral nerves may also cause pain in the arm and leg.

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