Disclosures: Imran Farooqi, MD: No financial relationships or conflicts of interest

Case Diagnosis: Atypical chest pain in Carpal Tunnel Syndrome

Case Description: A 73-year-old male retired electrician presents in August 2019 with an 8 year history of atypical left sided chest pain s/p stent placement in 2012. He describes intermittent episodes left pectoral “squeezing” and “shooting electric shock” chest pains lasting 15 minutes in duration. He describes nocturnal symptoms and sublingual nitroglycerin does not relieve the pain.

Setting: EMG Outpatient clinicAssessment/

Results: Pt has had multiple trips to the ED for the chest pain with an extensive cardiology workup including 7-9 normal cardiac catheterizations. Recent CTA Chest was negative for pulmonary embolus. Pt reports wrist pain with paresthesias in the left 1st, 2nd, 3rd, and lateral half of the 4th digits. Wrist flexion will lead to “shooting” pains radiating proximally from his hand/wrist into his forearm, arm, and left chest. Phalen’s test was positive on the left with reproduction of the patient’s atypical chest pain. EMG/NCS was performed positive for moderate/severe left sided CTS

Discussion: Phalen’s test or left wrist flexion consistently reproduced the patient’s chest pain. CTS produces pain in the median nerve distribution with hand and wrist paresthesias in the 1st, 2nd, 3rd, and lateral half of the 4th digits. Less commonly CTS does radiate proximally up to the forearm and also into the arm and shoulder. However, radiation into the chest is rare. The myotome for shoulder abduction and the pectoral muscles are innervated by C5-7 which are represented by the median nerve.

Conclusion: Patient had a left Carpal Tunnel Release surgery in February 2020 with improvement of his left sided chest pain with reduction of his pain and resolution of his nocturnal paresthesia. Multiple Cold Laser Treatments and Nocturnal Splint provided relief. Atypical symptoms in CTS should be considered after all other potential differential diagnoses are ruled out.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/atypical-chest-pain-in-carpal-tunnel-syndrome-cts-a-case-report/