From the Guidelines
Pulmonary embolism typically does not cause upper limb pain, as it primarily affects the lungs and cardiovascular system, leading to symptoms such as shortness of breath, chest pain, and rapid heartbeat. The symptoms of pulmonary embolism are well-documented in the guidelines on the diagnosis and management of acute pulmonary embolism by the European Society of Cardiology (ESC) 1. According to these guidelines, the clinical presentation of pulmonary embolism can be non-specific, making diagnosis challenging. However, the primary symptoms are related to the respiratory and cardiovascular systems, rather than the upper limbs.
In rare cases, a large pulmonary embolism can cause significant strain on the heart, leading to poor circulation throughout the body, which might result in discomfort in the extremities, including the arms. Additionally, if the clot that caused the pulmonary embolism originated from a deep vein thrombosis in the arm, there might be arm pain from the original clot site, not from the pulmonary embolism itself 1. The American Society of Hematology 2018 guidelines for management of venous thromboembolism provide estimates of the prevalence of deep vein thrombosis in the upper extremities, which can help inform diagnosis and treatment decisions 1.
Some key points to consider when evaluating upper limb pain in the context of pulmonary embolism include:
- The primary symptoms of pulmonary embolism are related to the lungs and cardiovascular system, rather than the upper limbs.
- A large pulmonary embolism can cause poor circulation, leading to discomfort in the extremities, including the arms.
- Deep vein thrombosis in the arm can cause arm pain, but this is a separate condition from pulmonary embolism.
- If you're experiencing arm pain and are concerned about pulmonary embolism, it's essential to seek immediate medical attention, as other conditions that can cause arm pain, such as heart attack, also require urgent care.
From the Research
Presentation of Pulmonary Embolism
- Pulmonary embolism (PE) is typically characterized by symptoms such as acute chest pain, shortness of breath, or syncope 2.
- However, PE can also present with atypical symptoms, making diagnosis challenging 3, 4, 5, 6.
Atypical Symptoms of Pulmonary Embolism
- Atypical presentations of PE can include shoulder and back pain 4.
- Flank pain is also a recognized atypical presentation of PE 6.
- There is no direct evidence in the provided studies to suggest that upper limb pain is a common presentation of PE.
Diagnosis and Management of Pulmonary Embolism
- The diagnosis of PE is determined by chest imaging, and the clinical probability of PE can be assessed using a structured score or clinical gestalt 2.
- Direct oral anticoagulants are recommended as first-line therapy for PE, with thrombolysis reserved for patients with systolic blood pressure lower than 90 mm Hg 2, 3.