What imaging modalities are recommended for evaluating left arm pain associated with numbness and tingling (paresthesia)?

From the Guidelines

Imaging for left arm numbness and tingling should begin with an MRI of the cervical spine and brachial plexus, as these symptoms often originate from nerve compression in the neck or thoracic outlet syndrome, as recommended by the most recent guidelines 1.

Recommended Imaging Modalities

The following imaging modalities are recommended for evaluating left arm pain associated with numbness and tingling:

• MRI of the cervical spine and brachial plexus to evaluate cervical radiculopathy, the brachial plexus, muscular attachments, and sites of compression 1
• Contrast-enhanced 3-D MR angiography (MRA) to assess for thoracic outlet syndrome (TOS) and evaluate the subclavian and axillary vessels 1
• Contrast-enhanced 3-D MR venography (MRV) to assess for venous TOS and evaluate the subclavian and axillary veins 1

Additional Imaging Considerations

In some cases, additional imaging modalities may be necessary, such as:

• CT scans with contrast to evaluate vascular causes or other conditions that may be contributing to the symptoms
• Ultrasound to evaluate superficial nerve entrapments, particularly at the elbow or wrist
• Nerve conduction studies and electromyography (EMG) to assess nerve function and locate areas of compression

Clinical Presentation

The imaging approach should be guided by the clinical presentation, with attention to symptom distribution (specific fingers affected), timing (worse at night or with certain positions), and associated symptoms like weakness 1. Early appropriate imaging is important as prolonged nerve compression can lead to permanent damage if left untreated.

From the Research

Imaging Modalities for Evaluating Left Arm Pain

• The recommended imaging modalities for evaluating left arm pain associated with numbness and tingling (paresthesia) include:
  • CT (Computed Tomography) scans 2, 3
  • MRI (Magnetic Resonance Imaging) scans, particularly diffusion MRI 2, 3, 4
  • CT angiography (CTA) 3
  • Perfusion imaging using MRI or CT 2, 4
• These imaging modalities can help identify ischemic lesions, vascular stenosis or occlusion, and other conditions that may be causing the left arm pain and paresthesia 2, 3, 4

Considerations for Imaging

• The choice of imaging modality may depend on availability and the patient's clinical presentation 3
• A comprehensive history, physical examination, and functional assessment can help narrow the differential diagnosis and guide the choice of imaging modality 5
• Electrodiagnostics, such as electromyography (EMG) and nerve conduction studies (NCS), may also be used to evaluate left arm pain and paresthesia 5