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Getting occasional pain in wrist area when exhaling a deep breath. What could be causing this?

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Cardiologist
Practicing since : 1981
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I have something really odd going on for the past couple of days. I get occasional pain in my left wrist area (palm side) when exhaling a XXXXXXX breath or coughing hard. No other pain. No radiating pain down the arm. No injury. Again, the pain only occurs when I exhale a XXXXXXX breath. The pain only lasts a few seconds. I don't have any other symptoms -- no tingling, no numbness, etc. What could be causing this?
Posted Tue, 27 Nov 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Anil Grover 2 hours later
Hi,
Thanks for writing in.
I am a qualified and certified cardiologist. I read your mail with diligence.
One thing I am sure that this pain has nothing to do with heart.
Analyzing your symptoms- short lasting pain in wrist on movement of rib cage and muscles taking part in respiration- can be because of temporary pressure on one of the sensory nerve which is carrying pain sensation from your left wrist. The nerves are more vulnerable to (and exposed to) pressure when these leave the spinal nervous system that is spinal cord coming out of vertebral column at neck region. Cervical spondylosis, cervical rib come to mind as immediate diagnoses worth excluding. This can be done by x-rays or scans. I will urge you to seek an appointment with a doctor who after thorough clinical examination would reach a decision what all tests need to be done. If there is any follow up query you have, I will be most happy to answer. While you are with the doctor get yourself have the baseline data for risk factors for coronary artery disease so that you can change your life style accordingly. Take Care. Good Luck.

Best Wishes.

Dr Anil Grover
MBBS, MD (Medicine) DM(Cardiology)
Cardiologist and Internist
http:/ WWW.WWWW.WW
Above answer was peer-reviewed by
 
Follow-up: Getting occasional pain in wrist area when exhaling a deep breath. What could be causing this? 17 hours later
Thank you for your thorough review and response. Two follow up questions:

1. What area of the neck (C1, C2, etc), do these exit the neck region? I just want to be sure that I get the xrays/scans of the right area.
2. What kind of baseline data (e.g. what specific tests and/or bloodwork) do you recommend for the coronary artery disease check?
 
 
Answered by Dr. Anil Grover 2 hours later
Thank you for writing back, I will take up your follow up questions, as you put them
Q:1. What area of the neck (C1, C2, etc), do these exit the neck region? I just want to be sure that I get the xrays/scans of the right area.

A: 1. Usually C stands for cervical and C1 is first vertebra which joins skull with the bony vertebral column. This is reference bony point for radiographer to focus to get x-ray or scan for the area. It is also used for referring to the nerve which comes out of the spinal cord(which runs within verterbral column) between the same named vertebra. For example C4 nerve comes out of C4 and on its way supplying the arm can be compressed by osteophytes or bony concretions which narrows the space between C4 and C5.

Q2. What kind of baseline data (e.g. what specific tests and/or bloodwork) do you recommend for the coronary artery disease check?

Following tests have increasing order of sensitivity and specificity in a stable disease:
1. EKG
2. Treadmill test
3. Stress (exercise or pharmacological) echocardiography.
4. Stress (exercise or pharmacological) radionuclide test (both 3 & 4 are 80-85% sensitive and about 85% specific)
5. CT coronary angiography almost 100% sensitive and specific but radiation exposure is more than acceptable)
6. Routine coronary angiography (Gold Standard)

Regards

Dr Anil Grover
Above answer was peer-reviewed by
 
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