Severe Left Arm pain | Figure 1

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Severe Left Arm pain

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The patient is a 64 y/o female presenting for c/o Right upper extremity pain for 1 week. The patient describes left upper extremity pain, intermittent sharp pain starting at scapula radiating down to fingertips. Pain is severe, 8/10 in severity. The patient does not have symptoms of bruising, swelling, redness, warmth, numbness, tingling, weakness. The patient did not have a loss of consciousness, no vomiting, no dizziness present, no blurry vision.

Review of Systems: denies chills/sweats, denies shortness of breath, denies neck pain/stiffness, denies lightheadedness

Physical Exam:

Constitutional: No acute distress

HEENT: Mucous membranes moist

CV: Regular rate and rhythm

Respiratory: Lungs clear without crackles,

Extremities: Non-tender. No edema. no pain to palpation, limited ROM b/l upper extremity. Left hand 2/5, R hand 3/5

Back: No tenderness

Neuro: No gross motor deficits,

Pmhx: Anxiety disorder; Bronchiectasis; Coordination of complex care; COPD, group D, by GOLD 2017 classification; Diverticulosis; Essential hypertension; Fecal occult blood test positive; Frequent falls; Gait instability; Hyperlipidemia; Moderate episode of recurrent major depressive disorder; Nausea; Neutrophilia; Preventative health care; Pulmonary nodules; Spondylosis; Subconjunctival hemorrhage; Tobacco dependence; Type 2 diabetes mellitus with diabetic neuropathy, with long-term current use of insulin; Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin; Vitamin D deficiency; Xerosis of skin

Medications: albuterol sulfate 2.5 mg/0.5 mL inhalation solution for nebulization; Alcohol Pads topical pads, medicated; ammonium lactate 12 % topical lotion; Chantix 1 mg oral tablet; diclofenac sodium 1 % topical gel; gabapentin 300 mg oral capsule; lancets 30 gauge miscellaneous misc; losartan 50 mg oral tablet; lovastatin 40 mg oral tablet; metformin 500 mg oral tablet extended release 24 hr; mirtazapine 15 mg oral tablet; Mucinex 600 mg oral tablet extended release 12hr; pen needle, diabetic 32 gauge x 1/4" miscellaneous needle; ProAir HFA 90 mcg/actuation inhalation HFA aerosol inhaler; Systane Ultra 0.4-0.3 % ophthalmic (eye) drops; Toujeo SoloStar U-300 Insulin 300 unit/mL (1.5 mL) subcutaneous insulin pen; Trelegy Ellipta 100-62.5-25 mcg inhalation blister with device; Trulicity 1.5 mg/0.5 mL subcutaneous pen injector; Vitamin D3 2,000 unit oral capsule; Zoloft 100 mg oral tablet

What is you Ddx? How would you approch this?

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