A 52-year-old white male initially presents complaining with left shoulder and arm dyskinesia. Patient states, “The arm feels like a bag of feathers at times.” He also describes paresthesia to the 4th and 5th digits of the left hand. The patient states that the problem started 9-10 months prior to his visit. He denies any trauma to his neck or left arm. Significant past history revealed a heart catherization 12 years ago for chest pain with negative results. Patient takes no medications and has no allergies. Pertinent social history includes a 35 pack year smoking history and moderate alcohol use. Family history is unremarkable.
Review of systems showed pertinent negatives for any cyanosis, rashes, or ulcerations of the extremities. The patient had no history of vertigo except during occasional use of left arm especially when raised above the head but not consistently. He also denies any transient paralysis, syncope , diplopia, vision loss or slurred speech, No history of hematuria or hematochezia.
Physical exam revealed a marked discrepancy of 75 mmHg in the systolic pressures of his left and right arms (left being lower) and a soft left subclavian artery bruit. The patient maintained left radial pulse when the arm was raised above the head. Patient also had no palpable pulses or edema of the feet. No splinter hemorrhages were noted to the nail beds. The patient had no ulcers to the mouth or skin. No purpuric or petechial lesions were noted. The patient had normal brachioradialis and patellar tendon reflexes bilaterally. Patient had good sensation to the fingers, hands, and arms to light touch. Patient had a negative Tinel and Phalens sign. No tremors were noted.
Selby, Sam; Garcia, G. Matthew; and Betz, Bill, "Subclavian Steal Syndrome in a 52 Year Old Male" (2009). Research Appreciation Day. Paper 4.