Left arm pain

[MNortP]

For a few months, I've been getting a constant pain in the muscles/tendons in my left upper arm. It's fine if I don't use it, but it's certain positions and movements that cause the pain rather than any effort I make. I was diagnosed with PMR in 2017 and after several ups and downs, I've been reducing from 2mg to 1mg over the last 3 months. I increased my pred to 10mg for 3 days and the pain went! I reduced to 5 for another couple of days and then back to 2 and now the pain is back. Any thoughts from anyone?

[piglette]

It seems that the PMR has decided 2mg is too low a dose at the moment. If 5mg was OK you could try 4 or 3mg perhaps to see if that works.

[PMRpro Ambassador]

As piglette says - maybe the pred dose is too low, You aren't heading relentlessly to zero, you are looking for the lowest effective dose. Alternatively - it could be a rotator cuff injury or bicep tendonitis since you say it is in certain positions. Any inflammatory condition will improve with more pred but there might be better approaches than using more pred.

But when you try a higher dose like that - don't go back to the dose where you were having a problem, go to the dose ABOVE. I'd say that in fact 2mg was barely enough but you only registered that when you tried to go to 1mg. Prof Dasgupta told us last summer that he often keeps patients on 2-3mg as it reduces the risk of relapses and having to go back to a higher dose to manage it.

[MNortP in reply to PMRpro]

Thanks. I'll probably try 3mg again and stick with it for longer. Ill also look into possible tendonitis or rotator cuff.

[HeronNS]

It can be a puzzle, but make sure it really is PMR before you reach for the pred bottle. How is the rest of your body? It's possible you need a little more pred, you are at a very low dose at the moment, but what may be happening with the arm is that for other reasons it's more vulnerable than other areas and therefore the first to tell you that something is amiss. I had pain in my arm, in my case the right, and it would be worse, quite excruciating actually, in some positions. It did get very much better when I had to take a higher dose of pred because I was developing the classic "pain all over" which surprised me because it had never felt like PMR and it responded to tylenol and aspirin. However I've since decided that it is more something to do with posture, use of arm (in my case too much mousework with the arm being stressed in a certain way), and issues with referred pain from my arthritic spine. I say this because the flare seems to be pretty much doused (we shall see as my pred continues to taper) and sometimes I still get the pain in the arm, just as sharply as before this latest pred/PMR adventure, and other times not at all. Taking up neglected activities like Nordic walking, observing and correcting my posture, carrying on with various physio exercises primarily for my neck, and being more sensible at the laptop, even a little ironing, are all contributing to improvement. All the rest of the PMR pains are gone, current dose 5 mg, tapering by .5 mg every few days to, hopefully, get back to my usual 2 mg.

I agree with PMRpro that it makes sense to look for and treat other causes, and if all else is as it should be, stay at a low dose like 2 mg for an extended time.

[MNortP in reply to HeronNS]

I'm thinking I probably have overused my arm when gardening. I tend to dig and then leave my left hand on the fork (to support me) while reaching down with my right.

[HeronNS in reply to MNortP]

Perhaps so. Apparently our muscles are weaker with PMR and pred, so it doesn't take much, sometimes, to hurt ourselves. My vaccinated arm (Shingrix on Tuesday) is still mighty sore. I barely felt the covid vaccines, but this is something else. At least it isn't a systemic reaction, which I feared. But now I have two painful shoulders, one is the on again, off again arthritic one I described, the other is the vaccine reaction. I do hope they both go away soon. 🙄

Now that you have some idea what might have triggered your pain, that's the first step towards recovery.

[MNortP in reply to HeronNS]

Yes. Thanks for your observations

[NickWarwick]

Hi MNP. I have had a painful upper left arm pretty much all the way through this journey. One specific muscle which shouts when i am pushing my arm up and away from my body. No better or worse when other bits of me are problematic or i am feeling ok, so i am think its just something i have to live with. Ditto a painful joint in my left big toe curiously.

Started 12 months ago and dropped to 6mg yesterday from 6.5mg ie 0.5mg drop every month at the moment.

[PMRpro Ambassador in reply to NickWarwick]

Funny you mention the toe. I can't remember now if it was pre-PMR or the early years, pre-PMR I think, but the joint in both big toes was sore and felt as if there was a bump on it, wearing shoes except walking shoes was very uncomfortable and I usually work Birkenstocks, with thick socks in winter. It persisted for a few winters and then disappeared as quickly as it had developed. Not the joint at the base of the toe (the MCP) but the middle one, the PIP. It doesn't seem as prominent as it was then - the Heberden's nods on my right index finger used to hurt similarly and no longer does but hasn't disappeared

[NickWarwick]

Interesting.

Looking back i am wondering if my toe was the first thing to suggest a future problem.

Maybe 3/4 months before this drama kicked off i experienced a hideously painful left toe joint and couldn't walk. Middle of the day and out of the blue.

Lasted about two hours and then disappeared completely.

I thought it might be gout, but a friendly GP ruled that out as we walked round the golf course together a few days later.

Very odd.

[PMRpro Ambassador in reply to NickWarwick]

Mine lasted a lot longer than that - but who knows.