Can a soft tissue injury exacerbate PMR symptoms?

[Horsewhisper]

Seeking a bit of guidance from you lovely people - I injured my left tricep on Monday afternoon and went to A&E on Tuesday as the pain was unbearable. No bones broken and the tendons are intact. It’s my left shoulder that has PMR.

The pain in my neck, shoulder and upper arm on my left side is so excruciating that I cannot sleep and it drives me to tears. I am taking co-codamol in the day and Tramadol at night to try and keep the pain levels under control. I am currently on 13.5 mg Pred.

I wondered if the PMR has flared up as a result of this muscle trauma and is exacerbating the pain? Has anyone experienced something similar?

[SnazzyD]

You have my sympathy! Can you say what happened and what movement or impact did the business?

[Horsewhisper in reply to SnazzyD]

Thanks Snazzy - I was holding onto the handles of a hay-laden wheelbarrow and got mobbed by the hungry horses out in the field. I turned sharply to my right to get out of the way, whilst leaving my left hand gripped onto the handle. My whole arm twisted in the process.

[SnazzyD in reply to Horsewhisper]

Ouch, so plenty of opportunity for some comprehensive soft tissue damage, so I’m not surprised the whole lot is unhappy. I think even a non PMR person would be smarting. So while a flare may be caused the level of discomfort sounds perfectly in proportion to the potential damage you’ve sustained. Although they couldn’t find any obviously snapped tendons there can be micro damage anywhere in that system. Did they check the attachments of your biceps other than x-ray, such as a thorough manual exam? You don’t need to have tendon end flapping in the breeze to have problems. Have a read to see if this rings any bells? coreem.net/core/biceps-and-...

Do you have any problems along your collar bone?

Another possible area that can cause trouble is around the acromium, as small area that can cause havoc over a wider area and is easily damaged

complete-physio.co.uk/acrom...

These are just two of many areas that only need a small tweak and you’ve got a lot of pain because the effect of torsion will have traveled from hand to neck.

If it was me, I’d be trying to get to a good physio who can diagnose rather than just follow standard exercise prescriptions. I’ve found a wide variation in skill. Also, I’ve used osteopaths for many sports injuries where the medics have said, “soft tissue, nothing we can do, go home and rest with pain killers”. This is ok but doesn’t guard against the development of increasing dysfunction as small but chronic issues come to visit and refuse to leave.

[Horsewhisper]

Really helpful info and links here Snazzy, thank you very much. The doc conducted a physical exam of the arm and said the tendon attachments were in place. He asked me if I heard a popping sound at the time of the accident - I didn’t hear anything. I’ll definitely book some physio to help with recovery, but thanks again for your speedy response and very helpful info - feeling a bit better already!

[PMRpro Ambassador in reply to Horsewhisper]

I imagine you had other things to think about at the time!!!!!

[Horsewhisper in reply to PMRpro]

Indeed! I think that if there was a popping sound of a breaking tendon, it would have been drowned out by me swearing at the horses rather loudly!

[PMRpro Ambassador in reply to Horsewhisper]

Perish the thought you SWORE Poor defenceless animals ... I can also only imagine the doc in question wasn't too familiar with horses????

[Horsewhisper in reply to PMRpro]

They were a bit shocked at my foul language…but soon forgot about it as they tucked into the hay! The doc was very young, (aren’t they all!) seemed very competent and was swift in his diagnosis. I’ll book some physio with a lady I’ve been to before - she’s older than me with tonnes of experience! I’ll see how I get on, thanks for your messages 😁

[PMRpro Ambassador]

Even a minor fall can trigger a flare of PMR.

[SheffieldJane]

Oh you poor, poor thing. In my experience physical trauma is another kind of stress that can lead to a PMR symptom flare. I would be inclined to increase Pred by 5 mgs for a week to 10 days and then return straight to my normal dose. This may just avert the crisis. Check that your doctor is agreeable. Mine tends to trust my forum trained instincts.

[Horsewhisper in reply to SheffieldJane]

Thanks SJ - I did wonder about upping the Pred for a while, my hips are starting to grumble now…

[SheffieldJane in reply to Horsewhisper]

It’s like putting out little fires before it becomes a full on bush fire. Good luck!

[Horsewhisper in reply to SheffieldJane]

Yes indeed! Pred at the ready!

[MrsNails]

Lots of Empathy - mines in my Neck, Arm, Hand & Fingers 😖

Have they suggested Amitriptyline? GP suggested putting my dose up to 50mg 🤦🏻 I take 20mg & l had increased it to 30mg (as that is what l am written up for) but 50mg 😵‍💫 so l’m taking 40mg but know l’ve got somewhere to go…..Hope you start improving soon.

MrsN

[Horsewhisper in reply to MrsNails]

Thank you Mrs N - sorry to hear how much you are affected by PMR. I might try Amitriptyline as I know that can ease the pain and help with sleep. I’ve strapped an ice pack to it today and rested it in a sling and it is starting to feel a tiny bit more comfortable 🤞Thanks for your kind wishes x

[MrsNails in reply to Horsewhisper]

If you do try the Amitriptyline take it around 7pm as then you sleep the side effects off! I’ve come to bed early as the pain is +++++ so hoping to catch an early night!

Take Care & hope you feel better soon 🍀

[Horsewhisper in reply to MrsNails]

I had a better night - a bit of breakthrough pain at 4 am - knocked it on the head with a couple of co-codamol. Sorry to read about your brachial neuralgia - such debilitating pain - I hope the accupuncture gives you some respite from it. I have found it quite useful from time to time to help me feel “right” again, a least for a period of time! I hope you have an easier day today! 🌸