Good morning everyone. I need advice please. My partner managed to fall yesterday (fell off a high kerb while looking to avoid traffic) He’s fractured his left wrist and is now in plaster in a sling but been told he may likely need an operation to pin and plate it. He’s in a great deal of pain, understandably. He was diagnosed with pmr in February 2021. Started on 15mg which was increased to 20mg which resolved his symptoms. Using the DSNS method he had very successfully just reduced to 6.5mg with no painful symptoms. What should he do now re pred dose? Obviously there’s an awful lot more inflammation floating around his system. Not to mention pain and stress. And what about pain killers? He’s so far taken 6 Co-codamol (15/500) since yesterday afternoon with no relief. We have paracetamol and Brufen. What’s best and at what dose? We really need advice re the pred dose please - obviously he doesn’t want to up it as the reduction was going so well. But he’s in so much pain, would the pred help the pain? Thanks in advance - I know someone will be along with good advice, despite it being early on a Sunday morning
Fractured wrist: Good morning everyone. I need... - PMRGCAuk
Fractured wrist
Ouch!…oh dear that’s nasty…
If Co-cocodamol isn’t helping doubt the paracetamol alone will, so long as he is careful to protect stomach he could take Ibruprofen for a few days - PMRpro often talks about her flooding dose (agreed by her Rheumy) see this post - healthunlocked.com/pmrgcauk...
Although he doesn’t want to, it might be wise to take extra Pred for a week or so, not for the pain per se, but the shock of the fall may well cause a flare, so perhaps best to pre-empt that happening.
Maybe up to 10mg for a few days (depending in decision on operation) and then back down to 7mg for a few weeks before recommencing taper. At this dose his adrenals may be under stress as well.
Hope it soon heals and he feels better.
Ooh dear ,that’s not fun. For the wrist perhaps ask the GP for some enteric coated Diclofenac that’s slow release. He could take Paracetamol too but check with the doctor and no more than 8 a day. Traumatic inflammation tends to reach a peak over 48 hours and he’ll also be hurting from whatever else he tweaked on the way down and after he bounced. Increasing the Pred isn’t what you need for that but as DL says a bit extra for a few days might mitigate the shock causing a flare. I’d be wary of taking paracetamol at maximum levels for more than a few days because for some that is still a bit too much for their liver. Is calling 111 an option for you, being that it is a Sunday?
Indeed - OUCH!
A fall - and one not as dramatic as that - can be enough to trigger a flare I'm afraid. So he may well have to up the pred. Can he differentiate between the pains? And actually - this would come under Sick Day Rules so maybe that is something to get clarified with the doctor.
15/500 co-codamol isn't particularly strong - not that much better than plain paracetamol. Don't get mixed up and add more paracetamol to the cocodamol - already a full dose of paracetamol there.
Has he been given stomach protection because of the fracture? They are very keen on that here because a fracture can cause acid release and gastric problems - it is the only time I have had severe stomach pain so watch out for that.
When is his fracture clinic appointment?
Thanks PMRPro. He’s not yet been given a fracture clinic appt. As yet. The doctor he saw yesterday said he’d get a phone call in the coming week with an appt.
He wasn’t given stomach protection but we have some Lansoprazole 30mg in the cupboard that he was given a while back for acid reflux (which hasn’t bothered him for ages) Should he take those?
Yes, he can differentiate between pmr pain and the current pain - he assures me he has no pmr pain.
He’s been totally left on his own by both gp and rheumatologist. Both had said they’d be calling him months and months ago but not heard from either of them. Fortunately (so far) the surgery seem happy to sign repeat prescriptions without question! I’ve learnt everything I know from this excellent site and passed it on to my partner.
Dorset Lady suggested your ‘flooding dose’ of 800gms Brufen - would that be an option as the Co-codamol aren’t doing much to help with pain so far?
Thanks again
Only if he takes it with food and lansoprazole - but yes, it might do the job but I think 111 and tell them the pain is intractable is a good idea. As I say, 15/500 may not be enough - my paramedic daughter gets no relief except with 30/500. 111 might manage to get you a script. But with cocodamol, do make sure he doesn't get bunged up! That would be all he needs!
I am so sorry your husband is in a lot of pain. You really should get your husband to talk to his doctor rather than taking advice from people on this discussion board, we are not qualified medically. Also he should not take medications prescribed for some previous reason without your doctor being aware. If he raises his pred dose and hits the PMR on the head he can reduce again quite quickly. If he has to increase the steroids he should, he is not helping himself by staying on the current dose. As it is a Sunday he can phone 111.
Hi Piglette, Thank you for replying to my message but I'm afraid I need to disagree with you regarding talking to our doctor rather than relying on advice on this message board. Several people on here know far more about pmr than either our GP or the rheumatologist my partner (not husband) saw once only. PMRpro, as well as having pmr herself for many years, also has an excellent medical background and regularly passes on advice from highly regarded Rheumatologists who are leaders in the field of PMR. She and several other ambassadors also point out links to scientific articles with helpful and relevant information. I don't feel any reluctance in asking for advice from others and would never accept anything without doing the research. As I said to PMRpro - my partner's GP hasn't contacted him for well over a year despite promising to, and we're still waiting for the promised February call from the rheumatologist (who was useless anyway)
I do agree that a lot of people on the board have had experience of PMR. However the rules of the board say we are NOT qualified to give advice. I know we do give suggestions, but if something were to go wrong we could be in a very difficult situation giving medical advice. We do not know your husband’s medical history, while your doctor does.
Hi Piglette, Yes, I do totally understand what you are saying. I was simply asking for advice, which I am grateful for from all responses. We will see how he goes and will try 111 if things don't improve very shortly with the co-codamol he is currently taking (we are aware of avoiding getting 'bunged up'!)
Co-codamol is pretty nasty at seizing you up! As I said we are asked not to give advice, quite sensibly. We can say what has helped us and suggestions, but as HealthUnlocked says “postings on this board do not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.”
Ah yes, a FOOSH fracture! (Fall on outstretched hand), the most common. I agree with Piglette. It sounds like round the clock pain medicine is needed to start. If or when he has surgery the anesthesiologist would likely give a stress dose of steroids for that. I had one 4 years into my PMR journey. Never needed surgery, but did need icing and Oxycodone for the first 2 days. I never increased my Pred and it was fine (I think I was around 4 to 5mg at the time). Extraordinary pain can be a sign something is wrong too. Needs at least a call to the ortho. Good luck, hope he gets relief soon.
I think we probably are eminently qualified to share our experiences with PMR, but less so with fractured bones. If your partner's wrist is so painful and medication is not working I think it is important to seek on site medical advice, even if it is only to find out exactly why there is so much pain and learn what are reasonable expectations for relief. I had a tibial plateau fracture and I have to say that for the most part as long as I remained immobile I was not in much pain at all. Your husband may have sustained a lot of soft tissue damage, now swelling, and possibly even the cast he's in is causing more discomfort. I do think consulting a local medically qualified person would be a good idea, especially if this continues for another day, because there may be something mechanical rather than medicinal which can help. I do hope he begins to feel better soon.
Be extremely careful if he has excessive pain. A friend of my sister fractured her ankle and was put in plaster while waiting for surgery. She was in a lot of pain but assumed it was the fracture. Two days later she collapsed and died from a blood clot. She was only in her forties. I know it was probably an extreme case but do not ignore if pain increases rather than decreases.
Thank you for your reply Shiv14. I must confess it wasn’t anything I’d thought of before but you’re absolutely right to point out the possibility of a blood clot - however remote the risk. Thankfully the pain hasn’t got worse and is very marginally better today. However, if it does increase I’ll make sure to get him back to A&E without delay.
I fell and broke my wrist while working in Santander so could only have a back slab as I needed to fly home at the end of the week (working the whole time). I was in a tremendous amount of pain when others were telling me that it shouldn't hurt that much so I put it down to the back slab, but even after getting back to the UK and getting it x-rayed again and re plastered it was still incredibly painful. After 5 weeks, so a week off the recommeded time for a straightforward break, they then decided to pin it in two places. Another 6 weeks of pain, again with everyone telling me it shouldn't be hurting. I have no idea why it hurt so much the whole time, but I didn't have LVV at the time so I can't imagine what a worry it must be. Does he have a pillow he can rest it on when he is sitting. If he is in a lot of pain you need to ring the fracture clinic and tell them, there may be something they missed.
I don't know - even with metalwork I had awful pain without the right pain relief. And sometimes that is hard to achieve. Especially if a nurse tells you you "need" some pain and refuses to bring the necessary!!!!!
Funny isn't it. Everyone told me I shouldn't be in pain. I had to work the whole time alongside it, for lots of reasons, but the final straw was being on a busy tube home and someone fell on me hitting my plastered arm and pushing the pin onto the bone!!!! Back to the fracture clinic to get it pulled back... you couldn't write it.
OUCH! Got funny feelings all down to my toes!!!!!
😂 exactly... it wasn't nice !!!
OMG - can’t imagine that pain! What a nightmare story. Poor you 😢
Had bad fractured wrist two years ago (referred to as Volar Barton).Have had PMR for four.
Hospital prescribed huge daily dose of Iboprofen (the tablets were pink)+ Co-codamol.
I was in a lot of pain, especially after the operation to pin the area, but with all the stress, I did NOT increase my daily Pred dose.
Eventually, after a month or so, the really bad pain (even taking the pain relief) subsided into an ache - and then nothing.
Take each day as it comes - some better than others. Of course, the added worry of losing work, and not doing it so well, also adds to the build up of stress. 🙂
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