Trapezius trigger point

[Broseley]

I seem to have developed a trapezius trigger point (according to Dr Google). About 3 weeks ago I first noticed a tender spot on my back slightly to the left of my spine, between my shoulder blades. It feels like a bruise. It has been slowly getting worse and is particularly bad on waking in the morning. It now feels very sore especially if I reach forward or round my shoulders. Is this related to PMR/GCA at all? Should I be worried about a flare? I've never had any problem in this area before. I'm on my 3rd week of 8mg pred reducing by 1mg every 6 weeks. Everything is fine otherwise.

[SheffieldJane]

Have you been sneezing with hay fever ? My husband has hurt the Trapezium muscle on two separate occasions with a violent sneeze.I think we are particularly prone to injuring our weakened muscles, from the use of Pred. I vomited once and had rib pain for a week.

We have a good physiotherapist nearby, who is also a Pilates teacher. She was able to help my husband and for me, she is familiar with PMR. Otherwise it seems to be rest and painkillers from the GP.

Try not to feel too stressed and frustrated. I think that is more likely to trigger a flare than this pain and limitation alone ( in my experience).

[Broseley in reply to SheffieldJane]

Thanks! No I've only sneezed a couple of times and don't get hay-fever. I think it stems back to wearing my sunhat. The toggle on the underchin string dug into my back when I was leaning against a chair back as I wear it at the back of my hat. It became uncomfortable so I moved it. But that was 3 weeks ago. Would that cause this problem? It felt bruised at the time but I didn't expect it to cause this problem.

[SheffieldJane in reply to Broseley]

Maybe! We are a bit Princess and the Pea. I had elbow pain that I traced back to habitually reading whilst leaning on one elbow.Get a new hat. 🙂 x

[Broseley in reply to SheffieldJane]

Before PMR I developed a real problem with my left arm which kept going numb. I realised that, sitting at a computer all day using the mouse with my right hand, I was resting my left arm on the table. Resting my arm on my knee didn't help. I found that putting my arm across my body with my hand on my right shoulder stopped it happening. Now I habitually sit like that even though I retired 4 years ago. It looks a bit strange I guess!

[SheffieldJane in reply to Broseley]

Needs must. What about treating yourself to a touch screen? I can’t even work my husbands stupid mouse. You can also get wrist rests and all sorts of equipment to enable ease of computer use. Mind you, you would still sit with your arm across your chest holding on to your shoulder. Shockingly I used to hang my head back at work, to think about what I was drafting. I now have cervical Spondylosis and bad head and neck pain - what an idiot!

[Broseley in reply to SheffieldJane]

Thanks, I have retired now, so don't sit at a desk anymore. The arm thing is just habit! I do it when i'm watching telly!

[PMRpro Ambassador]

Almost certainly part of myofascial pain syndrome - which can be part of PMR although it can happen all on its own too. Anything that makes your back muscles work hard to keep their usual position can make them protest but the trigger point is a knot of inflamed muscle fibres and it can irritate surrounding muscle.

I can improve it with a flooding dose of ibuprofen (800mg) and sitting with a hot water bottle over the sore area - it helps relax the muscle. Not ideal in this weather - some people do well with ice.

[Broseley in reply to PMRpro]

Thank you. I read that circular massage on the spot can help too. I can't take NSAIDS due to being on apixaban. I could try the ice though.As long as it's not a sign of an impending flare... I was slightly stiff in my shoulders and hips this morning too.

[PMRpro Ambassador in reply to Broseley]

I'm on Pradaxa. Occasionally my rheumy does a week of high dose NSAID infusions - to sort out s/i joint problems but ALWAYS with a PPI to protect my stomach. Once he said 2 weeks of oral ibuprofen, 800mg/day as a single dose. Also with a PPI. It does work if used early enough. I develop amazing bruises but no stomach problems.

I do prefer manual mobilisation of the trigger point - was hoping for that this time but had to wait weeks for appointments to get into physio at all and then the doctor was fixated on the hip bursitis and him using his favoured approach of external shockwave therapy - it works, I know that, but this time it is all too spread out because of lack of appointments and him being on summer holidays. He has a farm up a mountain - probably doing the hay harvest!

[Broseley in reply to PMRpro]

If the mountain doesn't come to Muhammed.... maybe offer to help with his hay harvest!I'm on omeprazole anyway at the insistence of the GP. I asked to come off it she said no not while I'm on steroids. But I've been told no way can I use ibuprofen or even the gel.

[SheffieldJane in reply to PMRpro]

Your medical services sound much more engaged than the ones we have in the uk.

[PMRpro Ambassador in reply to SheffieldJane]

Which is why I'm staying here as lomg as I can! Not as good as they were because of covid but I do see my doctors and f2f!

[Koalajane in reply to PMRpro]

I think that is what I have and believe it is caused by my job! I work on a checkout in a large supermarket! Perhaps it is time to retire. My pain is in the same place as Broseleys

[PMRpro Ambassador in reply to Koalajane]

That particular bit of mine improved once I wasn't working at a computer on a desk for hours. Funnily enough it is much better sitting on the sofa with a small table and half a dozen pillows behind me! It was something that was an early feature of my PMR - a strange tingling sensation into my shoulder blades on both sides, especially sitting without back support.

Never too soon to retire if you can afford to!! OH would sit down every few months and do spreadsheets to see how we would get on until we got our state pensions if he took early retirement which meant losing 15% of his NHS pension. One day he appeared and announced it would be OK. In fact it was better than OK because he did some consultancy - not MP pay for it mind, ,just pocket money! - but it kept him occupied and we still got to travel a bit for the international congress he edited the Proceedings for for love, they only paid the flights and the meeting but we would add a holiday to it - 10 days in China, a few days in S Korea, long holiday in Canada. So glad we did. Had he waited for 65 we'd not have had much of a retirement together.

[Broseley in reply to PMRpro]

It's worth making the most of any opportunities when you can. And it's definitely not worth flogging yourself to death by keeping going in a stressful job. I learnt this the hard way. The stress of less income is less than the job stress, in my case at least. I set myself up as a gardener for old ladies. I had some lovely clients who showered me with gifts at Christmas and I got out in the fresh air and had some regular exercise. On other days I did supply teaching then got a job in an FE college helping students with learning difficulties which proved to be so rewarding, even though the pay was rubbish.

[Missus835]

I also have this. Was told it's not PMR related but probably an "old pain coming back". I know it's PMR related, so I just nod my head. No sense trying to convince someone who doesn't want to listen.

[PMRpro Ambassador in reply to Missus835]

PMR always searches out anyone's weak points - so yes, might be an old pain coming back, but the PMR sought it out.

[Missus835 in reply to PMRpro]

Yes my not so amazing Rheumie said "we can't treat every pain in our body with Prednisone". Duh. I cannot stand this person. 😒

[PMRpro Ambassador in reply to Missus835]

"Did I ask you to?"

[Dochaz]

I had this exact thing for several months before I was diagnosed. It has completely disappeared since I started on Prednisone. So maybe a link?

[Broseley]

I'm sure I've read on here - PMRpro correct me if I'm wrong - that pred takes away all your inflammation. So all my pains from tendonitis in various joints and my sciatica, knee pain etc went away when I started on pred. Now I'm down to 8mg a few niggles are returning and now this trapezius trigger point. I don't think they are necessarily PMR as I've had them for years before diagnosis. That's why I loved being on pred when first prescribed, it was the first time I had been pain free in years!

[pata63 in reply to Broseley]

When I started Pred at 20mg many of my long term niggles went away. Most came back a year or so later. I have had that Trapezius trigger point for at least a decade, so long before PMR and long before Pred. The worst I can remember having the Trapezius trigger point in recent (PMR) times is when I had a Kidney Biopsy in Nov 2020. The entry point is well away from the trigger point, but my body seemed to think I had been stabbed in the back and completely tensed up.

I have regular massages and that helps, but I also learned that you can do it yourself with a tennis ball. You can do it lying down on a soft rug/yoga mat with the tennis ball in the right spot and roll around a bit. If that's too painful then do it standing up against a wall. That makes it a bit tricky to get the ball in the right place. I put it in at the top with my shoulders against the wall and wiggle a bit to give the ball a controlled descent to the right place. It may take practice. 😀 The method is described in Robin McKenzie's book Treat Your Own Back.

optp.com/Treat-Your-Own-Back

[Broseley in reply to pata63]

Thanks, I'll give that a go. It's in a hard to reach place, I can only reach by holding something. I gave my back a good scrub in the shower last night. That seemed to help!

[DorsetLady PMRGCAuk volunteer in reply to Broseley]

You’re right Pred does reduce inflammation whatsoever the cause -as many of us with pre-existing conditions have discovered over the years -OA in my case.

[PMRpro Ambassador in reply to Broseley]

There are some forms of inflammation it doesn't work for, such as in COPD and cystic fibrosis and some asthma although it does work for most asthma patients.

ncbi.nlm.nih.gov/pmc/articl...

There are also patients where prednisone doesn't work - but prednisolone does.