Flare?

[Miserere]

Hallo everyone.

As some of you know I had a total knee replacement before Christmas and progress since has been well. I am due to see the surgeon again on Friday and hopefully he will clear me for driving.

However, I have, over the last week or so, developed aches and pains in the shoulder, arms, wrists and hands and neck. For the last few weeks I have not been able to straighten my right arm as the elbow is painful (could this be from crutch useage?). The neck feels stiff and sometimes there seems to be a moveable headache, often above the right eye. Does any of this sound like a flare? I can still easily lift my arms above my head and I had started to do some yoga movements - maybe I should continue with these. Surely it's not osteoarthritis suddenly beginning to gallop everywhere?

I'm not sure whether to treat this as a flare and increase steroids for a few days or try another way to find out what is going on. Any thoughts appreciated. Thank you.

[piglette]

Quite possible it is a flare. I had quite a bad flare after my hip replacement op and a lot of others have mentioned flares after knee and hip ops. Your elbow oain could quite possibly be due to the crutch. It us surprising how the use of crutches can affect us.

[Miserere in reply to piglette]

Thanks, Piglette - in some ways I'm surprised it didn't happen before if it is a flare.

[piglette in reply to Miserere]

I did think that, but it may be something just pushed you over the edge when it did. I may be wrong of course!

[DorsetLady PMRGCAuk volunteer]

Could well be a combination of a flare and crutch usage - you are using upper body muscles differently from usual… so more stress on shoulders, neck etc which can lead to the odd headache.

Some people many crutches quite, well but I found then a right pain, and ditched them for walking stick[s] asap.

Have you tried ordinary painkillers? guessing your heavy duty ones post op are long good and may have masked these pains. See if that make any difference, if not then you may need to treat as flare - probably aware of usual protocol - but if not see here -

healthunlocked.com/pmrgcauk...

Hope you get the all clear next week…

[Miserere in reply to DorsetLady]

I agree with you, the crutches, past a certain point, become a nuisance so I am changing to a walking stick as I can walk now but would need some support outside. I shall take more ibuprofen again - I had reduced the amount to 400mg/day and was doing absolutely fine but maybe there are some days where more is needed. I am keen to reduce as the GP insisted on Omeprazole as well and I really don't like to take that for too long. Can you remember how long you were using painkillers for? I'll try extra ibuprofen first and see what happens. Many thanks.

[DorsetLady PMRGCAuk volunteer in reply to Miserere]

Heavy duty ones from hospital - until they ran out - and then on paracetamol 2 x 400mg morning and evening… by then opposite hip had decided to join in [replaced 6 months after knee]…. So can’t really compare like for like. Never took Ibuprofen, nor was I still on Pred at that time..

[Miserere in reply to DorsetLady]

Ah, thanks. I am allergic to paracetamol hence ibuprofen plus they are anti-inflammatory - just not keen on the omeprazole but needs must. Always good to hear someone else's experience, even if situation not the same.

[DorsetLady PMRGCAuk volunteer in reply to Miserere]

Agree it is - but have to say I do recover from surgery very well -and fortunately never needed any whilst on Pred -which I’m sure makes it more difficult for many.

[PMRpro Ambassador]

A flare is not an unreasonable suspicion - stress doesn't do PMR any good and a TKR is certainly a source of stress! But the right side problems, if that is the crutch side, could be the effort of using the crutch. Plus having the knee done will have altered the way you walk quite dramatically and that will put a fair bit of strain on all your back muscles and that could result in neck pain and headache.

I'd be less inclined to plump for a flare - and blood tests won't help as the ESR and CRP in particular are likely to be raised because of muscle trauma. Does pain relief help? And I mean PROPER pain relief used regularly, not a couple of paracetamol! But there is also no harm trying a few days "flare protocol" with pred and seeing what happens.

[Miserere in reply to PMRpro]

Thanks PMRpro - I will do as you suggest. At first one doesn't realise how much effect the surgery has and I have experienced strain in the back muscles, for certain. Yes, the right side is the crutch side so a walking stick if I need it from now on and an increase in ibuprofen to see whether that settles it down.

Many thanks for your suggestions. I'm glad you are all here!!

[PMRpro Ambassador in reply to Miserere]

I find a crutch easier myself but everyone is different - and the new way of walking is the primary problem I suspect.

[SnazzyD]

When did you start doing yoga?

[Miserere in reply to SnazzyD]

About 5 or 6 days ago. The physio discharged me as I could bend the knee more than 100 degrees and it sort of felt like a free pass. I have discovered, to my surprise, I can kneel. Maybe there is an amounts of DOMS involved.

[SnazzyD in reply to Miserere]

Hmm, I would have half an eye on that. Mt husband and I started yoga last autumn and we were in all sorts of discomfort after our muscles were put through very gentle and tailored (to us) movements that were a novel idea for our muscles. Does Paracetamol help? I don’t mean get rid of it, but does it give you some respite?

[Miserere in reply to SnazzyD]

No, ibuprofen doesn't seem to do much for it. I just tried my small tens machine and I can feel it is sore in the shoulder. I am allergic to paracetamol. I just wonder - I did some somatic movements (even easier and slower than yoga) and a few yoga moves, mainly on the floor. I did do the seated twist and forward bend but I had done these before with no problems. I'll just give it a bit of time and see what happens.

[pegpowell]

If you continue to use ibuprofen, be sure to take with food. I didn't the year before PMR diagnosis and I eventually ended up in the ICU for couple of days with a major ulcer bleed. That was in 2017 and I still have to take omeprazole because of it.

[Miserere in reply to pegpowell]

Thank you for this pegpowell - this is another reason I don't want to take it for too long together with the Omeprazole.