Pain during passive movement of hips = not PMR.. And other questions...

[Pullingmysocksup]

I have a few questions that I hope you can help with but where do I start?I went to my first Rheumatology appt on Friday at the university hospital. The doctor who saw me immediately thought I have PMR but wanted to run it by the senior training doctor. As I was lying down, he moved my legs out to the side, I said Ow, and he immediately said that it's not PMR because it shouldn't hurt when moved passively.

So I I went on to get a cortisone injection in my shoulder, a lung x-ray and waiting for an mri appointment which could take up to a month. In the meantime I've been prescribed Diclofenac.

The medical report states they suspect I have rheumatoid arthritis. My CCP and RF blood results are negative.

Here are my questions...

If naproxen hasn't done a damn thing (to whatever it is that I have), will diclo? I have these useless painkillers piling up and I don't see a reason for another packet.

I was very exhausted and in pain on that day. So much so that I didn't question the doctor when he came to the quick conclusion that it's not PMR.

For him to think it's probably RA: He didn't like the look of my bent elbows but I didn't tell him that's always been as straight as they go. Yoga teachers all over the world for 30 years have been trying to get me to straighten them.

The leg movements: I have been scrunched up in pain for so long due to a misdiagnosis and I wonder what kind of pain he's looking for, and why he would dismiss PMR so quickly.

I still don't think RA adds up to my symptoms, while PMR is spot on. We're told not to self-diagnose but at the same time we feel our bodies, nobody else.

I'm in so much pain at night it's barely worth getting into bed. I have not moved my body properly for two months; visibly smaller due to this (no weight loss). I'm self-employed and losing projects every week. It's miserable.

I would really appreciate any thoughts on any of the above!

[PMRpro Ambassador]

PMR plain and simple might not cause pain but trochanteric bursitis (TB) does I think if it is bad enough. And trochanteric bursitis is very often seen in PMR.

"Trochanteric bursitis is another feature commonly described in PMR. Cantini et al.(17) found that 100% of patients with PMR had trochanteric bursitis, compared with 64,7% of our patients. Ochi et al.(10) also showed that the amount of effusion in hip bursae was greater in patients with PMR than in patients with RA and in controls.

Although prevalent, bursitis and synovitis of the shoulder or hip are not specific for PMR. They are commonly found in the imaging examinations of patients with RA(9,11,16) and even in those of healthy elderly patients(8), in whom they are mostly related to mechanical or degenerative changes."

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

They do say that it can be seen in RA too - but his assertion that you don't get pain in PMR is wrong if you have TB that is bad enough.

"The classic symptom of trochanteric bursitis is pain at the greater trochanteric region of the lateral hip. The pain may radiate down the lateral aspect of the ipsilateral thigh; [5] however, it should not radiate all the way into the foot. Onset may be either insidious or acute. The symptoms are made worse when the patient lies on the affected bursa (that is, when lying in the lateral decubitus position).

Hip movements (internal and external rotation), walking, running, weight-bearing, and other strenuous activities can exacerbate the symptoms. Patients may report that the pain limits their strength and makes their legs feel weak.

Diagnosis of trochanteric bursitis

The most classic physical finding in trochanteric bursitis, also known as greater trochanteric pain syndrome (GTPS), is point tenderness over the greater trochanter, which reproduces the presenting symptoms. Palpation may also reproduce pain that radiates down the lateral thigh. Additionally, it has been reported that tenderness to areas that are either superior or posterolateral to the trochanter can be identified. [6]

Lateral hip pain can often be elicited by carrying out passive external rotation of the hip without provoking such symptoms by internal rotation or performing end-range adduction. [7] In addition, the external rotation can be combined with passive hip abduction. Lateral hip pain can be reproduced with flexion of the hip followed by resisted hip abduction. Groin pain or referred knee pain provoked by passive internal rotation of the hip may indicate hip joint pathology (eg, osteoarthritis). Performing other specific musculoskeletal examinations, such as the Trendelenberg test and Ober test, can help to identify other structural derangements that may lead to lateral hip pain"

emedicine.medscape.com/arti....

youtube.com/watch?v=Hkqr3mg...(Not working as expected?)

shows the hip exam - which one hurt that he said shouldn't?

[Blossom20]

Oh I feel your pain! Poor you. I really don't know why they don't let you report back about the painkillers not working and work out a sensible plan with you - i. e. agree it could be pmr and so try you on pred...It might be R.A as well, but if you feel better after the pred that would be half way there!

Best wishes to you..

[piglette]

What an idiot rheumatologist, haven’t they heard of people having PMR AND something else. Why can’t they use common sense, you don’t need medical qualifications to work that out.

[Pullingmysocksup]

PMRpro, Blossom, Piglette. Thanks for your feedback. I phoned the hospital and spoke to the junior doctor who was quite comforting really. They're pushing for an mri this week and will keep me for a couple of days in order to double check everything they've already come up with.

It seems it really could be RA which means MTX for me and hopping over to the RA group too.. I'm sure they're equally as charming and supportive as everyone here is ❤️

[PMRpro Ambassador in reply to Pullingmysocksup]

You don't have to leave us - and we are a rather different forum!!

Do let us know what they decide.

[Pullingmysocksup in reply to PMRpro]

Haha, yes, I gather! I rather like it here 😄

[DorsetLady PMRGCAuk volunteer in reply to Pullingmysocksup]

so do we 😊

[Pixix]

my bursitis pain regularly goes down my thigh to above the knee, but no further, justFYI. My G.p thinks ihave zero negative RA, & PMR…the two can come together, I think, sorry if that sounds negative, just want you to keep an open mind! S x

[PMRpro Ambassador in reply to Pixix]

I wonder if TB often gets confused with sciatic pain? Sciatic pain sometimes goes down to the foot, TB doesn't. But if the patient doesn't specify it could be confusing.

[Pixix in reply to PMRpro]

Could be. My TB pain goes down top of thigh, thinking about it, but doesn’t really reach my knee…whereas the sciatica goes down below the knee. Interesting thought!