Frozen shoulder and other shoulder disturbances in Parkinson's disease.

Abstract

suMMARY The frequency of shoulder disturbances, particularly frozen shoulder, has not been assessed previously in Parkinson's disease. In a survey of 150 patients compared with 60 matched control subjects a significantly higher incidence of both a history of shoulder complaints (43% vs. 23%) and frozen shoulder (12.7% vs. 17%) was found in the Parkinson's disease population. Those developing a frozen shoulder had initial disease symptoms indicative ofakinesia twice as frequently as tremor while the ratio was reversed in those without frozen shoulder. In at least 8% of the patients frozen shoulder was the first symptom of disease, occurring 0-2 years prior to the onset of more commonly recognised features. Parkinson's disease should be added to the list of causes of frozen shoulder, and clinicians must be aware that the latter is often the presenting symptom of Parkinson's disease.The occurrence of shoulder joint abnormalities has not, to our knowledge, been studied in the setting of Parkinson's disease. Although it seems intuitive that immobilised patients in the later stages of their illness might have a high incidence of shoulder disturbances, we have been impressed that a number of our patients have experienced difficulties before other features of Parkinson's disease were recognised. A systematic survey was undertaken to determine how important a problem this was in the Parkinson's disease population. The incidence of complaints related to the shoulder joints in a consecutive series of patients was examined, with specific interest in determining the frequency of frozen shoulder and the relation between its development and the timing and nature ofthe onset of Parkinson's disease.

Pain in multiple system atrophy

“…This is also the type of pain most frequently observed in IPD [8]. Twenty-three per cent of our MSA patients with pain had shoulder complaints, which is less than reported in IPD (43%) by Riley et al [16]. The frequency of "rheumatic" pain is also considerable in the general population aged 50 years and over, and whether it is more frequently encountered in MSA than in individuals of equivalent age remains questionable.…”

Prevalence, Classification, and Etiology of Pain in Parkinson's Disease: Association between Parkinson's Disease and Fibromyalgia or Chronic Widespread Pain

“…Two studies showed that the frequency of pain in PD patients was not significantly greater than that in controls (Quittenbaum and Grahn 2004;Chaudhuri et al 2006). On the other hand, 7 studies showed that the frequency of pain in PD patients was significantly greater than that in controls (Riley et al 1989;Clifford et al 1998;Etchepare et al 2006;Broetz et al 2007;Defazio et al 2008;Negre-Pages et al 2008;Beiske et al 2009;Ehrt et al 2009) (Table 1). Because there are more of the latter studies, including 2 extensive studies (Defazio et al 2008;Negre-Pages et al 2008), we think that the frequency of pain in PD patients is significantly greater than that in controls.…”

“…PD is characterized by resting tremor, slow and decreased movement (hypokinesia and akinesia), rigidity, postural instability, problems with gait, and impaired coordination. In addition to these motor symptoms, patients with PD often suffer from nonmotor symptoms, including severe pain (Riley et al 1989;Clifford et al 1998;Etchepare et al 2006;Broetz et al 2007;Defazio et al 2008;Negre-Pages et al 2008;Beiske et al 2009). …”

The Role of Surgery in Frozen Shoulder

“…Stam 11 Upper limb trauma Arkkila et al 12 Diabetes Choy et al 13 ACTH deficiency Wohlgethan 14 Hyperthyroidism Bowman et al 15 Hypothyroidism Okamura and Ozaki 17 Reduced bone mineral density Lundberg and Nilsson 18 Osteopenia Tuten et al 19 Cardiac surgery Pineda et al 20 Cardiac catheterisation through the brachial artery Bruckner and Nye 21 Neurosurgery Patten and Hillel 22 Radical neck dissection Smith et al 23 Dupuytren's disease Riley et al 24 Parkinson's disease Boyle-Walker et al 25 Cardiac disease Wadsworth 26 Pulmonary disease Jayson 27 Stroke Bunker and Esler 28 Hyperlipidaemia Hutchinson et al 29 Treatment with matrixmetalloproteinase inhibitor THE JOURNAL OF BONE AND JOINT SURGERY idiopathic frozen shoulder, of whom 41 were available for follow-up after five to ten years. The mean duration of the condition was 30.1 months, but 61% had slight restriction of movement, although in only 6% was it felt to be a handicap.…”