Hand deformities in Parkinsonism

Abstract

IN HIS original and classic description of the disease that now bears his name, PARKINSON [l] noted the progressive muscular rigidity, the characteristic pill-rolling tremor, the stooping posture, the shufEing gait and the akinesia that characterize this condition. He did not, however, describe the digital deformities that are the subject of this paper. C~GCESHALL [2] states that "Charcot first pointed out the resemblance between Parkinsonism and rheumatoid arthritis, especially the similar deformities of the hands and feet in the two disorders." PENNECHIETTI [3] also, has pointed out that Parkinsonism occasionally has been misdiagnosed as rheumatoid arthritis because of "the similar deformities of the hands and feet and the muscular rigidity, tremor and shiny appearance of the face which may occur in both." WECHSLER [4] notes that in Parkinsonism "muscular contractures, especially of the hands and feet, develop on the basis of muscular rigidities." CUTLER [5] writes that "the fingers are partly flexed, as in the resting position, and in the late stages cannot be extended. Hyperextension of the terminal phalanges is occasionally seen." SPILLER [61 states that ulnar deviation of the fingers is common in Parkinsonism. This report is an analysis of the hand deformities found to exist in a series of 86 patients with Parkinsonism examined in three large midwestem county medical care facilities-Washtenaw County (Mich.) Hospital, Wayne County (Mich.) Hospital and Cook County (Ill.) Hospital. Consistent with current medical thought [71 the patients have been divided into two diagnostic categories, those with a history of encephalitis lethargica and those of idiopathic etiology. The age, race, and sex characteristics of the patients are shown in Table 1. Because there are some students of Parkinsonism [S] who believe that all cases of the disease are of encephalitic origin, it is worth noting that there are significant age differences in the two groups here described. In race and sex the two groups are comparable. It is notable that all but two of the patients are white, despite the fact that in the county medical care institutions studied, a large proportion of the patients (over 40 per cent) are Negroes.

Limb contractures in levodopa-responsive parkinsonism: a clinical and investigational study of seven new cases

“…The exact incidence of limb contractures in PD is unclear, perhaps because it is rare and often unrecognised. In a series of 86 parkinsonian patients Reynolds et al [19] in 1965 found that 34 (40%) had some deformity in the hands. These deformities were more frequent among those with post-encephalitic parkinsonism (71%) than without (24%).…”

Orthopedic Complications of Parkinson's Disease

“…A striatal hand has been described in 8.4% and striatal foot occurred in 5.9% of advanced-stage PD patients in one series [2]. The incidence of hand deformity in the pre-levodopa era was probably much higher, reaching 24% in one study [12]. Striatal abnormalities are more frequent in multiple system atrophy, where they have been described in 26.3% of individuals [2].…”

“…Striatal abnormalities are more frequent in multiple system atrophy, where they have been described in 26.3% of individuals [2]. Historically, the occurrence of Parkinson' DIP, distal interphalangeal joints striatal hand was particularly high in post-encephalitic parkinsonism, where 71% of patients developed such deformities in one series [12]. Striatal hand is characterized by flexion of the distal interphalangeal (DIP) joints, extension of the proximal interphalangeal (PIP) joints with flexion of the metacarpophalangeal (MCP) joints, fifth digit abduction, ulnar wrist deviation, and occasionally tight fist clenching [2,12,13].…”

“…Further, rheumatoid arthritis is usually bilateral, while the striatal hand in PD tends to be asymmetric [14]. Hand deformity significantly correlates with rigidity, as 72% of those with deformity have severe rigidity [12].…”

“…Typical abnormalities resembling rheumatoid arthritis, with ulnar deviation of the fingers (a), flexion of the metacarpophalangeal joints (MCP) and extension of interphalangeal joints (a, b). Reproduced from Reynolds and Petropoulos[12]. Copyright (1965), with permission from Elsevier.…”