Striatal deformities of the hand and foot in Parkinson's disease

Orthopedic Complications of Parkinson's Disease

“…The positioning mimics that of rheumatoid arthritis, but there are no signs of local joint involvement, such as tenderness, heat, and swelling ( Figure 33.1). 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].…”

“…Similarly to axial skeletal deformities, the side of the hand or foot deformity tends to coincide with the side of initial symptoms and worse PD-related disability [2]. Thalamotomy has been reported to improve hand deformities [14,15], but it is not yet clear whether deep brain stimulation (DBS) has a consistent effect on striatal hand or foot.…”

“…This syndrome is characterized by the insidious development of shoulder stiffness, pain, and loss of active and passive external rotation in the absence of an obvious intrinsic joint abnormality [14]. The condition usually improves without intervention, but the immobility may last weeks to months longer than the pain.…”

“…In his original monograph, James Parkinson described a "propensity to bend the trunk forward" that became one of the clinical hallmarks of the disease [17]. About 8.4% of PD patients develop spinal deformities, a prevalence that is higher than in the general population [14]. In general, spinal deformities occur in patients who are receiving levodopa, most likely because they have advanced disease rather than because of any direct causal relationship.…”

“…One of the most typical forms of dystonia affecting PD patients is camptocormia, or the "bent-spine" syndrome, which has an incidence of 12.9% [14]. Camptocormia is defined by marked trunk anteroflexion, which subsides in the recumbent position or when leaning against a wall or other type of support ( Figure 33.3).…”