Original ArticleUltrasonographic imaging findings of the shoulder in patients with Parkinson disease
Introduction
Parkinson disease (PD) is a multisystem neurodegenerative disorder recognized increasingly in aging populations. It is characterized by cardinal clinical features, including bradykinesia, tremor, rigidity, and postural instability [1,2]. For most people with PD, the most serious concerns relate to the motor system, namely stiffness, slow movement, impaired handwriting and coordination, poor mobility, and poor balance. However, more than half of all people with PD experience painful symptoms [3,4]. Aching, stiffness, numbness, and tingling sensation at some point over the course of the illness are commonly reported. Defazio et al. reported that pain may begin at clinical onset of PD or thereafter as a nonmotor feature of the disorder [5]. Aching muscles and joints are especially common in PD. Rigidity, posture instability, abnormal mechanical stress on the joints, and lack of spontaneous movement contribute to musculoskeletal problems in PD. Not only the pathological condition of the musculoskeletal system, but the insult in the descending inhibitory control system of the basal ganglia attribute the pain [6].
According to the previous study, the prevalence of musculoskeletal pain was 40–90% in PD, which was the most common form of PD-related pain [6]. A frequent musculoskeletal complaint, and often the first sign of PD, is shoulder pain or shoulder disorders, including frozen shoulder, bursitis, and rotator cuff lesions [[7], [8], [9]].
Over the past 10 years, high-resolution ultrasound (US) has been a popular and readily available technique for evaluating shoulder disorders. The imaging modality allows for detailed assessment of a wide range of changes to different anatomic structures of the shoulder joint, including the rotator cuffs, biceps tendon, and subdeltoid bursa [10]. In their study involving 33 patients with PD, Koh et al. found that 22 patients had abnormal US findings on the dominant side. Moreover, all those 22 patients with abnormal US findings had a tendon tear, and 9 patients had frozen shoulder [11]. However, because that study did not include a control group, diagnosis of frozen shoulder on the basis of US findings remains controversial.
In this study, we evaluated patients with PD by using a combination of physical examination and ultrasonography of the shoulder and compared the frequency and type of shoulder disorder in US findings between patients with PD and healthy participants. With appropriate diagnosis, the pain caused by the musculoskeletal system in shoulder joint could be treated in more precisely and specialized therapeutic approaches. The correlation between shoulder disorder or abnormal US finding and PD severity was also examined.
Section snippets
Study design and settings
It was a prospective and case-control study. Patients aged 50–80 years who fulfilled the diagnosis of PD, according to the United Kingdom Parkinson's Disease Society Brain Bank [12], were recruited consecutively from a neurology clinic in the authors' hospital. For the control group, sex- and age-matched healthy volunteers were recruited among the companions of patients or hospital personnel. This research has been approved by the IRB of the authors' affiliated institutions and the informed
Baseline characteristics
In total, 105 individuals with or without PD were enrolled for the study (Fig. 1). Three PD group patients were excluded due to having previous shoulder joint surgeries (n = 1) and cognitive impairment (n = 2); two control group participants were excluded owing to having previous surgery for shoulder fracture and tendon tear. Finally, the PD and control groups each had 50 patients. Their respective mean ages were 66.1 ± 7.2 and 65.8 ± 8.3 years. The average disease duration was 44.8 ± 38.8
Discussion
This study results demonstrated that shoulder pain, pain intensity, disability, and function were significantly greater in the PD group. Additionally, significantly greater AROM and PROM limitations were noted. Concerning US findings, biceps long head tendon sheath effusion (40%) and supraspinatus tendon tear (22%) were commoner in the PD group. Regarding PD staging according to the modified Hoehn and Yahr method, we found significant differences in supraspinatus tendinopathy (by US
Conclusion
Patients with PD had more limited shoulder AROM and PROM. In US findings, evidence existed that patients with PD more frequently had biceps long head tendon sheath effusion, humeral head cortical irregularity, and supraspinatus tendon lesions. On comparing different degrees of the disease severity, we found a statistical difference in passive flexion and supraspinatus tendinopathy on US findings. We recommend the use of more detailed evaluations using high-resolution ultrasonography or MRI
Ethical approval statement
Ethical approval was provided by institutional review board of Shin Kong Wu Ho-Su Memorial Hospital.
Declaration of competing interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Acknowledgments
The authors would like to acknowledge the financial support provided by the Shin Kong Wu Ho-Su Memorial Hospital Institutional Review Board approval of the study protocol.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
No funding source was involved.
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