Ultrasonographic imaging findings of the shoulder in patients with Parkinson disease

Abstract

Background

Shoulder disorders, including frozen shoulder, bursitis, and rotator cuff lesions, are common musculoskeletal problems in patients with Parkinson disease (PD). Because musculoskeletal ultrasound (US) can clearly image shoulder joints, we aimed to evaluate shoulder joints using US in patients with PD and healthy participants and correlation between US and PD severity.

Methods

This is a prospective case-control study. 50 patients with PD and 50 healthy subjects from the outpatient department were administered US for bilateral shoulders. For data analysis, we chose the more severely affected side in the PD group for matching with the corresponding shoulder in the control group according to age, sex, and body mass index. Pain and disability were measured using the Visual Analogue Scale (VAS) for pain, Shoulder Pain and Disability Index (SPADI), and the Shoulder Disability Questionnaire (SDQ).

Results

The PD group had higher VAS pain scores during activity (p = 0.003) and rest (p < 0.001), as well as the SPADI and SDQ scores (p < 0.001). In US findings, biceps long head tendon sheath effusion (p = 0.001), humeral head cortical irregularity (p = 0.012), and abnormality in the supraspinatus tendon (p = 0.003) were significantly greater in the PD group. Intra-group analysis in the PD group demonstrated a significant difference in passive flexion (p = 0.019) and supraspinatus tendinopathy (p = 0.033) on US examination during different disease stages.

Conclusions

Patients with PD had more supraspinatus tendinopathy on US findings than control subjects. The lesion was significantly associated with disease severity.

Clinical trial number

NCT02702232.

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.