»   Other Symptoms: Aging or Parkinson's?

  »   Therapies

As Parkinson's Disease progresses, it is common to experience changes in the spine, hands and feet.

Nearly every person who lived with Parkinson's Disease will experience some degree of muscle rigidity. Muscle rigidity associated with Parkinson's is most noticeable in the muscles that flex the limbs and trunk. Common experiences include bending of the neck, curling of the trunk with slumping of the shoulders and bending at the wrists, fingers, elbows, hips and knees. These changes progress over time.

A third or more people with Parkinson's Disease eventually experience changes in posture, although this occurs most often in advanced Parkinson's Disease. Some people experience severe postural changes with extreme leaning forward or to one side.

Other common changes include dystonia, muscle spasms and cramps that are particularly common in the feet; and osteoporosis, where weakened bones which can increase risk of falls and fractures. Lastly, it is important to look at the impact of orthopedic surgeries for non-Parkinson's Disease related spine deformities, hip and knee replacement and other bone problems, which may present unique challenges for people with Parkinson's Disease. Although people with Parkinson's Disease can benefit from such surgeries, they may have a longer and more complicated recovery than people without Parkinson's Disease.

Rigidity, weakened muscles and involuntary muscle contractions (dystonia) can cause painful deformities for people with Parkinson's Disease. A tilted or twisted spine also can throw a person off balance and increase the risk of falling. These common changes in the skeleton and bones can occur with Parkinson's Disease:
  »  Frozen Shoulder: stiffness, pain and loss of range of movement in the shoulder. Many people experience this symptoms before a Parkinson's Disease diagnosis.
  »  Flexed Fingers or Toes (striatal hand and foot): one finger may extend, the thumb may fold inwards, fingers may clamp down onto the palm and on the foot, the big toe may flex upwards while other toes curl under.
  »  Stooped Posture (camptocormia): the spine bends forward when walking, in the most severe cases as much as 90 degrees. This posture arises because the hips and knees are flexed and will go away when lying down.
  »  Leaning Sideways (Pisa Syndrome): involuntarily tilting of the trunk to one side when sitting, standing or walking which always occurs on the same side.
  »  Scoliosis: sideways twisting, or curvature, of the spine.
  »  Dropped Head (anterocollis): the head and neck flex forward while the chin may drop all the way down to the sternum, or the breastbone. This is more common in multiple system atrophy than Parkinson's Disease.
  »  Bone Fractures: people with Parkinson's Disease are at risk of broken bones from falling, especially from landing on the hip. Kneecap fractures are also common, painful and sometimes not even diagnosed.
  »  Low Bone Density: Bones may become weak and at risk for osteoporosis from lack of weight-bearing exercise, like walking, and from too little calcium and vitamin d in their diet. Other risk factors include older age, gender, low body weight and smoking. A person with Parkinson's who has osteoporosis is more likely to break a bone if they fall.

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Other Symptoms: Aging or Parkinson's Disease?

Because the biggest risk factor for developing Parkinson's Disease is age, skeletal problems associated with aging are often experienced by people with Parkinson's. While it is not clear than Parkinson's Disease increases the risk or even the severity of these other skeletal conditions, the problems of this disease can make the symptoms of these conditions more prominent.

  »  Osteoarthritis
The joint damage is associated with general wear and tear on the joint is nearly universal in aging. Osteoarthritis tends to affect larger joints such as the hip and knee.

  »  Arthritis of the Spine
This is very common. This may contribute to the development of spinal stenosis which is narrowing of the canal in the spine that houses the spinal cord. In severe cases, spinal stenosis causes damge to the nerves as they exit the spine or even to the spinal cord itself.

  »  Fibrous Discs
Disorders of the fibrous discs between the bones of the spine can also cause pain, or limb numbness or weakness

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Medical therapies can help relieve the rigidity and muscle contractions that contribute to changes in posture. The approach to therapy very much depends on a person's unique symptoms and overall health. Your doctor may advise:

  »  Dopamine: The gold-standard medication for treatment of Parkinson's Disease symptoms. If you are not already taking dopamine, starting on this drug may improve symptoms like stooped posture and help prevent them from becoming permanent. If you already take dopamine, review your dose and schedule with your doctor to make sure you are getting the most out of this treatment.

  »  Botulinum Injections (Botox): These injections relax muscles that are flexed or having spasms. They are typically used in specific areas that are affected, such as the hands, feet and neck, but not in larger muscles involved in postural abnormalities of the trunk.

  »  Deep Brain Stimulation: This is a surgical procedure which may offer benefit for certain types of muscle contractions.

  »  Surgery: Surgical therapies ( joint replacement, spinal surgery) may be required to treat significant osteoarthritis, disc disease or spinal stenosis. As with any surgical treatment, the risks and benefits should be weighed carefully.

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