Shoulder Disorders in Patients With Parkinson's Disease
Shoulder Disorders in Patients With Parkinson's Disease
Parkinson's disease (PD) is a multisystem neurodegenerative disorder that is increasingly
 recognized in our ageing population. It is characterized by cardinal clinical features
 including bradykinesia, tremor, rigidity, and postural instability. For most people with PD,
 the most serious concern is with the motor system: stiffness, slowness of movement, impaired
 handwriting and coordination, poor mobility and balance. However, more than half of all
 people with PD have experienced painful symptoms. Most people experience aching, stiffness,
 numbness and tingling at some point in the course of the illness. Defazio et al reported that
 pain may begin at clinical onset of PD or thereafter as a non-motor feature of PD.5 Aching
 muscles and joints are especially common in PD. Rigidity, lack of spontaneous movement,
 abnormalities of posture and awkward mechanical stresses all contribute to musculoskeletal
 pain in PD.
One of the most common musculoskeletal complaints is shoulder pain or shoulder disorders,
 including frozen shoulder, bursitis, and rotator cuff lesions. Actually, shoulder pain or
 shoulder disorder can be the first sign of PD. The prevalence and severity of shoulder
 disorders in Parkinson's disease are not totally clear. In a retrospective study, Stamey
 found shoulder pain was present in 11% of patients with PD.

 Over the past ten years ultrasound (US) has become popular in the evaluation of shoulder
 disorders. It allows for the detailed assessment of a wide range of changes involving
 different anatomic structures of the shoulder joint, including rotator cuffs, biceps tendon,
 and subdeltoid bursa. Koh et al found among 33 PD patients, 22 patients had abnormal US
 findings on the dominant side, and all 22 patients with abnormal US finding had a tendon tear
 and 9 patients had frozen shoulder. However, there were no control group in Koh' s study, and
 diagnosis of frozen shoulder with US findings is still controversial.

 The purposes of this study are to evaluate patients with PD with a combination of physical
 examination and US study of the shoulder, and to compare the frequency and type of shoulder
 lesion in US between patients with PD and normal subjects. The investigators also plan to
 test the correlation between shoulder disorders or US abnormality and the severity of PD.
Inclusion Criteria:

 -  Patients fulfilled the diagnosis of PD, as described by the United Kingdom Parkinson's
 Disease Society Brain Bank,

 -  Aged 50 to 80 years old.

 Exclusion Criteria:

 -  Fracture or dislocation of the shoulder,

 -  Previous shoulder joint surgery,

 -  Severe medical comorbidities,

 -  Cognitive impairment (Mini-Mental Status Examination < 24).