Assessment of striatal & postural deformities in patients with Parkinson's disease

Abstract

Background & objectives: Though striatal and postural deformities are known to occur commonly in atypical Parkinsonism patients, these may also be seen in patients with Parkinson's disease (PD). These are frequently misdiagnosed as joint or orthopaedic pathology leading to unnecessary investigations. This study was conducted to observe the various striatal and postural deformities among patients with PD in India.

Methods: This study was conducted at a tertiary care teaching institute in north# India. Seventy consecutive patients with PD diagnosed as per the modified UK Brain Bank criteria were included. Various striatal (hand & foot) and postural (antecollis, camptocormia, scoliosis & Pisa syndrome) deformities and their relation with the duration of disease, severity [measured by the Unified Parkinson's Disease Rating Scale (UPDRS)] and levodopa intake were analyzed.

Results: Of the 70 patients with PD, 34 (48.57%) had either striatal or postural deformities. Striatal foot was the most common deformity observed (25.71%). Camptocormia was the second most common deformity (20%). Striatal and postural deformities were seen in more advanced PD as suggested by significantly higher UPDRS and Hoehn and Yahr scale (P<0.001). Striatal deformities were more ipsilateral to PD symptom onset side (agreement 94.44%). Pisa and scoliosis concavity were more on contralateral side to PD symptoms onset side (66.67%).

Interpretation & conclusions: Our results showed that striatal and postural deformities were common and present in about half of the patients with PD. These deformities we more common in patients with advanced stage of PD.

Fig. 1

Striatal hand showing flexion at metacarpophalangeal joint with extension at interphalangeal joint and ulnar deviation of the left hand (A), which was confirmed by hand X-rays (B), striatal toe showing lateral flexion of the great toe with flexion of other toes (C), which was confirmed by foot X-rays (D).

Fig. 2

Pisa syndrome in a patient with Parkinson's disease characterized by leaning towards left side (A), which was confirmed by spine X-rays (B).

Fig. 3

A patient with Parkinson's disease with scoliosis with concavity towards left side (A), which was confirmed by spine X-rays (B).

Fig. 4

Camptocormia in a patient with Parkinson's disease (A and B), which was corrected by pushing against wall (C) and while lying down (D).

Fig. 5

Antecollis in a patient with Parkinson's disease (A) which was confirmed by cervical spine X-rays (B) and relieved completely on lying supine (C).