Does anyone have difficulty with fluid and smooth movements of joints?
For a long time now if I try to make circular movements with my wrists or ankles they don't move in a smooth, fluid way. They move in a cog wheel, staccato fashion. It's the same with my shoulders. I lie on one side in bed and try to move the uppermost shoulder in small circular movements (just the shoulder, not the whole arm) and it's the cog wheel, rachety thing again.
For the shoulders in particular I get electric shock type of nerve pain when I do this.
Sound familiar?
Thank you in advance.
Written by
frankaspergilus
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One of my doctors did say a year or so ago when this first started happening that it might be the beginning of PD but I had been telling him for years about other PD symptoms anyway.
Of course, every neuro I've seen says it isn't PD but don't come up with any alternatives. I also think that, although it's a significantly noticeable movement problem for me, when they test for it in their offices they can't feel it like I do. Which is why they should listen to what I say when I explain it. But they think they know better.
My PD started with cogwheel movements - but not so much in circular movements but especially when flexing or lifting the arms or legs. I panicked immediately and got a diagnosis 2 years later (through DAT SCAN)......
Rigidity is increased muscle tone that occurs throughout the entire range of motion of a limb that does not change with passive acceleration by the examiner. Rigidity is often likened to the quality of a metal being bent (i.e., lead pipe rigidity).
Characteristically, rigidity is brought out or aggravated by the activating the contralateral limb (such as having the patient rotate their shoulder as if they were drawing circles in the air), a phenomenon known as activated rigidity. If a patient has both rigidity and a tremor, cogwheel rigidity results (i.e., rachet-like resistance). True rigidity implies basal ganglia dysfunction on the contralateral side.
The most common cause of rigidity is Parkinson's disease. Rigidity is also seen in drug-induced parkinsonism, diffuse Lewy-body disease, progressive supranuclear palsy and multisystem atrophy.
Cogwheeling in: Current concepts in the diagnosis and management of Parkinson's disease - 2003 pmc.
Excerpt:
Additionally, patients with Parkinson's disease may show a cogwheel type of rigidity. Here the muscles, on passive movement, have a ratchet-like feel. If rigidity and cogwheeling are not present when the patient is relaxed, the signs may be brought on by having the patient open and close their contralateral hand during the examination.
A focused examination should be performed to evaluate whether a patient has symptoms and signs that may suggest other forms of parkinsonism than Parkinson's disease (Table 1).
Evaluation of changes in vertical eye movement is important to rule out progressive supranuclear palsy. Postural blood pressure changes, other autonomic abnormalities, including a history of bladder instability, and cerebellar features such as early gait instability should be assessed to rule out multiple system atrophy. Although falls and swallowing problems are consistent with late Parkinson's disease, if they occur early and are accompanied by a lack of treatment response, they may be suggestive of progressive supranuclear palsy or multiple system atrophy. Early dementia and other features may suggest Lewy body dementia, corticobasal degeneration or vascular parkinsonism.
Patients with early onset parkinsonism (aged < 40 years) should always be evaluated for Wilson's disease with measurement of serum copper and ceruloplasmin levels, 24-hour urine collection for copper excretion and slit-lamp examination for Kayser–Fleischer rings.
Cogwheel: Clinical Features, with Video Documentation, of the original Familial Lewy Body Parkinsonism caused by α-Synuclein Triplication (Iowa Kindred) - 2011 pmc.
Parkinson’s Disease and Its Management. Differential diagnosis : cogwheel in PD vs in benign essential tremor. 2015 pmc.
Excerpt:
The term commonly used to describe this phenomenon in PD patients is “cogwheel rigidity.” 72,73,123 This is best described as tension in the muscle, which displays small jerks or a ratchet-like quality when moved passively. Cogwheel rigidity requires an unambiguous diagnosis, since benign essential tremor may also present with a cogwheeling phenomenon.71,74
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