Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Πόταγας Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Στεφανής Λεωνίδας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευστάθιος Χρονόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βασιλοπούλου Σοφία, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Κυρώζης Ανδρέας, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μαστρόκαλος Δημήτριος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νάσκα Ανδρονίκη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Κλινική και παρακλινική διερεύνηση της δυσλειτουργίας του ώμου στη νόσο του Πάρκινσον
Translated title:
Clinical and paraclinical assessment of shoulder dysfunction in Parkinson's disease
Summary:
Introduction: The potential impact of Parkinson's disease (PD) on shoulder movement and function has not been extensively studied. The thesis aims to: a) evaluate the correlation between shoulder dysfunction and PD parameters and stages, b) highlight possible clinical predictors of shoulder pathology.
Material and Methods: The study sample includes 300 PD patients with no other co-morbidities that could be involved in shoulder pathology. Participants were randomly selected at the outpatient clinics of "Eginitio" University Hospital and a modified version of the Hoehn and Yahr (H&Y) scale was used to classify participants according to PD stages. Any alteration in the quality and the range of motion, measured by a goniometer, was defined as shoulder dysfunction. Contractile and non-contractile structures were assessed clinically with specific musculoskeletal tests. Dynamic and static ultrasonography (US) was used to examine both shoulders of early PD patients. Correlation analyses and multivariate logistic regression models were applied.
Results: Shoulder dysfunction, characterized by pain and hypomobility, involved tendons (60.3%) and articular structures (45.3%). Approximately 7 out of 10 early PD patients were diagnosed with shoulder dysfunction (65.8%, n=275). Dysfunction was positively correlated with tremor (r=0.80), rigidity (r=0.78) and the duration of the interval period between pain onset to PD diagnosis (r=0.52) (p<0.001). Articular and tendon abnormalities were sonographically detected in 81/100 and in 62/100 early PD patients, respectively. Notwithstanding the small sample size that significantly limits the precision of the findings, shoulder tendon dysfunction was found to be positively associated with the risk of hypomobility (OR=30.33, 95%CI=5.45-168.8, p<0.001), tremor (OR=16.82, 95%CI=0.91-310.32, p<0.058) and rigidity (OR=14.70, 95%CI=1.12-192.20, p<0.040), after controlling for potential confounders. Among all participants (n=300), approximately half (46.6%) reported pain episodes on average 1.07 years before the cardinal PD signs onset.
Conclusions: Shoulder dysfunction appears to occur in the early PD stages and may increase the risk of sonographically detected tendon abnormalities. Tremor and rigidity were found to be associated with tendon dysfunction. Early consideration of PD involvement in shoulder pain and dysfunction is recommended.
Main subject category:
Health Sciences
Keywords:
Parkinson’s Disease, Shoulder dysfunction, Shoulder pain, Musculoskeletal ultrasonography, Frozen shoulder
Number of references:
101
