Hands in Extra-Pyramidal Syndromes: A Study of 13 Cases
Nadine Sturbois-Nachef, MD; Etienne Allart, MD; Michel-Yves Grauwin, MD; Christian Fontaine, PhD
University Hospital, Lille, France
Parkinson's disease (PKD) has a high prevalence, with 150 cases per 100,000 people. Clinical signs combine a large range of symptoms, among which motor symptoms that can be axial or peripheral. Little is known about hand abnormalities in PKD contrarily to spastic hand. The aim of this study was to assess hand deformities encountered in this pathology.
Inclusion criteria were: patients with PKD presenting hand deformities. Exclusion criteria were: associated pyramidal spasticity, peripheral neuropathy, rheumatism or muscular associated disease. The following were studied: demographic criteria, disease's diagnostic date, spontaneous deformity of hands, passive and active mobility of hand and upper limb, and the House score. Standard hand radiographs (anteroposterior and lateral) were done.
Nine patients (16 hands) were reviewed. Two patients were excluded, one because of an associated pyramidal syndrome and the other because of sensorimotor sequalae of ulnar nerve trauma at the wrist. Thirteen hands were included in 5 women and 2 men; mean age was 71.2 (63-83). The diagnostic of PKD was meanly made for 13 years (3-26), with the first hand symptoms appearance at 3.5 years (0.3-11). Intrinsic position of hand was noted in 10 hands, with swan neck deformities in one. Eight had spontaneous metacarpophalangeal (MCP) abduction of the little finger, five had ulnar deviation of all the fingers, one of which presented ulnar dislocation of the extensor apparatus. Two had a slight adductus thumb with flexion of the first MCP joint. Seven had wrist flexion contracture, four of which had flexus-ulnar inclination. The others had a wrist contracture in straight position. Passive mobility was complete in all, except two, who presented retraction of the interossei of the third and fourth fingers. None had true articular stiffness. Active mobility was complete except MCP extension in three with intrinsic position of hand. Mean House score was globally good, meanly at 7.7/8 (6-8), reflecting functional hands. Radiographic evaluation noted MCP subluxation in 2 hands, and non-specific osteoarthritis: basal thumb in 4 hands, scaphotrapeziotrapezoid in 2.
Hand in PKD is a little-known entity, very different from spastic hand with a predominant concern of the intrinsic muscles and with conserved active control of the upper limb and the hand. Therapeutic plans of these hands (e.g. botulinum toxin injections, or surgery such as intrinsic muscle release, partial neurectomy of the deep branch of ulnar nerve) are though different from other neurological hand and must consider these specificities.
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