Musculoskeletal problems as an initial manifestation of Parkinson's disease: a retrospective study.

OBJECTIVE

The purpose of this study was to review the prevalence of musculoskeletal pain in the prodromal phase of PD, before the PD diagnosis is made.

METHODS

A retrospective review of 82 PD patients was performed. Hospital inpatient notes and outpatient clinic admission notes were reviewed. The initial complaints prompting patients to seek medical attention were noted, as were the initial diagnoses. The symptoms were considered retrospectively to be associated with PD.

RESULTS

Musculoskeletal pain was present as a prodromal PD symptom in 27 (33%) cases initially diagnosed with osteoarthritis, degenerative spinal disease, and frozen shoulder. The mean time from the initial symptom appearance to dopaminergic treatment was 6.6 years in the musculoskeletal pain group and 2.3 years in the group with typical PD signs. Significant improvement of musculoskeletal pain after the initiation of dopaminergic treatment was present in 23 (85%) cases.

CONCLUSIONS

Of the PD patients who went on to develop motor features of PD, one third manifested musculoskeletal pain as the initial symptom. A good response to L-DOPA therapy was seen in 85% of cases presenting with musculoskeletal pain. Our findings suggest that musculoskeletal pain may be a significant feature in earlier PD stages.