Parkinson's and shoulder dysfunction

[matt]

We have recently had an influx of several parkinson's patients with a variety of complaints including cervical pain and UE pain/weakness. For several patients we have a definitive diagnosis such as spondylosis, a bulging disc, or postural changes associated with Parkinsonism. My question is, if our goal is to correct a dysfunction, and these dysfunctions are either a direct result, or compounded by, a progressive condition causing rigidity and decreased motor control, what should our treatment goal be? Is it to maintain mobility/flexibility/functionality/strength, which may be of most benefit to the patient, or attempting to correct a biomechanical dysfunction such as the spondylosis or postural issues? Although both are important, we only have a limited amount of time with each patient.

[cpendo]

I think that we should perform the usual treatment protocols, i.e. MFR, SPROM, exercises, while taking into consideration that Parkinsons causes these problems. Realizing that when stretching the patient is not guarding intentionally, but maybe because of rigidity. HOwever, I think that the most important factor there is to teach the patient as many things, stretches and exercises they they can perform at home that will not only decrease their pain, increase the stability, and mobility but also as many stretchs that can increase their flexibility. I think since it is progressive that we need to use our skills to show them how to maintain themselves at home.

[justCat]

I agree that the patient should be instructed to follow through with HEP and stretching on a daily basis. Does the Parkinson's cause the cervical dysfunction or was that present before the Dx? I don't think that matters much as long as a reduction of pain is given. When pain can not be reduced with a HEP then i would address more of the cervical dysfunction, depending on the patient you may have time for both.