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A professional sportsperson with subtle motor symptoms and signs: early-onset Parkinson's disease

PainSci » bibliography » Ferreira et al 2023
updated
Tags: diagnosis, medicine, knee, case, leg, limbs, pain problems

Six pages on PainSci cite Ferreira 2023: 1. The Complete Guide to IT Band Syndrome 2. The Complete Guide to Patellofemoral Pain Syndrome 3. 38 Surprising Causes of Pain 4. Diagnosing Runner’s Knee 5. Cramps, Spasms, Tremors & Twitches 6. Science round-up: six painful science stories from 2023 

PainSci commentary on Ferreira 2023: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Ferreira et al tell the frustrating story of a hockey referee who went through several months of therapy and investigation of a “presumed knee injury” … but it was all barking up the wrong tree. The real explanation of the pain? The early stages of Parkinson’s disease.

Physical therapists and surgeons all missed it. Not judging. Diagnosis is hard! Medicine is messy! (Okay, maybe judging a teensy bit.)

Although dystonia is often more obvious, it can be subtle and readily mistaken for ordinary musculoskeletal problems. And it’s always important to bear in mind that stubborn painful problems can be early warning signs of more serious diseases… and although any one type may be rare, they are common as a group.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

A 41-year-old professional hockey referee was referred to our clinic with an 8-month history of walking difficulties; previously he had consulted several orthopaedic surgeons and had undergone physical therapy—with limited benefit—for a presumed knee injury. The patient had no notable medical history, but reported two maternal aunts with Parkinson's disease which had presented at over the age of 65 years; his parents and sister were healthy. On examination he appeared generally fit and well; however, a neurological examination found that he had hypomimia, mild rigidity, and bradykinesia on motor tasks in both legs, but predominantely in the right (video). The patient's gait showed dystonic posturing of the right foot with involuntary plantar flexion and inversion, and asymmetrically reduced arm swing; his walking difficulties improved by running and walking backwards (figure; video). Additionally, despite having difficulties walking, he reported no problems while riding his bicycle (video).

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