Not sciatica but Parkinson’s

Dr. James Noake describes a case that looked like “typical” musculoskeletal symptoms — sciatica initially — but was actually early onset Parkinson’s:

This lady had some improvement in pain post deep gluteal space sciatic nerve decompression. But at review, her lower limb control deteriorated, poor coordination, gait pattern continuing to change. … It seems the relatively subtle changes in neuromuscular control due to the central neuro condition led to her ‘typical’ MSK symptoms: lumbopelvic, hip, leg pain, then subacromial pain. Neurologist acknowledged he’d seen this evolution of symptoms before in young sporty patients.

Aches and pains can be the tip of pathological icebergs. You might think that this is really rare, and of course this specifically is indeed rare… but rare problems are not so rare collectively. And an awful lot of them are milder, or otherwise tricky to diagnose, and so it’s easy to underestimate their numbers — because for every case that gets obvious after a while, there must be, what, at least three that aren’t? Or maybe a dozen? The bottom line is that is that disease probably explains more pain than we tend to think it does.

I keep a list of examples like this, or all the (often surprisings) things that can ultimately turn out to be the explanation for persistent pain. It is perpetually incomplete.

Dr. Noake on “lessons learned”:

Stay open-minded about wider medical diagnoses. Review & safety net if things don’t quite add up. Ask questions, don’t accept at face value.

 See also “That’s no knee injury.”