Category: Parkinsonism, Others
Objective: To identify signs of hand deformations in PD patients with earlier diseases, and compare with intermediate and late phases patients.
Background: “Striatal hand signs”, first described by Jean Martin Charcot as “digital deformations simulating primitive chronic joint rheumatism”, have been reported in 10% of advanced PD patients. Such deformities may be misdiagnosed and the typical deformity associated with the striatal hand is the flexion of the metacarpophalangeal joints, extension of proximal interphalangeal joints, flexion of distal interphalangeal joints and ulnar deviation. Another deformation is the flexion of the metacarpophalangeal fingers and medialization of thumb (U shaped – “monkey-wrench sign”). We believe that mild hand deformities may be present in earlier phases of the disease and may help the clinical diagnosis of PD.
Method: We evaluated 36 PD patients: early (<4 years), intermediate (4 to 10 years) and advanced phase disease (> 10 years), according to UKPDS Brain Bank Diagnostic Criteria and no other causes to justify the symptoms, age and side of onset, disease duration, disease severity – left / right side, and presence of hand deformities and “monkey-wrench sign”.
Results: We had 14 patients < 4 years of disease duration, 9 between 4 to 10 years and 13 > 10 years. 1/3 had right side onset and 2/3 left onset. 33 of 36 patients presented the “Monkey- Wrench sign” (91.67%), unilaterally or asymmetrically, and it was present in all PD patients > 4 years of disease onset, but it was present in 78.6% of less than 4 years. All the patients who did not present the sign, had the disease for less than 4 year (1, 3 and 2 years, respectively) of motor onset. The sign was present together with the other classic hand-striatal signs, as previously described. The striatal hand signs, were easily detected in the more affected side of the motor symptoms, and we detected a disease severity greater on the side where striatal hand is more present as compared to the less affected side.
Conclusion: Striatal hand deformities and the “monkey-wrench” sign may be useful to differentiate PD from non-parkinsonian, when they are unilateral or asymmetrical signs and no other diseases can explain the signs, as well as, it could be used to differentiate in a more visual way, patients with tremors of parkinsonian origin and other etiologies, such as essential tremor.
References: 1 – Baizabal‐Carvallo, J. F., Alonso‐Juarez, M., Murillo Ortiz, B., & Fekete, R. (2019). Clinical Correlations of Striatal Hand Deformities in Parkinson′s Disease. Acta Neurologica Scandinavica. 2 – Ashour, R., Tintner, R., & Jankovic, J. (2005). Striatal deformities of the hand and foot in Parkinson’s disease. The Lancet Neurology, 4(7), 423–431. 3 – Spagnolo, F., Fichera, M., Bucello, S., Houdayer, E., Baroncini, D., Sarro, L., … Volonté, M. A. (2013). Striatal hand in Parkinson’s disease: the re-evaluation of an old clinical sign. Journal of Neurology, 261(1), 117–120. 4 – Padhan, P., Danda, D. (2010). Parkinsonism Mimicking Rheumatoid Arthritis. The Journal of Rheumatology, 37(6), 1266–1266. 5 – Meng, T., & Bruce-Hickman, D. (2018). Striatal hand in a woman with Parkinson’s disease. British Journal of Hospital Medicine, 79(2), 109–109.
To cite this abstract in AMA style:I. Teixeira, V. Souza, C. Zorzenon, B. Veiga, V. Borges, H. Ferraz. “Striatal Hand Signs” and early diagnosis of Parkinson’s Disease: The “Monkey-Wrench Sign”. [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/striatal-hand-signs-and-early-diagnosis-of-parkinsons-disease-the-monkey-wrench-sign/. Accessed September 25, 2023.
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