scholarly journals Rapid Destructive Arthropathy of the Knee in Parkinson’s Disease with Pisa Syndrome: A Case of Knee-Spine Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hirokazu Takai ◽  
Masato Kitajima ◽  
Seiko Takai ◽  
Tomoki Takahashi ◽  
Ken-ichi Katsura ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Joint Surface ◽  
Lateral Side ◽  
Radiographic Findings ◽  
Postural Reflexes ◽  
Pisa Syndrome ◽  
Postural Deformity

The changes occurring in knee osteoarthritis often cause alterations in the spinal loading condition, which further lead to degenerative changes. This close relationship of the knee and spine has been reported as knee-spine syndrome. A 60-year-old woman with Parkinson’s disease (PD; Hoehn-Yahr stage IV) had severe knee pain with moderate lateral osteoarthritis of the knee (Kellgren-Lawrence classification grade II). Conservative therapy had no effect at all, and the knee developed destructive osteoarthritis rapidly without any traumatic episodes. The radiographic findings progressed to Kellgren-Lawrence grade IV within a month. Magnetic resonance imaging revealed partial depression of the joint surface, including shredded ossicles and substantial amounts of synovial fluid. The imaging findings were considered to be caused by a subchondral insufficiency fracture (SIF). Total knee arthroplasty was performed using a semiconstrained prosthesis. The alignment of her lower extremity improved, and the patient could walk without knee pain. The patient had Pisa syndrome, a lateral flexion of the trunk, which is a postural deformity of the trunk secondary to long-standing PD. The postural deformity in PD is not based on spinal deformity itself but on the loss of postural reflexes and the imbalance of muscle tonus. Her left knee pain appeared 1 month after L1-L4 posterior lumbar interbody fusion (PLIF) as the Pisa syndrome to her left side worsened. The more the trunk tilts to the lateral side, the center of the gravity axis will shift and pass through more lateral points of the knee and result in higher knee load. The stress concentration from the spine to the lateral joint of the knee caused lateral knee osteoarthritis, namely, knee-spine syndrome. When patients undergo correction surgery for adult spinal disorder with impairment of postural reflexes, they need to be followed up carefully regarding not only the spinal alignment but also the lower extremities.

scholarly journals Use of Botulinum Neurotoxin in Parkinson’s Disease: A Critical Appraisal

Toxins ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 87
Author(s):  
Wolfgang H. Jost
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Botulinum Neurotoxin ◽  
Critical Appraisal ◽  
Freezing Of Gait ◽  
Sufficient Data ◽  
Pisa Syndrome ◽  
Focal Hyperhidrosis ◽  
Detrusor Hyperactivity ◽  
Important Indication

For well over 30 years, the botulinum neurotoxin (BoNT) has been used for a large number of indications, some of which however have not been licensed. Admittedly, approval varies in many countries and this permits a large spectrum for evaluation. Thus, BoNT is used for patients with Parkinson’s disease (PD) and other Parkinson’s syndromes (PS) in varying degrees of frequency. We have to distinguish between (1) indications that are either approved or (2) those not approved, (3) indications that might be a result of PS and (4) finally those which appear independent of PS. The most important indication for BoNT in PS patients is probably sialorrhea, for which approval has been granted in the majority of countries. Cervical dystonia is a frequent symptom in PS, with anterocollis as a specific entity. A further indication is blepharospasm in the different forms, especially the inhibition of eyelid opening in atypical PS. The use of BoNT in cases of camptocormia, the Pisa syndrome and neck rigidity is still a matter of debate. In dystonia of the extremities BoNT can be recommended, especially in dystonia of the feet. One well-known indication, for which however sufficient data are still lacking, involves treating tremor with BoNT. As to autonomic symptoms: Focal hyperhidrosis and detrusor hyperactivity can be mentioned, in this last case BoNT has already been approved. A number of further but rare indications such as freezing-of-gait, dyskinesia, and dysphagia will be discussed and evaluated.

scholarly journals Differential Contribution of the Medial and the Lateral Side of the Joint to Symptoms in Knee Osteoarthritis: A Radiographic and Laboratory Analysis in the Nagahama Study

Cartilage ◽  
2021 ◽  
pp. 194760352110258
Author(s):  
Kazuya Nigoro ◽  
Hiromu Ito ◽  
Tomotoshi Kawata ◽  
Shinichiro Ishie ◽  
Yugo Morita ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Clinical Outcomes ◽  
Knee Pain ◽  
High Sensitivity ◽  
Analysis Of Covariance ◽  
Radiographic Evaluation ◽  
Radiographic Feature ◽  
Lateral Side ◽  
Cross Sectional ◽  
Medial Side

Objective: This cross-sectional study aimed to explore the differences of the medial and lateral sides of the knee joint and precise radiographic abnormalities in contribution to the knee pain and clinical outcomes. Design: Participants 60 years or older who underwent radiographic evaluation were included. Knee radiography was assessed using grading systems of the Osteoarthritis Research Society International (OARSI) atlas. The Japanese Knee Osteoarthritis Measure (JKOM) was evaluated as clinical outcomes. Serum high-sensitivity C-reactive protein (hsCRP) was used to evaluate systemic inflammation. We divided the participants into normal, medial-, lateral-, and medial & lateral-OA types and compared their JKOM using an analysis of covariance. Furthermore, we analyzed the relationship between the knee pain and stiffness of JKOM and the grading of each radiographic feature using a multiple regression model. Results: Lateral- and medial & lateral-OA groups had a significantly worse symptoms in the total and the pain score, especially in movement subscales, in JKOM score. Lateral-OA groups had higher hsCRP than medial-OA group. Multivariate analysis showed that medial joint space narrowing (JSN), and lateral femoral and tibial osteophytes significantly affected knee pain (adjusted odds ratios: 1.73, 1.28, and 1.55, respectively). The radiographic changes are associated with pain more in JSN in the medial side and osteophytes in the lateral side. Conclusion: Lateral- and medial & lateral-OA groups showed worth symptom. In addition, medial JSN and lateral osteophytes have potent effects on the knee pain.

P6.18 Pisa Syndrome in Parkinson's disease: EMG features disclose two different underlying pathophysiological mechanisms

2011 ◽  
Vol 122 ◽  
pp. S88
Author(s):  
A. Fasano ◽  
A. Di Matteo ◽  
G. Squintani ◽  
L. Ricciardi ◽  
T. Bovi ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Pathophysiological Mechanisms ◽  
Pisa Syndrome

Pisa syndrome in a patient with pathologically confirmed Parkinson's disease

2016 ◽  
Vol 42 (7) ◽  
pp. 654-658 ◽  
Author(s):  
Paolo Solla ◽  
Oriol Grau-Rivera ◽  
Ellen Gelpi ◽  
Francesco Marrosu ◽  
Maria José Martí
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Pisa Syndrome

scholarly journals Deterioration of postural deformity in Parkinson’s disease patients with punding and hobbyism

2019 ◽  
Vol 69 ◽  
pp. 179-183
Author(s):  
Ryoma Aoki ◽  
Makoto Shiraishi ◽  
Kyohei Mikami ◽  
Tsutomu Kamo
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Postural Deformity

scholarly journals Parkinson’s Disease and Symptomatic Osteoarthritis Are Independent Risk Factors of Falls in the Elderly

2019 ◽  
Vol 12 ◽  
pp. 117954411988493 ◽  
Author(s):  
Anneli Teder-Braschinsky ◽  
Aare Märtson ◽  
Marika Rosenthal ◽  
Pille Taba
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Knee Osteoarthritis ◽  
The Elderly ◽  
Control Group ◽  
Increased Risk ◽  
Symptomatic Knee ◽  
Risk Of Falls ◽  
Risk Factors For Falls

Objectives: Deteriorating functionality and loss of mobility, resulting from Parkinson’s disease, may be worsened by osteoarthritis, which is the most common form of joint disease causing pain and functional impairment. We assessed the association between symptomatic hip or knee osteoarthritis, falls, and the ability to walk among patients with Parkinson’s disease compared to a control group. Methods: A total of 136 patients with Parkinson’s disease in Southern Estonia and 142 controls with an average age of 76.8 and 76.3 years, respectively, were enrolled in a retrospective case-control study. Information on falls and related fractures during the previous year was collected from the patients with Parkinson’s disease and controls. Covariates included gender, age, mobility, duration of Parkinson’s disease, and fractures. Results: Patients with Parkinson’s disease were at an increased risk of falls compared to the control group, and for the higher risk of fractures. Symptomatic knee or hip osteoarthritis was a significant independent predictor of falls in both patients with Parkinson’s disease and controls. The higher risk for fractures during the previous year was demonstrated in symptomatic osteoarthritis. Risk factors for falls included also female gender, use of sleep pills, and the inability to walk 500 m. Conclusions: Symptomatic hip and knee osteoarthritis are risk factors for falls and related fractures among the elderly population with and without Parkinson’s disease. The inability to walk 500 m could be used as a simple predictive factor for the increased risk of falls among elderly populations.

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