Archive:Parkinson disease

Physical Examination of Parkinson's Disease

1. Introduce yourself and wash your hands

2. Listen for the patient's characteristic speech pattern

• Microphonia
• Soft
• Faint
• Palilalia - repetition of last word similar to stuttering
• Hard to understand

3. Inspection

• Mask like facies
• Flexed posture
• Few spontaneous movements
• Stooped posture
• Sialorrhea (Drooling)

4. Tremor

• Resting
• Pill rolling (4-8Hz)
• Begins distally, fingers hands, forearm, feet and can involve the chin and mouth
• Decreased tremor with finger to nose testing
• Increaqsed tremor in left hand if clenching the right hand
• Increased tremor with serial 7's

5. Gait

• Ask to ris, walk, turn quickly, stop and start
• March a petite pas (shuffling gait)
• Difficulty initiating, stopping, turning and with balance
• Propulsion/retropulsion (difficulty maintaining balance if tapped)
• Festination (walk faster and faster so that they do not fall over)
• Lack of arm swing
• Kinesia paradoxica (can do rapid movements but not slow ones)
• Bradykinesia

6. Dampening - difficulty with repeated movements such as tapping the thumb and index finger together

7. Tone

• test at both wrists
• begins as weakness, tremor, motor slowness, stiffness, fatigable in a single limb or hemiparetic
• cogwheel rigidity
• if no hypertonia, ask the patient to move their head side to side. This maneuver should increase cogwheeling rigidity
• Dorsal tendon reflexes are unaffected

8. Face

• Titubation - tremor of head
• blinking absence
• blepharospasm - involuntary closure of the eyelids
• blepharoclonus - flutter of closed eyelids
• sialorhea - excessive drooling
• masked facies
• glabellar tap positive
• speech - monotone, soft, faint, repetition of last word
• supranuclear palsy - weakness of upward gaze
• seborrheic brow - a sweaty or greasy brow
• diaphoretic brow - due to autonomic dysfunction

9. Orthostatic hypotension

10. Writing

• micrographia

11. Mental status - do an Minimental Status Exam and also look for

• dementia
• slowed thinking
• depression
• insomnia
• drug effects