What are the typical symptoms?
So when we talk about Parkinson's disease there are a number of symptoms and signs that the patient comes to us and tells us about and that we look for when we examine the patient. So one of the most common features is what we call a resting tremor. And by that we mean somebody notices a tremor, usually it starts in the upper extremities so in a hand, but it can be in a foot, it can be in the chin and this tremor is mainly present when the patient isn't using the limb. So they're sitting watching TV or when they start walking their hand will shake. Then when they go to use that arm the hand stops shaking. So in general it tends not to be something that's very functionally limiting because it is a resting tremor, but that's one of the cardinal features. And usually it's asymmetric in onset, so it starts on one side and then it progresses to the other side.
Having said that, just because you don't have a resting tremor it doesn't mean you can't have Parkinson's disease. But certainly if that sign is there it is very helpful for a physician in making the diagnosis.
The other things that you can see is what we call rigidity or stiffness, and there's also something called bradykinesia or slowness of movement. So people often come to us and say, Well, I'm weak. I'm getting weaker. In fact, it's not that the muscles are weak. When we actually test the muscles they're very strong. However the movements are very slow and sort of rachety. And so imagine if you're trying to open a jar, if you can't get a nice full turn you'll have difficulty opening that jar. It's not because the muscle is weak. It's just because you're having difficulty making that nice movement. So the things we talk about then are tremor, this rigidity or stiffness and bradykinesia or slowness.
One other feature that we commonly see is what we call postural instability, which tends to be a balance problem, but this is not typically an early sign that we see in Parkinson's disease, and it can be seen in other things as well.
Are people in any sort of pain with Parkinson's?
You know pain is actually a very interesting question with Parkinson's disease because we do recognize that some patients do have pain associated with it. It's actually not uncommon, for instance, for a person before they're diagnosed to end up going to see an orthopedist or their family doctor or rheumatologist because their shoulder will hurt, and they think they've got something wrong with the joint. In fact what's happening is that that joint is stiff and not moving, and that can result in pain.