Prevalence and physiotherapist awareness of shoulder pain and/ or stiffness as an early symptom of Parkinson’s disease: An Australian perspective

Musculoskeletal pain is known to be an associated symptom of Parkinson’s disease (PD). However, there is limited literature that describes the likelihood of shoulder pain and/or stiffness as an early presentation of the disease. The aim of this study was to determine the prevalence of shoulder pain and/or stiffness as an initial symptom of PD and to gain an understanding of physiotherapy awareness of this early symptom. Two cross-sectional, purpose-designed surveys were undertaken. A postal survey was mailed to 189 patients with PD and an online survey was emailed to 336 physiotherapists. A response rate of 63% was obtained for PD patients and 23% for physiotherapists. Of the patients with PD, 13% reported onset of shoulder pain and/or stiffness within 5 years prior to diagnosis, with no reported past history of shoulder issues. Of these patients, 8% specifically reported shoulder symptoms as the initial manifestation of the disease. However, 74% of physiotherapists surveyed were unaware of the potential for the early presentation of this symptom. This study has reinforced the potential for shoulder pain and/or stiffness to be an early symptom of PD and has identified a key area for knowledge improvement for physiotherapists in order to reduce the potential of misdiagnosis and mismanagement of this symptom.