Cog-wheeling - Does everyone with Parkinson's have this symptom?


#1

Hello,
I have today been told by my GP that the consultant I saw said I don’t have cog-wheeling so therefore don’t have Parkinson’s, despite having other symptoms including a tremor in right arm and leg. The consultant didn’t tell me anything except I didn’t have Parkinson’s, and did very little to examine me, so this was the first I had heard of it.
Can anyone tell me if a lack of cog-wheeling in my wrists means I definitely am free of Parkinson’s.
Kind regards
Rose


#2

When I first saw my neurologist she spent ages trying to find cog wheeling and eventually did say that she had so I think it may sometimes be difficult to detect.


#3

What exactly is cog wheeling pls?


#4

(Copied from a website)

Cogwheeling in Parkinson’s disease is that jerky feeling in your arm or leg that you (or your doctor) can sense when rotating that limb or joint. It is an early symptom of Parkinson’s.

What Is Cogwheeling?

The feeling is similar to a ratchet wrench that hesitates before “clicking” forward into its next position. Cogwheeling was named for the cogwheel, a toothed wheel or gear that clicks forward and back, rather than running smoothly.


#5

Thank you


#6

I am no expert but cog-wheeling is not mandatory for diagnosis, especially early on, and can be difficult to detect by non-experts. However, our GP detected it in my husband, the first (useless) neurologist he saw declared his neurological examination was “essentially normal”(!), and the movement disorders specialist neurologist we went to for a second opinion examined my husband carefully and told him he had Parkinson’s.

There is a very good lay summary of the most recent (2016) diagnostic criteria for Parkinson’s here: https://scienceofparkinsons.com/2016/06/30/new-criteria-for-parkinsonss-disease/


#7

Thank you again Mountainair, I shall keep pushing for a more thorough diagnostic appintment.
Rose


#8

Thank you for explaining it, I wasnt too sure!
Rose


#9

Thank you, that is useful to know
Rose


#10

I was examined by three doctors that said I had definite cog wheeling. When I was examined by them again many months later, they all said they noticed an improvement. I think my improved exercise helped it. Then it got worse. I think it can depend on what kind of day you are having when you are examined.


#11

That is interesting Lilac, as I was having a good day when he checked my wrists. Plus as I have osteoarthritis in my hands, etc, I am aware of keeping my hands moving as I don’t want them to stiffen up. Sorry for delay in responding, I am away at the moment.


#12

Cog-wheeling is not a requirement

MDS clinical diagnostic criteria for Parkinson’s disease. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G. Mov Disord. 2015 Oct;30(12):1591-601.

Similar to previous criteria, the Movement Disorder Society PD Criteria retain motor parkinsonism as the core feature of the disease, defined as bradykinesia plus rest tremor or rigidity

Rigidity

As outlined in the MDS‐UPDRS, rigidity is judged on “slow passive movement of major joints with the patient in a relaxed position and the examiner manipulating the limbs and neck.”

Rigidity refers to “lead‐pipe” resistance; that is, velocity‐independent resistance to passive movement not solely reflecting failure to relax (ie, distinct from spasticity or paratonia).

Although the cogwheel phenomenon is often present (and may reflect tremor incidentally felt while assessing tone), isolated “cogwheeling” without “lead‐pipe” rigidity does not fulfill minimum requirements for rigidity.

https://books.google.co.uk/books?id=uiDuCgAAQBAJ&pg=PA22&lpg=PA22&dq=froment%27s+manoeuvre+synkinesis&source=bl&ots=UDf679n3Je&sig=e_x65g8i-j0slBGltOT3sVbsNMo&hl=en&sa=X&ved=2ahUKEwiQv-z2z_3dAhVszoUKHQkqBHIQ6AEwC3oECAIQAQ#v=onepage&q=froment’s%20manoeuvre%20synkinesis&f=false

Parkinson’s disease and other movement disorders M.Edwards, N.Quinn, K.Bhatia, M.Stamelou OUP 2nd Ed. 2016

Rigidity: this is a feeling of resistance when moving the patient’s relaxed limb. The rigidity in parkinsonism is often described as ‘lead pipe’ rigidity: it is present to the same extent throughout the range of movement and occurs when flexing or extending the limb. It is not affected by how fast the limb is moved. It tends to become more prominent when the patient voluntarily moves the other limbs. This effect (“Froment’s manoeuvre”) is also called synkinesis’.

Tremor: the typical parkinsonian tremor is a rest tremor. The tremor often involves the thumb, and it is the rhythmic flexion movement of the thumb against the index finger that gives rise to the phrase ‘pill-rolling’.

When tremor is combined with rigidity, eg at the wrist, movement of the limb when the patient is relaxed will produce a feeling that the limb is stiff and moves in little jumps, like a cog-wheel. This is the meaning of the phrase ‘cog-wheel rigidity’

MDS-UPDRS Part III: Motor Examination 3.3 RIGIDITY

Instructions to examiner: Rigidity is judged on slow passive movement of major joints with the patient in a relaxed position and the examiner manipulating the limbs and neck.

First, test without an activation maneuver.

Test and rate neck and each limb separately.

For arms, test the wrist and elbow joints simultaneously.

For legs, test the hip and knee joints simultaneously.

If no rigidity is detected, use an activation maneuver such as tapping fingers, fist opening/closing, or heel tapping in a limb not being tested. Explain to the patient to go as limp as possible as you test for rigidity.

0: Normal: No rigidity.

1: Slight: Rigidity only detected with activation maneuver.

2: Mild: Rigidity detected without the activation maneuver, but full range of motion is easily achieved.

3: Moderate: Rigidity detected without the activation maneuver; full range of motion is achieved with effort.

4: Severe: Rigidity detected without the activation maneuver and full range of motion not achieved.


#13

Thank you Appletree, some really useful information there, and I think I understand more about it now.
I have an appointment for a second opinion on 6th November, so hope I will find out more soon.