Thread by @hyderabaddoctor

A #runner who would #swing his left arm more than the right
1. I have been running outdoors for two years. Over a period of time, one gets familiar with fellow runners- specially their style, pace & endurance. This post is about one of those runners, who was a regular (like me)😆

2. He had one odd style- he would swing his right arm lesser than the left while #running or #walking.
He would continue in the same style for about 60-70 minutes of his #RUN.
His #pace was excellent- 60 minutes for a 10 km run.
#MedTwitter #neurotwitter

3. Our interaction was limited to "Good mornings".
Six months had passed since I first saw him. At this point, I noted that I could outpace him on a few occasions (I was much slower than him to start with).
I had started to think about possibility of a #neurological #disease.

4. One day, we finished our runs at the same time. Being inquisitive, I could not control, introduced myself as a doctor and sought his permission to ask a few queries. He agreed that his pace had slightly reduced but was unsure about the reduced right arm swing. He was 42-yr-old

5. Next day, he stopped & confirmed that right arm swing had indeed reduced. He managed to watch a video of one of his earlier runs (that was saved in his computer), which clearly showed that right arm moved slower and the magnitude of movement was lesser as compared to left arm.

6. He wished for a detailed evaluation at my clinic. Examination confirmed reduced right arm swing, while walking.
He had no shoulder pain.
Muscle strength and muscle tone examination was normal.
However, rigidity was noted in right arm on distracting him (activated rigidity).

7. Now, I was almost sure of my clinical diagnosis.
Reduced arm swing and activated rigidity on one side (right side in this case) was highly suggestive of #Parkinsons disease (PD).
Patient wished for a confirmatory test.
18F DOPA PET scan confirmed the diagnosis of PD.

8. After detailed discussion, low dose anti-parkinsonian medications were started.

One year has since passed, and he is doing well.
He continues to show up for his daily runs (running is his life, as he often says), and yes, now, his right arm swings as much as his left arm.

9. Take home message:
Reduced arm swing on one side can be the earliest sign of Parkinson's disease.
Careful clinical evaluation & investigations (if needed) can help in diagnosing PD at early stage.
Early initiation of medical treatment can significantly improve quality of life.

For medicos:
Other common causes of reduced arm swing on one side-
1. Frozen shoulder (adhesive capsulitis);
2. Old brain stroke with residual arm weakness/spasticity;
3. Gunslinger's gait

Reference article for Gunslinger's gait- an interesting read for everyone (regarding Putin's and a few other Russians with reduced right arm swing while walking)
doi.org/10.1136/bmj.h6…