Objective: To describe a case report with video which shows the ability of STN DBS to eliminate trigger finger (Stenosing Tenosynovitis) in a patient with PD.

Background: Orthopedic complications of Parkinson’s disease are not common. Postural changes in the trunk such as PISA syndrome, camptocormia are well described, as are striatal deformities of the hand and foot. Unfortunately, these problems are difficult to treat and don’t respond well to dopaminergic medicines. While there are reports of the beneficial effects of STN DBS on postural deformities in PD, there is no description of the impact of STN DBS on orthopedic hand changes.

Method: This is a case report of at 65 year old right handed woman who was treated with B STN DBS. She had Stenosing Tenosynovitis (trigger finger) of her left hand, which she and her neurologist noted to improve immediately during intraoperative macrostimulation. This case report reveals a video showing the finger problems post operatively before DBS was activated, and after stimulation settings were stable.

Results: STN DBS was performed after 8 years of PD. Indications for DBS were tremor, motor fluctuations, with off time and dyskinesia. Physical exam was notable for joint clicking, and snapping which slowed finger movements. During the placement of B STN DBS, macrostimulation was applied: 1-4+ PW 90 rate 185, at 2 mAmp tremor and bradykinesia improved, and she was able to open and close her hand without any clicking or snapping of the joint. When she returned for initial programming the joint problem was still present (video 1), and again improved. Video (video 2) shows no evidence of this orthopedic problem at follow up.

Conclusion: This case report illustrates the positive and immediate, effect of STN DBS on eliminating trigger finger in a patient with PD. This is important because joint problems are common in PD, hard to treat, and little is known about their exact pathophysiology. Joint deformities in PD are more common on the most affected side in PD. Bradykinesia, rigidity, reduced range of motion likely play a role in their etiology, but to what extent is unknown. While it seems reasonable that alleviating bradykinesia and rigidity with STN could lessen orthopedic problems, it seems unlikely that a response would be immediate was it was in this case. This case report is intended to inspire further larger scale investigations into the interplay between neurologic and orthopedic problems in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-stn-dbs-on-a-musculoskeletal-problem-a-case-report/