Movement Disorders and Musculoskeletal System: A Reciprocal Relationship

Abstract

The association of movement disorders (MDs) with musculoskeletal (MSK) disorders is observed in two principal scenarios. First, MDs patients may present with MSK issues. This phenomenon is primarily observed in parkinsonian syndromes, but may also be seen in patients with dystonia, Tourette syndrome, and some gene-related MDs. Second, there are MSK disorders that may produce or mimic MDs. Important primary MSK disorders producing MDs are joint hyperlaxity syndrome, non-traumatic craniovertebral junction anomalies, congenital muscular torticollis, and rheumatoid arthritis. Peripheral trauma to the MSK system may also lead to MDs commonly referred to as peripherally induced MDs. The exact pathogenesis of these disorders is not clear, however many patients have associated sensory phenomena such as complex regional pain syndrome. Herein, we provide an overview of disorders that may manifest with a combination of MSK and MDs, as detailed above. The most common MDs are discussed in each section, along with important clinical points, suggested diagnostic workups, and possible differential diagnoses.The musculoskeletal (MSK) system is primarily involved in locomotion, movement, and physical tasks performance to support and protect the body's organs mechanically. 1 The system consists of muscles and tendons, bones, joints, ligaments, cartilage, fascia, intervertebral discs, synovial capsule, and other fibrous tissues. 1 There are complex neurologic, physiologic, and biomechanical interactions between the MSK system and the other parts of the body.MSK and movement disorders (MDs) are two large subspecialties, each containing a huge number of separate disease entities characterized by a rich diversity in clinical manifestation. The association between MSK disorders and MDs is significant, but, complex. In some instances, it may be merely coincidental. In others, it may reflect direct and causative association. In this review, we provide an educational and practical overview of the association between MSK disorders and MDs. We begin with MDs where there are associated MSK issues. Then we have discussed MSK conditions that may be associated with MDs or may mimic MDs. MethodsWe reviewed English-written articles and abstracts published in PubMed from January 1950 to July 31, 2021 using the combination of "Medical Subject Headings" "Musculoskeletal" AND [("movement disorders"), or ("parkinsonian syndromes"), or ("tremor"), or ("dystonia"), or ("athetosis"), ("tics"), or ("chorea"), or ("myoclonus"), or ("ataxia"), or ("stereotypy"), or ("camptocormia"), or ("Pisa syndrome"), or ("dropped head syndrome"), or ("scoliosis"), or ("striatal hand"), or ("striatal foot")]. Additional searches were also done using the combination of search terms "Movement disorders" AND [("joint hyperlaxity syndrome"), or ("pseudodystonia"), or ("craniovertebral junction anomalies"), or ("rheumatoid arthritis"), or ("peripheral trauma to musculoskeletal system") or ("complex regional pain syndrome")]. We excluded articles related to non-human species. T...

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