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Cogwheel rigidity is a cardinal sign of Parkinson's disease, marked by muscle rigidity that reacts with superimposed ratchetlike movements when the muscle is passively stretched. This sign can be elicited by stabilizing the patient's forearm and then moving his wrist through the range of motion. (Cogwheel rigidity usually appears in the arms but can sometimes be elicited in the ankle.) The patient and examiner can see and feel these characteristic movements, thought to be a combination of rigidity and tremor.
After you have elicited cogwheel rigidity, take the patient's history to determine when he first noticed associated signs of Parkinson's disease. For example, has he experienced tremors? Did he notice tremors of his hands first? Does he have “pill-rolling” hand movements? When did he first notice that his movements were becoming slower? How long has he been experiencing stiffness in his arms and legs? Has his handwriting gotten smaller? While taking the history, observe him for signs of pronounced parkinsonism, such as drooling, masklike facies, dysphagia, monotone speech, and an altered gait.
Find out which medications the patient is taking, and ask if they have helped relieve some of his symptoms. If he's taking levodopa and his symptoms have worsened, find out if he has exceeded the prescribed dosage. If you suspect an overdose, withhold the drug. If the patient has been taking a phenothiazine or another antipsychotic drug and has no history of Parkinson's disease, he may be having an adverse reaction. Withhold the drug, as appropriate.
disease. With Parkinson's disease, cogwheel rigidity occurs together with an insidious tremor, which usually begins in the fingers (unilateral pill-roll tremor), increases during stress or anxiety, and decreases with purposeful movement and sleep.
Bradykinesia (slowness of voluntary movements and speech) also occurs. The patient walks with short, shuffling steps; his gait lacks normal parallel motion and may be retropulsive or propulsive. He has a monotone way of speaking and a masklike facial expression. He may also experience drooling, dysphagia, dysarthria, and the loss of posture control, causing him to walk with his body bent forward. An oculogyric crisis (eyes fixed upward and involuntary tonic movements) or blepharospasm (complete eyelid closure) may also occur.
Phenothiazines and other antipsychotics (such as haloperidol, thiothixene, and loxapine) can cause cogwheel rigidity. Metoclopramide infrequently causes it.
If the patient has associated muscular dysfunction, assist him with ambulation, bathing, feeding, and other activities of daily living, as needed. Provide symptomatic care as appropriate. For example, if the patient develops constipation, administer a stool softener; if he experiences dysphagia, offer a soft diet with small, frequent feedings. Refer the patient to the National Parkinson Foundation or the American Parkinson Disease Association, both of which provide educational materials and support.
Cogwheel rigidity doesn't occur in children.
Read excerpts from these other book chapters related to Stiff neck:
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1 
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