Cogwheeling in Parkinson's Disease

When Your Arms or Legs Feel Like a Ratchet Wrench

Cogwheeling is one of the symptoms of Parkinson's disease. It is a jerky feeling in your arm or leg that you (or your doctor) can sense when moving or rotating your affected limb or joint. It is an early effect of Parkinson's disease.

a man with Parkinson's Disease holds his knee
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What Is Cogwheeling?

The movement of cogwheeling can be described as 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.

You may feel it in your elbow, wrist, ankle, knee, or other joints. It can affect both sides of your body, but it doesn't have to be symmetrical—cogwheeling can affect one side of your body, but not necessarily the other.

Testing for Cogwheeling in Parkinson's

Cogwheeeling is a common effect of Parkinson's disease. Many people with the condition can feel the cogwheeling in their joints or limbs.

Some people describe it as an almost audible "click" as the joint moves forward a notch. The affected limb can feel stiff as you move it. It shouldn't be associated with pain, and you will still continue to be able to move your joints even if you have cogwheeling. And you should rest assured that movement will not damage your joint that is affected by cogwheeling.

Physical Examination

Parkinson's disease is a clinical diagnosis. There is no blood test or imaging test that can confirm it. Your doctor will base your diagnosis on your signs and symptoms.

Your doctor will test you for cogwheeling during your diagnostic assessment for Parkinson's disease.

To perform this test, your doctor will ask you to relax and then will move the joints of your wrist, arm, or leg. If your doctor encounters choppy resistance while moving your joint limb, then you might be diagnosed with Parkinson's disease.

If the cogwheeling isn't immediately obvious, your doctor may ask you to move your limb or joint on the opposite side of your body—for example, you may be asked to raise and lower your left arm while your doctor is checking your right side for cogwheeling. This action can help to tease out the cogwheeling effect, especially if it's subtle.

Cogwheeling usually progresses along with tremors and rigidity, which are primary motor symptoms of Parkinson's disease. In Parkinson's disease, rigidity is a type of stiffness that feels like resistance to any type of movement. Parkinson's disease tremor is a rhythmic shaking movement that occurs at rest, with tensing and relaxation of the affected muscles.

How to Control Cogwheeling

The symptom of cogwheeling can be reduced with the treatments that are normally used for managing Parkinson's disease.

Parkinson's disease is treated with drugs that include levodopa and dopamine agonists. Medications often help control the symptoms, especially at the early stages of the disease. However, these medications can cause side effects and they may become less effective over time as your disease progresses. If the symptoms of Parkinson's disease become difficult to manage with medication, some people may have interventional treatments, such as deep brain stimulation (DBS).

Regular exercise can also be valuable for you if you have Parkinson's disease, and it may lessen the cogwheeling effect. You may also be referred to physical therapy. A physical therapist can help guide you in creating an exercise plan that is best for your Parkinson's disease. Dancing to music is also considered an activity that may help reduce stiffness and other symptoms of Parkinson's disease.

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  1. American Parkinson Disease Association. There is no test to diagnose Parkinson’s Disease.