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To the Editor:
The article by Pressley et al. provides important information about health care use in Parkinson disease (PD).1 Incidentally, this study shed interesting light on falls and injury mechanisms in PD. Earlier studies noted that arm fractures seemed rare in PD.2 The current survey strongly indicates that injuries in PD affect the upper extremities less often than the lower extremities. In fact, recalculation of the original data shows that in PD, the risk of upper extremity injuries was almost significantly lower compared with controls (table). At first sight, this is unexpected because patients with PD fall predominantly forward (figure 1A)3; such forward falls typically cause wrist fractures because subjects land on the outstretched hand.4 We propose two explanations. One possibility is that patients keep their hands in pockets of their clothes owing to shame of hand tremors. Another explanation is that arm movements are delayed or abnormally directed in PD. We examined protective arm movements in patients with PD placed …
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