The term writer's cramp represents one of the most widely recognized focal dystonias in clinical practice, with approximately 3-7 cases per 100,000 individuals [1] [2] [3]. It is defined as a task-specific motor abnormality of the hand characterized by involuntary and either sustained or persistent contractions of muscle groups that are needed for the task of writing to be carried out [4] [5] [6] [7]. Because of these contractions, the arm, hand, or finger are in an abnormal posture (thus preventing the individual from performing this task), which is the principal component of the clinical presentation [1] [3] [4] [5] [6]. In addition to abnormal posturing, patients complain of tremor during writing, use of excessive force to hold the pen, but also pain and significant discomfort [2] [6] [8]. Abnormal hand posture, joint, and muscle cramping has been confirmed in patients when performing other manual tasks as well, and the term complex writer's cramp is used to describe this clinical entity [2]. Some studies have documented the surprisingly common presence of a "mirror dystonia" - muscle spasms of the opposite hand during the physical examination [6]. Furthermore, some reports have stressed the role of writer's cramp impeding professional work, whereas others found significantly higher rates of anxiety disorders and depression in this patient population [2] [6] [9], indicating that the burden of this seemingly benign condition on the quality of life may be much greater than anticipated.

• Hand Pain

  There are so many people who suffer with hand pain, numbness and other problems – and they don’t know that chiropractic care is an option for their hands. [chiropractichandandfootclinics.com]

  William Kormos, editor-in-chief of Harvard Men's Health Watch and a primary care physician at Massachusetts General Hospital For more on the causes and treatment of hand pain, buy Hands: Strategies for strong, pain-free hands, a Special Health Report [health.harvard.edu]

  I think it’s funny that hand pain can be considered a mental disorder rather than a physical one. There are multiple reasons why you might experience numbness or pain in your fingers, hand or wrist. Muscles in the hand can cramp and get overused. [swensonbookdevelopment.com]

• Unconsciousness

  […] heliocentric view of the cosmos displaced humans from their previously accepted place at the centre of the universe; Darwin's evolutionary theory placed humans firmly within, as opposed to above, the order of nature; and Freud's ideas about the power of the unconscious [en.wikipedia.org]

• Muscle Cramp

  Albert Schweitzer (1875-1965) the world-famous philosopher, theologian, concert organist, musicologist, philanthropist and winner of the 1952 Nobel Peace Prize suffered throughout most of his life from severe and painful muscle cramps in his right upper [ncbi.nlm.nih.gov]

  Trans Amer Soc Artif Int Organs. 1975; 21: 479-482 Gotloib L Servadio C Muscle cramps during maintenance hemodialysis. Lancet. 1972; 2: 877 Stewart WK Fleming LW Manuel MA Muscle cramps during maintenance hemodialysis. [ajkd.org]

  An electromyographic study of induced and spontaneous muscle cramps. Electroenceph Clin Neurophysiol. 1957;9:139-147. Google Scholar | Crossref | Medline 8. Jansen PHP, Joosten EMG, Van Diyck JAAM, et al. The incidence of muscle cramps. [journals.sagepub.com]

• Myopathy

  Muscle cramps in chronic thyrotoxic myopathy. Arch Neurol. 1986;19:315-320. Google Scholar | Crossref 18. Roberts HJ. Spontaneous leg cramps and “restless legs” due to diabetogenic hyperinsulinism: observations on 131 patients. [journals.sagepub.com]

• Distractibility

  Distraction therapy is also used by not letting the patient think about it too much. Botox injections do give effective results for everyone. [onlymyhealth.com]

  Relaxation and distraction. Relieve stress-induced cramping through relaxation techniques like deep breathing and visualization, or through distractions like writing with both hands at the same time. Sensory re-education. [healthline.com]

• Fear

  Herbs are great boon to mankind which are side effects free and can be taken for long time without any fear. Herbs in writer’s cramp play very important role and treat this painful situation effectively. [alwaysayurveda.com]

  Apparently Tom was a poor swimmer and half way across the lake the boy either lost his nerve, or got cramps, and in fear clung onto Max pulling both of them down into the dark and murky water. [medium.com]

  A few years later he returned, very much excited and unhappy because he was suffering from writer's cramp and feared that he might be obliged to give up his work. [central-fixation.com]

  Some of the extra work is being pushed by authors themselves, who are easing their own fears that if they stay out of the fickle book market too long, they might be forgotten. Ms. [nytimes.com]

• Anxiety Disorder

  Furthermore, some reports have stressed the role of writer's cramp impeding professional work, whereas others found significantly higher rates of anxiety disorders and depression in this patient population, indicating that the burden of this seemingly [symptoma.com]

  According to research, many writer’s cramp patients exhibited state and trait anxiety disorders more frequently than healthy patients. Other studies have found obsessive-compulsive behavior symptoms being exhibited by those with writer’s cramp. [marijuanadoctors.com]

• Difficulty Writing

  Patients may also present with varying degree of disability and symptoms, such as experiencing more difficulty writing down-stroke as compared to writing upstroke.[2] Electrical sensors (EMG) inserted into affected muscle groups, while painful, can provide [en.wikipedia.org]

  She developed difficulty writing with her right hand at age 8. The problem started selectively with writing but soon spread to involve other tasks. She switched to writing with her left hand, and developed writing problem two years later. [clinicalmovementdisorders.biomedcentral.com]

• Chorea

  However in clinically definite MS, a variety of movement disorders, namely tremor, dystonias, chorea and parkinsonism have been described and were thought to be secondary to demyelinating lesions in critical regions [ 4, 5, 6, 7 ]. [ispub.com]

  The movements follow a similar pattern, and these repetitive postures support the diagnosis (unlike chorea which is random). Dystonia is often is often better first thing in the morning. [cmdg.org]

• Perseveration

  Persevere. If you love it and work at it and take it and yourself seriously, you are a writer. And you will be published. How about those specializing in non-fiction? All of the above applies. Plus, take research seriously. [cynthialeitichsmith.com]

The diagnosis of a writer's cramp is primarily based on clinical findings (as the exact etiology remains unknown in the majority of cases) [1] [2] [6], which is why the role of a properly obtained patient history and a detailed physical examination is essential. Physicians must assess the circumstances that precede the appearance of involuntary muscle contractions (prolonged repetitive movements seen in writing, hence the term writer's cramp) [6], as well as their duration and severity and other associated symptoms. Because the disorder appears almost always when performing the specific task of writing, patients should be asked to write during the physical examination in order to confirm the disorder. The wide differential diagnosis of tremor and dystonia, however, necessitates a more thorough laboratory and imaging workup. In addition to a detailed family history that may reveal similar illnesses in close family members, imaging studies of the endocranium and electrophysiology testing are recommended. Typical findings on electromyography (EMG) are co-contraction of both the agonist and antagonist muscles of the hand and forearm [10].

Surgical treatment of dystonia Eur J Neurol. 2010. Krauss JK. Department of Neurosurgery, Medical School Hannover, Hannover, Germany. Surgical treatment of dystonia has experienced a tremendous change over the past decade. [raysahelian.com]

Fine force control was within the 95% confidence interval of the control group after treatment. In conclusion, force regulation was disturbed in patients and improved after BoNT treatment. [ncbi.nlm.nih.gov]

Hence, an ecletic therapy treatment was planned including pharmacotherapy (anxiolytics) and behavior therapy (retraining) was used as a treatment regime. [jmhhb.org]

Thalamic deep brain stimulation has been helpful in some patients. [ 13, 14 ] In exceptional cases, stereotactic nucleus ventro-oralis thalamotomy may be of value. [ 15 ] Prognosis Prognosis is variable, as is response to treatment. [patient.info]

It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor. [dystonia.org.uk]

Treatment and prognosis of all these disorders will be different than FHD. [annalsofian.org]

Writer's cramp is a rare movement disorder of unknown etiology, in which a cramp is elicited primarily or exclusively with writing. We describe a patient with primary writer's cramp that was completely improved by drinking a small amount of alcohol. [ncbi.nlm.nih.gov]

The diagnosis rests on clinical criteria and exclusion of other possible etiologies. The term writer's cramp represents one of the most widely recognized focal dystonias in clinical practice, with approximately 3-7 cases per 100,000 individuals. [symptoma.com]

The actual etiology of writer's cramp is unknown. [medscape.com]

Research in Progress First Online: 29 September 2011 123 Downloads 2 Citations Abstract Writer's Cramp is a functional motor disorder classified as an occupational neurosis included under ICD-9 and under Other specified neurotic disorders of uncertain etiology [link.springer.com]

Writer's cramp as a segmental dystonia has an unknown etiology and pathologic substrate. However, few studies have pointed out the cerebellum as a target neuroanatomic structure [ 10 ]. [ispub.com]

Epidemiologic Study of Dystonia in Europe (ESDE) Collaborative Group. Neurology 1999;53:1871-1873. Duane DD: Spasmodic torticollis: clinical and biologic features and their implications for focal dystonia. Adv Neurol 1988;50:473-492. [karger.com]

Epidemiological Study of Dystonia in Europe (ESDE) Collaborative Group. A prevalence study of primary dystonia in eight European countries. J Neurol 2000;247:787-92. 7. Matsumoto S, Nishimura M, Shibasaki H, Kaji R. [jmhhb.org]

"Epidemiology, phenomenology, and therapy of musician's cramp" in Music, Motor Control, and the Brain. Oxford, New York: Oxford University Press, 2006: 265-282. ^ A. J. Lees, N. Turjanski, et al. [en.wikipedia.org]

[…] effect of writer's cramp. [ 2 ] The main pathophysiological mechanisms explaining the disorganisation of the sensory-motor system appear to be loss of inhibition, aberrant neural plasticity, and defective learning-based sensory-motor integration. [ 3 ] Epidemiology [patient.info]

Its pathophysiology has been related to faulty sensorimotor integration, abnormal sensory processing, and impaired motor planning. [ncbi.nlm.nih.gov]

Prevention of Writer's Cramps Some Basic Tips To Prevent Such Repetitive Strain Injuries Include: Performing functions within limits, managing the pace of work and spacing the activities whenever possible. [epainassist.com]

An extinction procedure consisting of response-cost and response-prevention measures is tested using an A-B-A-B design. Two patients totally unable to write, were able to increase cramp latency and were gradually retrained to write. [ncbi.nlm.nih.gov]

Focal Hand Dystonia cannot be prevented, there are things you can do to lower the risk of developing it. [orthotoc.com]

Botulinum toxin can be injected into the affected muscles to prevent the cramping and spasms. Surgery is rare. More information on Writer’s Cramp Dystonia Foundation E-medicine [aanem.org]

1. Goldman JG. Writer's cramp. Toxicon. 2015;107(Pt A):98-104.
2. Kruisdijk JJM, Koelman JHTM, de Visser BWO, de Haan RJ, Speelman JD. Botulinum toxin for writer’s cramp: a randomised, placebo‐controlled trial and 1‐year follow‐up. J Neurol Neurosurg Psychiatry. 2007;78(3):264-270.
3. The Epidemiological Study of Dystonia in Europe (ESDE) Collaborative Group A prevalence study of primary dystonia in eight European countries. J Neurol 2000;247(10);787–792.
4. Waissman FQ, Pereira JS, Nascimento OJ. A new therapeutic proposal for writer's cramp: a case report. Sao Paulo Med J. 2010;128(2):96-98.
5. Richardson SP, Beck S, Bliem B, Hallett M. Abnormal Dorsal Premotor-Motor Inhibition in Writer’s Cramp. Mov Disord. 2014;29(6):797-803.
6. Shamim EA, Chu J, Scheider LH, Savitt J, Jinnah HA, Hallett M. Extreme Task-Specificity in Writer’s Cramp. Mov Disord. 2011;26(11):2107-2109.
7. Kubota Y, Murai T, Okada T, et al. Obsessive-compulsive characteristics in patients with writer’s cramp. J Neurol Neurosurg Psychiatry. 2001;71(3):413-414.
8. Jackman M, Delrobaei M, Rahimi F, et al. Predicting Improvement in Writer’s Cramp Symptoms following Botulinum Neurotoxin Injection Therapy. Louis ED, ed. Tremor Other Hyperkinet Mov (N Y). 2016;6:410.
9. Pekmezovic T, Svetel M, Ivanovic N, et al. Quality of life in patients with focal dystonia. Clin Neurol Neurosurg. 2009;111:161–164.
10. Rhoad RC, Stern P. Writer's cramp--a focal dystonia: etiology, diagnosis, and treatment. J Hand Surg Am. 1993;18(3):541-544.