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Writer's Cramp

Organic Writer's Cramp

Writer's cramp belongs to the group of focal dystonias and is distinguished by the presence of involuntary contraction of muscles responsible for finger, hand or arm movement, which may be repetitive and/or continuous. The term stems from the fact that contractions occur when writing, but they could also be seen when other tasks are performed. An abnormal hand posture and tremor are the main findings. The diagnosis rests on clinical criteria and exclusion of other possible etiologies.


Presentation

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.

Asymptomatic
  • Our findings suggest that patients with writer's cramp may have divergent responses in striatal dopamine release during an asymptomatic motor task involving the dystonic hand and an unrelated asymptomatic task, sentence production.[ncbi.nlm.nih.gov]
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]
  • 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]
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]
  • 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.[symptoma.com]
  • Muscle Cramps: Causes, Signs, Symptoms and Types of Muscle Cramps[epainassist.com]
Painful Muscle Cramps
  • 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]
Psychiatric Symptoms
  • The exclusion criteria included significant cognitive dysfunction, active psychiatric symptoms, and evidence of other central nervous system diseases or other medical disorders.[ncbi.nlm.nih.gov]
Bradykinesia
  • View Article PubMed Google Scholar McKeown MJ, Palmer SJ, Au WL, McCaig RG, Saab R, Abu-Gharbieh R: Cortical muscle coupling in Parkinson’s disease (PD) bradykinesia. J Neural Transm Suppl. 2006, 70: 31-40. 10.1007/978-3-211-45295-0_7.[bmcneurosci.biomedcentral.com]
Motor Symptoms
Aura
  • We report two monochorionic twins that progressively developed, between ages 5 and 10, a combination of episodic neurological disorders including paroxysmal exercise-induced dyskinesia, migraine without or with aura, absence seizures and writer's cramp[ncbi.nlm.nih.gov]
  • Publishers also believe that Salinger-like reclusiveness, which once created an aura of intrigue around an author, is not a viable option in the age of interconnectivity.[nytimes.com]
Neglect
  • However, as shown by this interdisciplinary study, psychodynamic factors should not be neglected. Special attention should be given to the patients' experience of the syndrome and secondary psychoreactive processes.[ncbi.nlm.nih.gov]
  • I’ve been so busy writing and teaching for LitReactor.com, I have completely neglected my own blog. Contrary to appearances, I have been busy! I have contributed over 40 articles to LitReactor and even started teaching an online grammar class.[writerscrampblog.wordpress.com]

Workup

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].

Treatment

  • After 1 year, 20 of 39 patients were still under treatment with a positive effect.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • Starr 7 considers the prognosis good for recovery, "provided a sufficient period of rest can be enforced. This rest must, however, be absolute rest of the function affected," he says.[central-fixation.com]

Etiology

  • 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]
  • 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]
  • 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]

Epidemiology

  • 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]
  • […] 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]
Sex distribution
Age distribution

Pathophysiology

  • BACKGROUND: Writer's cramp is a type of task specific idiopathic focal dystonia and has an incompletely understood pathophysiology.[ncbi.nlm.nih.gov]

Prevention

  • 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]
  • 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.[symptoma.com]

References

Article

  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.

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Last updated: 2019-07-11 22:14