by Marshaneil Soumi D' Rozario | 27 Jan 2018
Writer’s cramp is a sudden spasm, experienced while engaging in tasks requiring certain fine motor movement or in a calculated change of position of the fingers or hand. It is a focal dystonia of the fingers, hand and forearm. It causes a persistent discomfort while writing or playing musical instruments. Dystonia can be defined as an involuntary action due to sustained muscle contraction with abnormal postures. The symptoms may be isolated to only those tasks or affect the muscles in a more general way and spread to affect many tasks. The following actions like, excessive gripping of a pen or utensil, flexing of the wrist, elevation of the elbow, and occasional extension of a finger or fingers causing the utensil to fall from the hand are common symptoms of writer’s cramp.
Dr. Sathish Kumar V, Consultant Neurologist & Stroke Specialist Fortis Malar Hospital, Chennai imparts more information about writer’s cramp. According to him, writer’s cramp is of two category that is primary or secondary. Dystonic writer's cramp may occur in conjunction with generalized or segmental dystonia. In most rare cases, individuals with DYT1 dystonia (which is primary and usually generalized) will have writer's cramp as the only symptom. If the writer's cramp is secondary, there may be a greater frequency of pain.
The terms used to describe writer’s cramp are :
Focal hand dystonia
Dr. Sathish Kumar further adds that the diagnosis of writer's cramp is based on information from the individual and the physical and neurological examination. Presently, there is no test to confirm diagnosis of writer's cramp and in most cases, laboratory tests are normal. The hands can be affected by many conditions. Arthritis, tendon problems, and muscle cramps can all cause pain in the hands. Carpal tunnel syndrome is the result of nerve compression. Writer's cramp is often mistaken for over-use conditions. Over-use syndromes or repeated-use syndromes are usually characterized by pain, whereas writer's cramp is more likely to cause problems with coordination. Focal hand dystonia is responsible for only about 5% of all conditions affecting the hand.
Types of Writer’s cramp:
Simple - Simple writer's cramp have difficulty with only one specific task. For example, if writing activates the dystonia, as soon as the individual picks up a pen or within writing a few words, dystonic postures of the hand begin to impede the speed and accuracy of writing.
Dystonic - The symptoms of dystonic writer’s camp will be prevalent not only when a person is writing but also when performing other activities, such as shaving, using eating utensils, applying make-up.
In his opinion, sometimes the disorder progresses to include the elevation of shoulders or the retraction of arm while writing. Tremor is usually not a symptom of writer's cramp. The symptoms usually begin between the ages of 30 and 50 years old and affect both men and women. Cramping or aching of the hand is not common. Mild discomfort may occur in the fingers, wrist, or forearm. A similar cramp may be seen in musicians as the violin is bowed, in certain athletes such as golfers, or in typists.
Writer's cramp may occur with no family history.
Cases of inherited writer's cramp have been reported, usually in conjunction with early-onset generalized dystonia, which is associated with the DYT1 gene.
There is no single strategy, applicable for every case of writer's cramp. One of the most effective methods is adapting tasks to try to avoid triggering the dystonic movements. This may involve occupational therapy or using assistive/adapted devices.
A multitude of oral drugs has been studied to determine benefit for people with writer's cramp, but none appear to be uniformly effective. About 5% of people's symptoms improved with the use of anticholinergic drugs, such as Artane (trihexyphenidyl), Cogentin (benztropine).
Botulinum neurotoxin injections into selected muscles are helpful in treating writer's cramp, especially when significant deviation of the wrist or finger joints is present. Although this treatment is not effective for all people, significant improvement in writing and reduction of pain is seen in at least two-thirds of those persons treated.
Complementary therapies may be explored, and if pain is present regular relaxation practices may benefit an individual's sense of overall well being.
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