Writer's Cramp Clinical Presentation

  • Author: Jonathan B Strober, MD; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: May 10, 2012
 

History

  • Incoordination, cramping, and aching of the hand with task-specific movements are usually the initial complaints.
  • The hand assumes a semiflexed position of the fingers with possible hyperextension of the fingers and hyperflexion or extension of the wrist with supination or pronation.
  • The symptoms become exaggerated with attempts to perform a specific task, such as writing. In some cases, the hand may dart across the page with a sudden jerk.
  • A related condition is primary writing tremor. Affected individuals exhibit a prominent large-amplitude tremor only with writing.
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Physical

  • Neurologic examination findings are usually normal.
  • Subtle findings include mild dystonic postures developing either spontaneously or with movement and reduced arm swing.
  • One third of patients have a tremor in the affected arm or hand while writing or when the extremity is outstretched. Observation of the limb during writing is an important part of the examination; the assumption of dystonic postures should be demonstrable. Patients affected with primary writing tremor, a variant of writer's cramp, may exhibit a large-amplitude tremor only during writing. In contrast to essential tremor, action or sustentation tremors are not seen with other tasks such as holding a full cup of liquid or coordination testing. Dystonic posturing is usually not seen with this condition.
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Causes

  • Writer's cramp frequently affects persons who write a great deal or perform other repetitive hand movements such as typing.
  • Approximately 5% of patients have a positive family history of a similar condition.
  • Five to ten percent report an accident or injury to the hand or arm immediately preceding the onset of symptoms.
  • Several possible, but rare, associations have been reported, including C6 ruptured disk, lithium use, basal ganglia or cortical tumors, arteriovenous malformations (AVMs), and stroke. However, most cases are idiopathic.
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Contributor Information and Disclosures
Author

Jonathan B Strober, MD  Director, Pediatric Muscular Dystrophy Association Clinic; Associate Clinical Professor, Departments of Pediatrics and Neurology, Division of Child Neurology, University of California at San Francisco

Jonathan B Strober, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen T Gancher, MD  Adjunct Associate Professor, Department of Neurology, Oregon Health Sciences University

Stephen T Gancher, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, and Movement Disorders Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Nestor Galvez-Jimenez, MD, MSc, MHA  Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

References

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  2. Goto S, Shimazu H, Matsuzaki K, Tamura T, Murase N, Nagahiro S, et al. Thalamic Vo-complex vs pallidal deep brain stimulation for focal hand dystonia. Neurology. Apr 15 2008;70(16 Pt 2):1500-1. [Medline].

  3. Baur B, Schenk T, Furholzer W, Scheuerecker J, Marquardt C, Kerkhoff G, et al. Modified pen grip in the treatment of Writer's Cramp. Hum Mov Sci. Oct 2006;25(4-5):464-73. [Medline].

  4. Chen R, Hallett M. Focal dystonia and repetitive motion disorders. Clin Orthop. Jun 1998;(351):102-6. [Medline].

  5. Chen RS, Tsai CH, Lu CS. Reciprocal inhibition in writer's cramp. Mov Disord. Sep 1995;10(5):556-61. [Medline].

  6. Cohen LG, Hallett M. Hand cramps: clinical features and electromyographic patterns in a focal dystonia. Neurology. Jul 1988;38(7):1005-12. [Medline].

  7. Epidemiologic Study of Dystonia in Europe (ESDE) Collaborative Group. Sex-related influences on the frequency and age of onset of primary dystonia. Neurology. Nov 10 1999;53(8):1871-3. [Medline].

  8. [Best Evidence] Kruisdijk JJ, Koelman JH, Ongerboer de Visser BW, 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. Mar 2007;78(3):264-70. [Medline].

  9. Marsden CD, Sheehy MP. Writer's cramp. Trends Neurosci. Apr 1990;13(4):148-53. [Medline].

  10. Rhoad RC, Stern PJ. Writer's cramp--a focal dystonia: etiology, diagnosis, and treatment. J Hand Surg Am. May 1993;18(3):541-4. [Medline].

  11. Schmidt A, Jabusch HC, Altenmuller E, et al. Dominantly transmitted focal dystonia in families of patients with musician's cramp. Neurology. Aug 22 2006;67(4):691-3. [Medline].

 
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