eMedicine Specialties > Neurology > Movement and Neurodegenerative Diseases

Writer's Cramp: Differential Diagnoses & Workup

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
Contributor Information and Disclosures

Updated: Jan 19, 2010

Differential Diagnoses

Dopamine-Responsive Dystonia
Multiple Sclerosis
Parkinson Disease
Wilson Disease

Other Problems to Be Considered

Primary writing tremor
Postural tremor
Idiopathic torsion dystonia

Workup

Imaging Studies

  • MRI - If a structural lesion is suspected

Procedures

  • Electromyography/nerve conduction studies
    • To evaluate for nerve injury, if trauma is the suspected cause
    • Confirm diagnosis by showing simultaneous contraction of agonist and antagonist muscles

More on Writer's Cramp

Overview: Writer's Cramp
Differential Diagnoses & Workup: Writer's Cramp
Treatment & Medication: Writer's Cramp
Follow-up: Writer's Cramp
References

References

  1. Tinazzi M, Farina S, Bhatia K, Fiaschi A, Moretto G, Bertolasi L, et al. TENS for the treatment of writer's cramp dystonia: a randomized, placebo-controlled study. Neurology. Jun 14 2005;64(11):1946-8. [Medline].

  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].

Further Reading

Keywords

focal hand dystonia, graphospasm, musician's cramp, writer's cramp, focal dystonia, dystonic conditions, repetitive movements, spinal reciprocal inhibition

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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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, University of South Florida School of Medicine, Tampa General Hospital
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: Nothing to disclose.

 
 
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