Writer’s cramp also known as focal hand dystonia is an idiopathic movement disorder of adult onset which is characterized by abnormal posturing and movement of the hand and/or forearm during tasks requiring skilled hand use, such as writing. Focal dystonia is a neurological disorder which causes involuntary muscle contractions in one body part. It may cause muscle twitches in the neck, face, jaw, feet or hands. Writer’s cramp is a task-specific focal dystonia of the hand where ‘focal’ refers to the symptoms being limited to one location (the hand), and ‘task-specific’ means that symptoms first occur only when the individual engages in a particular activity (writing). The first sign of writer’s cramp is that it makes it difficult for someone to write, especially for lengthy periods of time.

Types of writer’s cramp

1. Simple writer’s cramp: It involves difficulty only with writing. The abnormal postures and involuntary movements begin soon after one picks up a pen so it only affects ones ability to write.
2. Dystonic writer’s cramp: It moves beyond the one task. Symptoms will show up not only during writing, but also when doing other activities with ones hands — like shaving or applying makeup. Other hand-focused activities may also prompt symptoms.

Common symptoms of writer’s cramp:

• fingers gripping the pen or pencil very hard
• wrists flexing
• fingers extending during writing, making it difficult to hold the pen
• wrists and elbows moving into unusual positions
• hands or fingers failing to respond to commands
  
  

  In simple writer’s cramp, the hand will respond normally during other activities and only become uncontrollable during the trigger activity.

   

  Causes of Writer’s cramp:

  The exact cause of writer’s cramp is not known. It is believed to be a mixed result of many factors. The excessive fine motor activity, possibly complicated by a tense or otherwise inappropriate writing technique is thought to be one factor. Recent studies point out that there appears to be a genetic component to focal hand dystonia (FHD) as up to 20% of those with writer’s cramp have a family member with some form of dystonia. Other studies show that these types of focal dystonia are the result of a basal ganglia and/or sensorimotor cortex malfunction in the brain.

   

  Treatment plan:

• Physical and occupational therapy: This involves learning how to hold pen differently, using fatter pens or grips, using special-made splints, and changing the arm position can all help writer’s cramp.
  
  
• Botulinum neurotoxin (Botox) injections: Botox injections into selected muscles can help ease writer’s cramp, especially when the wrist or fingers move into unusual postures.
  
  
• Oral medications: Anticholinergic drugs have been found to help some people.
  
  
• Sensory re-education and motor retuning: This process of identifying textures and temperatures with your fingers helps retrain brain patterns that cause writer’s cramp.  This rehabilitation therapy uses splints on your unaffected fingers to help retrain the affected fingers.
  
  
• Counseling: Relieve stress-induce cramping through relaxation techniques like deep breathing and visualization, or through distractions like writing with both hands at the same time. The methods of relaxation, gradual approximation, desensitization, retraining and avoidance have been found to be effective.

   

Reference

Axtell, B. (2018). Writer’s Cramp: Causes, Symptoms, Treatment, and More. Healthline. Retrieved 16 August 2022, from https://www.healthline.com/health/writers-cramp.

Pearce, J. “A note on scrivener’s palsy.” J Neurol Neurosurg Psychiatry. 2005 April; 76(4): 513. doi:10.1136/jnnp.2004.044743

Sataloff, Robert Thayer, Alice G. Brandfonbrener, and Richard J. Lederman, eds. Textbook of Performing Arts Medicine. New York: Raven Press, 1991.