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Writer's Cramp
The Symptoms
In cases of repetitive muscle strain, it presents as a lingering
tension and discomfort in the hand or forearm. Dystonic Writer’s Cramp,
which is due to a malfunction of the central nervous system, has
sometimes remarkably specialised symptoms. These include excessive
gripping of the pen, the involuntary extension of fingers, hand tremors
and distinct muscle spasms.
The Causes
Cramp of the hand or forearm is a prescribed industrial injury (A4). It
is recognised by the benefits agency as being associated with certain
occupations involving repetitive movements, particularly handwriting,
typing and routine assembly work. Dystonia is a neurological disorder.
Though it may appear to be triggered by work activities or a localised
hand injury, it is believed to be the result of malfunction in the area
of the brain known as the basal ganglia, rather than any external
physical cause.
The Doctor’s Examination
In the UK, GPs receive little training in the diagnosis and treatment
of musculoskeletal disorders. Ideally your doctor will refer you to a
specialist who has taken an interest in RSItype conditions, usually a
rheumatologist or neurologist. A diagnosis of Dystonic Writer’s Cramp
is based upon clinical observation. Sometimes an EMG will be done to
show which muscles are overactive and to what degree. (Electrodes are
inserted into the muscles fibres and the electrical activity displayed
on an oscilloscope).
Treatment
Initial treatment of cramp of the hand or forearm involves limiting the
activities which place a strain on the muscles and tendons of this
region. Most commonly you will be advised to return to work after a
period of rest. You may be offered painkillers or anti-inflammatories,
though these treatments alone are usually unsatisfactory.
Though each case has to be considered individually and non-occupational
factors should also be investigated, generally some changes will be
needed at work. Areas to consider include pacing, posture, reducing
repetition and force, rest breaks and the use of ergonomically designed
tools and equipment, e.g. a thick pen held in the palm of the hand, to
reduce the risk of further injury. Learning to write with the
non-dominant hand can be tried, though there is a one-in-four chance of
Writer’s Cramp eventually affecting that hand too.
Other alternative forms of treatment should be considered, including
physiotherapy or deep tissue massage. For more detailed advice, please
refer to the RSI Awareness Information sheet ‘RSI – Its Nature and
Treatment’.
There is no cure for Dystonia. Whilst the results are inconsistent,
treatments which are available to ease the symptoms include;
acupuncture, relaxation techniques and hypnotherapy. Some forms of the
disorder respond to injections of botulinum toxin. For specific advice
about Dystonia, please contact:
The Dystonia Society
46-47 Britton Street
London EC1M 5UJ
Tel (020) 7490 5671
Fax (020) 7490 5672
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