What is writer’s cramp?
Writer's cramp is a specific type of focal dystonia that affects your fingers, hand, or forearm. Focal dystonia of the hands is a neurologic movement disorder. The brain sends incorrect information to the muscles, causing involuntary, excessive muscle contractions. These signals can make your hands twist into odd postures.
Writer’s cramp is known as a task-specific dystonia. It happens almost only when you perform a particular activity. Other highly skilled movements can incite focal hand dystonia — things like playing a musical instrument, typing, or sewing.
Other terms used to describe writer's cramp or similar problems include:
- musician’s cramp
- focal hand dystonia
- arm dystonia
- finger dystonia
- task-specific dystonia
- occupational cramp or dystonia
- the “yips”
Anyone can get a task-specific dystonia like writer's cramp. Estimates range from 7 to 69 per million people in the general population.
Are there different types?
There are two basic types of writer's cramp: simple and dystonic.
Simple writer's cramp involves difficulty with only writing. The abnormal postures and involuntary movements begin soon after you pick up a pen. It only affects your ability to write.
Dystonic writer's cramp moves beyond the one task. Symptoms will show up not only during writing, but also when doing other activities with your hands — like shaving or applying makeup.
What symptoms can it cause?
Sometimes holding a pen or pencil too tightly can cause the muscles in your fingers or forearms to spasm after you’ve been writing for a long time in one sitting. This would be a painful overuse problem. But writer's cramp is more likely to cause trouble with coordination.
Common symptoms of writer’s cramp include:
- 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
Your hand usually won’t ache or cramp. But you may feel mild discomfort in your fingers, wrist, or forearm.
In simple writer’s cramp, the hand will respond normally during other activities and only become uncontrollable during the trigger activity. In dystonic writer’s cramp, other hand-focused activities may also prompt symptoms.
What causes this condition and who’s at risk?
Focal dystonia is a problem with how your brain talks to the muscles in your hand and arm. Experts think that repetitive hand movements result in remapping of certain parts of the brain.
Simple writer’s cramp is associated with overuse, poor writing posture, or holding the pen or pencil improperly. However, symptoms begin after holding the writing tool for just a few moments, not after hours.
Although stress doesn’t cause hand dystonia, it can aggravate symptoms. Stressors — like test-taking — can make your writer’s cramp worse. But worrying about and focusing on the cramping can also make it worse.
Dystonic writer’s cramp is less common than simple writer’s cramp and may occur as part of generalized dystonia that affects several parts of the body. In this case, the involuntary movements can occur when you’re doing other non-writing tasks, such as using a knife and fork.
It’s possible for writer's cramp to be inherited, usually with early onset generalized dystonia, which is associated with the DYT1 gene.
How is this condition diagnosed?
If you think you may have focal dystonia, start by visiting your doctor. They may refer you to a neurologist. Your doctor will ask you a series of questions and perform a physical and neurologic exam.
They’ll be looking for the following:
- specific triggers of dystonia
- which muscles are involved
- characteristics of the spasms and postures
- which body parts are affected
- which activities are affected
- whether any muscles are affected while at rest
Although not routinely recommended for diagnosis, nerve conduction and electromyography studies may help your doctor rule out other possible causes of your symptoms. Brain imaging usually isn’t necessary.
Overuse syndromes are usually painful, but writer’s cramp primarily causes coordination and control issues. If your condition is painful, your doctor may check for:
What treatment options are available?
There’s no simple, one-size-fits-all approach to treating writer’s cramp. And there’s no cure. You may need to try a variety of therapies, and probably will have to combine a couple of them.
A typical treatment plan may include:
- Physical and occupational therapy. Learning how to hold your pen differently, using fatter pens or grips, using special-made splints, and changing your paper or 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, such as trihexyphenidyl (Artane) and benztropine (Cogentin), help some people.
- Relaxation and distraction. Relieve stress-induced cramping through relaxation techniques like deep breathing and visualization, or through distractions like writing with both hands at the same time.
- Sensory re-education. This process of identifying textures and temperatures with your fingers helps retrain brain patterns that cause writer’s cramp.
- Sensory motor retuning. This rehabilitation therapy uses splints on your unaffected fingers to help retrain the affected fingers.
- Surgery. Both pallidotomy and pallidal deep-brain stimulation have been effectively used for generalized dystonia, but surgery isn’t usually necessary for task-specific dystonia like writer’s cramp.
Are complications possible?
For some people, the cramping and unusual movements in the hands may also include muscles around the elbow and shoulder. You may develop a tremor or shaking that accompanies the cramping. You may develop a second dystonia, like of the eyelids or vocal chords. Symptoms can also begin to affect the other hand.
About half of people with simple writer’s cramp will end up progressing to having dystonic writer’s cramp. Other hand-related activities like eating or brushing your teeth may also be affected.
About two-thirds of those with writer’s cramp have ongoing problems with their writing. Handwriting may eventually become illegible.
What’s the outlook?
Although there’s no cure for writer’s cramp, treatments can lessen symptoms and perhaps prevent simple writer’s cramp from affecting other activities or your other hand. A combination of physical, mental, and drug therapy can help you retain your ability to write — so you can keep handwriting letters to your friends and family.