What is writer’s cramp?
Writer’s cramp is a common term for an abnormal muscle tone in the hand muscles as a result of certain tasks like writing. The more correct medical term is mogigraphia and the common term ‘writer’s cramp’ should not detract from the fact that this condition, or similar muscle conditions, can arise from other repetitive tasks apart from writing. It occurs in less than 70 people out of 100,000 in the United States and affects men more commonly. Typically the symptoms are seen between 30 to 50 years of age and women are more likely to exhibit symptoms at a younger age than male sufferers. Overall writer’s cramp is a condition that does not receive much attention because many sufferers opt to live with it without seeking medical advice.
Writer’s Cramp Meaning
To fully understand the meaning of ‘writer’s cramp’, one has to look at the anatomy of the hand and how it is affected. Simply, the hand is one of the most flexible parts of the body in that it has more joints within a small area than any other part of the body. It is also the most active part of the body as just about most tasks require the hands. Muscles located within the forearm and hand itself contract and relax to pull and release long tendons attached to bones. This allows for the various movements of the hand.
Muscles can tolerate significant physical activity but it is also affected by overuse. When muscles are strained and fatigued, it goes into spasm. Parts of the muscle, or the entire muscle, goes into involuntary contraction and stays in that state for a period of time. This is also known as a cramp. The medical term ‘dystonia’ is used to describe such involuntary cramps and since it is localized to one part of the body, writer’s cramp can be more accurately described as focal dystonia. Focal simply means that the abnormal muscle tone is localized to one part.
However, focal dystonia on its own is not a complete description of writer’s cramp. Since this abnormal and localized muscle tone is due to certain activities such as writing, writer’s cramp can therefore more correctly be described as task-specific focal dystonia. There are very few commonly practiced activities that require quick and intricate muscle contractions like with writing. This refers to both hand writing and typing. Therefore the term ‘writer’s cramp’ is used to describe task specific focal dystonia.
Writer’s cramp is not just simply a matter of overuse and strain. There is more to the process that leads to the condition. There are two groups of muscles for movement of the hand and fingers. This ensures movements in opposite directions giving the hand a great deal of flexibility and versatility. Normally the muscles of one group relaxes as the muscles of the opposite group contracts due to the inhibition of one group by the spinal activity. This ensures that the hand or fingers can be pulled in one direction without opposition and resistance. It is this “pull and release” mechanism that is affected in writer’s cramp.
People with writer’s cramp do not exhibit normal activity of the spinal inhibition that should relax one group of muscles when the opposite group contracts. In other words, opposing muscles may pull against each other. However, this abnormality in sensory processing and motor coordination may extend from the brain centers. It is more likely to be related to incorrect processing of signals due to overuse of the muscles and repetitive motions and is therefore not a “brain problem” in most cases. There are some rare instances where a problem with the spinal nerves and brain itself may play a role in the development of writer’s cramps.
Writer’s Cramps vs Carpal Tunnel Syndrome
There is sometimes confusion about writer’s cramps and carpal tunnel syndrome.
- Writer’s cramp is a problem with the muscles of the hand and fingers specifically relating to its tone.
- Carpal tunnel syndrome is inflammation of the muscle tendons of the hand thereby pressing against the nerve that runs with these tendons through a narrow passage in the wrist known as the carpal tunnel.
- Both conditions can arise with overuse of the hands, although writer’s cramp is more specifically related to writing while carpal tunnel is caused by various other types of repetitive motions.
- Writer’s cramp and carpal tunnel syndrome can resolve spontaneously without any need for treatment but there is great chance of relapse.
- Pain in writer’s cramp stems from the muscles while pain in carpal tunnel is a result of compression of the median nerve.
Writer’s Cramp Causes
The most common cause of writer’s cramps and therefore the name of this condition is excessive writing or similar repetitive hand movements like typing.
A small but significant number of patients with writer’s cramp had an accident prior to the symptoms starting up. This possibly indicates a traumatic cause although it is not always clear how this may contribute to the condition.
About 5% of patients with writer’s cramp have a family history of the condition. This means that a parent or sibling may also currently have or have previously had writer’s cramp at some point in their lives. It is unclear whether this is a genetic risk factor or learned behaviour from childhood.
There may be various other causes of writer’s cramp although it is rare overall.
- Defective blood vessels – arteriovenous malformations.
- Ruptured intervertebral disc, usually C6.
- Tumors of the brain, especially in the basal ganglia or cortex.
- Unknown causes (idiopathic).
Writer’s Cramp Symptoms
There is usually no significant pain especially in the early stages. Patients report an aching or cramping feeling that is persistent and while rest eases the discomfort initially, it may be persistent in later stages. Movement aggravates the discomfort and overuse can intensify it to a large degree.
There may be difficulty with coordination of the hand. In the early stages this may be seen as a slight loss of precision movements although the major tasks with the hand can still be performed. It gradually gets worse with sudden jerking at times when writing. A writer’s tremor is a separate condition that may also be present as a twitching or shaking when writing only.
The abnormality in the resting position is not an actual structural deformity. Instead the ‘pulling’ of the muscles in spasm may alter the normal alignment of the hand during rest especially. The fingers may not curl inwards to the same degree as it normally would during rest. The hand may be curled or twisted in a manner that is not normally seen in the resting state.
Writer’s Cramp Diagnosis
A physical examination along with a history of repetitive use of the hand in tasks such as writing or typing are usually sufficient to reach a diagnosis. Neurological tests should be conducted to rule out a nerve problem. The results of these tests are usually normal. Other tests that may be considered includes :
- Electromyography and nerve condition studies
- Magnetic resonance imaging (MRI)
Writer’s Cramp Treatment
Although a small number of cases will resolve spontaneously, there is usually recurrence of the condition. However, there may be a contributing factor to these relapses as patients may return to repetitive tasks that caused the condition a short while after experiencing some relief. The cycle in these cases may be ongoing. Nevertheless, even patients who discontinue these activities also have a high degree of relapse.
Overall the treatment for writer’s cramp is not very promising. There may be some degree of relief for periods of time but it is not usually ongoing for a sufficient period of time to restore the quality of life or hold much promise for the person to return to their previous tasks and remain symptom free. These treatment measures include :
- Medication like anticholinergic drugs, beta blockers and botulinum toxin injections provide some relief for symptoms. Botulinum has shown the be the most effective although the results are not permanent.
- Transcutaneous electrical nerve stimulation (TENS) where low voltage electrical current is delivered through electrodes on the skin to block pain impulses.
- Surgery on the thalamus in the brain (thalamotomy) and thalamic deep brain stimulation are extreme therapeutic measures that have fairly good results but are reserved for the most extreme cases.
Writer’s Cramp Prevention
The key to long term management and preventing the condition in individuals who are at risk of developing writer’s cramp involves various behavioral changes and ergonomics. This includes :
- Gripping the pen in a different way so as to ease the strain on the muscles. Changing the grip in this regard may sometimes place some strain on the joints and other muscles in the short term.
- Limiting the hours of activity especially if it some of this writing time is not for occupational reasons.
- Using alternative devices for transcription like typing for those who are usually involved in handwriting, dictation and speech-to-text recognition software.
Article reviewed by Dr. Greg. Last updated on June 15, 2012