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Focal Dystonia Syndrome

Focal dystonia syndrome is a poorly understood musculotendinous overuse condition often affecting musicians such as piano players. It is also found in writers and is commonly referred to as "writer's cramp" or graphospasm as well.

It is thought that the condition is the result of muscular overuse in task-specific activities that generally causes cramping in the hand. Symptoms usually occur when trying to do a task that requires fine motor movements - initially only during specific tasks and eventually spreading to affect many other tasks. Unlike other over-use conditions for which it is often mistaken such as Carpal Tunnel - prompting muscle cramps and pain, Focal Dystonia Syndrome is more likely to affect coordination and cause mild discomfort.

When Focal Dystonia affects only one task, such as writing, it is called simple. But when it affects other activities requiring similar hand posture, it is called dystonic. Sometimes the disorder progresses to include the elevation of shoulders or retraction of the arm while writing. The most common symptoms include slight aching in the fingers, wrist, or forearm.

The condition is believed to result from the improper functioning of the basal ganglia, which are deep brain structures involved in the control of movement. The cause of this improper functioning is unknown. The treatment options generally focus on alleviating the symptoms.

Those at Risk
Evidence of the condition is generally seen in both men and women between the ages of 30 and 50. The condition is often diagnosed in musicians who play the piano as well as those who play the violin. It has also been seen in athletes such as golfers and in typists as well.

Diagnosis
Patient history combined with a physical, and sometimes neurological, examination will confirm a focal dystonia. An electromyogram (EMG) can help determine which muscles are overactive and to what extent.

Treatment
The condition can be treated with a period of rest and refrain from the activity that prompted it. In persistent cases, either oral medication, botulinum toxin injections or surgery is indicated. Additionally, physical therapy and muscular retraining may be beneficial, depending on the form of dystonia.