Journal of Hand Therapy
Volume 22, Issue 2 , Pages 172-182 , April 2009

Differences in Physical Characteristics and Response to Rehabilitation for Patients with Hand Dystonia: Musicians' Cramp Compared to Writers' Cramp

  • Alison L. McKenzie, PT, PhD

      Affiliations

    • Corresponding Author InformationCorrespondence and reprint requests to Alison L. McKenzie, PT, PhD, Department of Physical Therapy, Chapman University, One University Drive, Orange, CA 92624
  • Cindy Barrango, DPT

      Affiliations

    • Work completed in partial fulfillment of the Doctor of Physical Therapy Degree at Chapman University, Orange, California.
  • Tricia Wong, DPT

      Affiliations

    • Work completed in partial fulfillment of the Doctor of Physical Therapy Degree at Chapman University, Orange, California.
  • Nancy Byl, PT, PhD

      Affiliations

    • Work completed in partial fulfillment of the Doctor of Physical Therapy Degree at Chapman University, Orange, California.

References 

  1. Marsden CD, Sheehy MP. Writer's cramp. Trends Neurosci. 1990;13(4):148–153
  2. Sheehy MP, Marsden CD. Writers' cramp—focal dystonia. Brain. 1982;105:341–343
  3. Byl N, Hamati D, Melnick M, Wilson F, McKenzie A. The sensory consequences of repetitive strain injury in musicians: focal dystonia of the hand. J Back Musculoskeletal Rehabil. 1996;7:27–39
  4. Braun C, Schweizer R, Heinz U, Wiech K, Birbaumer N, Topka H. Task-specific plasticity of somatosensory cortex in patients with writer's cramp. Neuroimage. 2003;20:1329–1338
  5. Byl N, Wilson F, Merzenich M, et al. Sensory dysfunction associated with repetitive strain injuries of tendonitis and focal hand dystonia: a comparative study. J Orthop Sports Phys Ther. 1996;23(4):234–243
  6. Byl NN, Melnick M. The neural consequences of repetition: clinical implications of a learning hypothesis. J Hand Ther. 1997;10(2):160–174
  7. Byl NN, et al. A primate model for studying focal dystonia and repetitive strain injury: effects on the primary somatosensory cortex. Phys Ther. 1997;77(3):269–285
  8. Byl NN, McKenzie A, Nagarajan SS. Differences in somatosensory hand organization in a healthy flutist and a flutist with focal hand dystonia: a case report. J Hand Ther. 2000;13:302–309
  9. Byl NN, McKenzie AL. Treatment effectiveness for patients with a history of repetitive hand use and focal hand dystonia: a planned, prospective follow-up study. J Hand Ther. 2000;13:289–301
  10. Bara-Jimenez W, Catalan MJ, Hallett M, Gerloff C. Abnormal somatosensory homunculus in dystonia of the hand. Ann Neurol. 1998;44:828–831
  11. Bara-Jimenez W, Shelton P, Sanger TD, Hallet M. Sensory discrimination capabilities in patients with focal hand dystonia. Ann Neurol. 2000;47:377–380
  12. Elbert T, Candia V, Altenmuller E, et al. Alteration of digital representations in somatosensory cortex in focal hand dystonia. Neuroreport. 1998;16:3571–3575
  13. McKenzie AL, Nagarajan SS, Roberts TPL, Merzenich MM, Byl NN. Somatosensory representation of the digits and clinical performance in patients with focal hand dystonia. Am J Phys Med Rehabil. 2003;82:737–749
  14. Stinear CM, Byblo WD. Task-dependent modulation of silent period duration in focal hand dystonia. Mov Disord. 2005;20:1143–1151
  15. Tamura Y, Matsuhashi M, Lin P, et al. Impaired intracortical inhibition in the primary somatosensory cortex in focal hand dystonia. Mov Disord. 2008;23:558–565
  16. Deuschl G, Toro C, Matsumoto J, Hallet M. Movement-related cortical potentials in writer's cramp. Ann Neurol. 1995;38:862–868
  17. Chen R, Wassermann EM, Canos M, Hallet M. Impaired inhibition in writer's cramp during voluntary muscle activation. Neurology. 1997;49:1054–1059
  18. Bütefisch CM, Boroojerdi B, Chen R, Battaglia F, Hallet M. Task-dependent intracortical inhibition is impaired in focal hand dystonia. Mov Disord. 2005;20:545–551
  19. Byrnes M, Mastaglia F, Walters S, Archer S-A, Thickbroom GW. Primary writing tremor: motor cortex reorganization and disinhibition. J Clin Neurosci. 2005;12:102–104
  20. Murase N, Rothwell JC, Kaji R, et al. Subthreshold low-frequency repetitive transcranial magnetic stimulation over the premotor cortex modulates writer's cramp. Brain. 2005;128:104–115
  21. Tamburin S, Manganotti P, Marzi CA, Fiaschi A, Zanette G. Abnormal somatotopic arrangement of sensorimotor interactions in dystonic patients. Brain. 2002;125:2719–2730
  22. Quartarone A, Rizzo V, Bagnato S, et al. Homeostatic-like plasticity of the primary motor hand area is impaired in focal hand dystonia. Brain. 2005;128:1943–1950
  23. Toro C, Deuschl G, Hallet M. Movement-related electroencephalographic desynchronization in patients with hand cramps: evidence for motor cortical involvement in focal dystonia. Ann Neurol. 2000;47:456–461
  24. Byl NN, Nagarajan SS, Merzenich MM, Roberts T, McKenzie A. Correlation of clinical neuromusculoskeletal and central somatosensory performance: variability in controls and patients with severe and mild focal hand dystonia. Neural Plast. 2002;9(3):177–202
  25. Butterworth S, Francis S, Kelly E, McGlone F, Bowtell R, Sawle GV. Abnormal cortical sensory activation in dystonia: an fMRI study. Mov Disord. 2003;18:673–682
  26. Evinger C. Animal models of focal dystonia. NeuroRx. 2005;2:513–524
  27. Meunier S, Garnero L, Ducorps A, et al. Human brain mapping in dystonia reveals both endophenotypic traits and adaptive reorganization. Ann Neurol. 2001;50:521–527
  28. Garraux G, Bauer A, Hanakawa T, Wu T, Kansaku K, Hallet M. Changes in brain anatomy in focal hand dystonia. Ann Neurol. 2004;55:736–739
  29. Byl NN. Learning-based animal models: task-specific focal hand dystonia. ILAR J. 2007;48:411–431
  30. Hallett M. Pathophysiology of writer's cramp. Hum Mov Sci. 2006;25:454–463
  31. Bohlhalter S, Leon-Sarmiento FE, Hallet M. Abnormality of motor cortex excitability in peripherally induced dystonia. Mov Disord. 2007;22:1186–1189
  32. Eckert T, Peschel T, Heinze HJ, Rotte M. Increased pre-SMA activation in early PD patients during simple self-initiated hand movements. Neurology. 2006;253:199–207
  33. Gilio F, Curra A, Inghilleri M, et al. Abnormalities of motor cortex excitability preceding movement in patients with dystonia. Brain. 2003;126:1745–1754
  34. Lim VJ, et al. Perceptual differences in sequential stimuli across patients with musician's and writer's cramp. Mov Disord. 2003;18:1286–1293
  35. Macar F, Coull J, Vidal F. The supplementary motor area in motor and perceptual time processing: fMRI studies. Cogn Process. 2006;7:89–94
  36. McDonnell M, Thompson P, Ridding M. The effect of cutaneous input on intracortical inhibition in focal task-specific dystonia. Mov Disord. 2007;22:1286–1292
  37. Quartarone A, Bagnato S, Rizzo V, et al. Corticospinal excitability during motor imagery of a simple tonic finger movement in patients with writer's cramp. Mov Disord. 2005;20:1488–1495
  38. Rosenkranz K, Cadar A, Rothwell JC. Differential modulation of motor cortical plasticity and excitability in early and late phases of human motor learning. J Neurosci. 2007;27(44):12058–12066
  39. Hallet M. The neurophysiology of dystonia. Arch Neurol. 1998;55:601–603
  40. Fiorio M, Tinazzi M, Bertolasi L, Aglioti SM. Temporal processing of visuotactile and tactile stimuli in writer's cramp. Ann Neurol. 2003;53:630–635
  41. Sanger TD, Tarsy D, Pascual-Leone A. Abnormalities of spatial and temporal sensory discrimination in writer's cramp. Mov Disord. 2001;16:94–99
  42. Tinazzi M, Frasson E, Bertolasi L, Fiaschi A, Aglioti S. Temporal discrimination of somesthetic stimuli is impaired in dystonic patients. Neuroreport. 1999;10:1547–1550
  43. Tinazzi M, Priori A, Bertolasi L, Frasson E, Mauguiere F, Fiachi A. Abnormal central integration of dual somatosensory input in dystonia. Evidence for sensory overflow. Brain. 2000;123:42–50
  44. Kaji R, Rothwell J, Katayama M, et al. Tonic vibration reflex and muscle afferent block in writer's cramp. Ann Neurol. 1995;38:155–162
  45. Ikeda A, Shibasaki H, Kaji R, et al. Abnormal sensorimotor integration in writer's cramp: study of contingent negative variation. Mov Disord. 1996;11:683–690
  46. Abbruzzese G, Marchese R, Buccolieri A, Gasparetto B, Trompetto C. Abnormalities of sensorimotor integration in focal dystonia. A transcranial magnetic stimulation study. Brain. 2001;124:537–545
  47. Lourenço G, Meunier S, Vidailhet M, Simonetta-Moreau M. Impaired modulation of motor cortex excitability by homonymous and heteronymous muscle afferents in focal hand dystonia. Mov Disord. 2007;22:523–527
  48. Ridding MC, Sheean G, Rothwell JC, Inzelberg R, Kujirai T. Changes in the balance between motor cortical excitation and inhibition in focal, task-specific dystonia. J Neurol Neurosurg Psychiatry. 1995;59:493–498
  49. Oga T, Honda M, Toma K, et al. Abnormal cortical mechanisms of voluntary muscle relaxation in patients with writer's cramp: an fMRI study. Brain. 2003;125:895–903
  50. Frasson E, Priori A, Bertolasi L, Mauguiere F, Fiaschi A, Tinazzi M. Somatosensory disinhibition in dystonia. Mov Disord. 2001;16:674–682
  51. Ikoma K, Samii A, Mercuri B, Wassermann EM, Hallett M. Abnormal cortical motor excitability in dystonia. Neurology. 1996;46:1371–1376
  52. Simonetta-Moreau M, Lourenco G, Sangla S, Mazieres L, Vidailhet M, Meunier S. Lack of inhibitory interaction between somatosensory afferent inputs and intracortical inhibitory interneurons in focal hand dystonia. Mov Disord. 2006;21:824–834
  53. Sommer M, Ruge D, Tergau F, Beuche W, Altenmuller E, Paulus W. Intracortical excitability in the hand motor representation in hand dystonia and blepharospasm. Mov Disord. 2002;17:1017–1025
  54. Richardon SP, Bliem B, Lomarev M, Shamin E, Dang N, Hallet M. Changes in short afferent inhibition during phasic movement in focal hand dystonia. Muscle Nerve. 2008;37:358–363
  55. Delmaire C, Krainik A, du Montcel T, et al. Disorganized somatotopy in the putamen of patients with focal hand dystonia. Neurology. 2005;64:1391–1396
  56. Peller M, Zeuner KE, Munchau A, et al. The basal ganglia are hyperactive during the discrimination of tactile stimuli in writer's cramp. Brain. E publication. Jul 19, 2006.
  57. Prodoehl J, Corcos DM, Vaillancourt DE. Effects of focal hand dystonia on visually guided and internally guided force control. J Neurol Neurosurg Psychiatry. 2006;77:909–914
  58. Prodoehl J, MacKinnon CD, Comella CL, Corcos DM. Rate of force production and relaxation is impaired in patients with focal hand dystonia. Parkinsonism Relat Disord. 2006;12:363–371
  59. Fiorio M, Tinazzi M, Aglioti S. Selective impairment of hand mental rotation in patients with focal hand dystonia. Brain. 2006;129:47–54
  60. Albanese A, Barnes MP, Bhatia KP, et al. A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES task force. Eur J Neurol. 2006;13:433–444
  61. Rosset-Llobet J, Fabregas i Molas S, Rosines i Cubells D, Narberhaus Donner B, Montero i Homas J. Clinical analysis of musicians' focal hand dystonia. Review of 86 cases. Neurologia. 2005;20:108–115
  62. Conti AM, Pullman S, Frucht SJ. The hand that has forgotten its cunning-lessons from musicians' hand dystonia. Mov Disord. 2008;23:398–406
  63. Grafman J, Cohen LG, Hallet M. Is focal hand dystonia associated with psychopathology?. Mov Disord. 1991;6:29–35
  64. Hughes M, McLellan DL. Increased co-activation of the upper limb muscles in writer's cramp. J Neurol Neurosurg Psychiatry. 1985;48:782–787
  65. Cohen LG, Hallet M. Hand cramps: clinical features and electromyographic patterns in a focal dystonia. Neurology. 1988;38:1005–1012
  66. Nakashima K, Rothwell JC, Day BJ, Thompson PD, Shannon K, Marsden CD. Reciprocal inhibition between forearm muscles in patients with writer's cramp and other occupational cramps, symptomatic hemiparesis due to stroke. Brain. 1989;112:681–697
  67. Gordon NS. Focal dystonia, with special reference to writer's cramp. Int J Clin Pract. 2005;59:1088–1090
  68. Hallet M. Physiology of dystonia. Adv Neurol. 1998;78:11–18
  69. Cimatti Z, Schwartz D, Bouordain F, et al. Time-frequency analysis reveals decreased high-frequency oscillations in writer's cramp. Brain. 2007;130:198–205
  70. Tinazzi M, Fiorio M, Stanzani C, et al. Temporal discrimination of two passive movements in writer's cramp. Mov Disord. 2006;21:1131–1135
  71. Weise D, Schramm A, Stefan K, et al. The two sides of associative plasticity in writer's cramp. Brain. 2006;129:2709–2721
  72. Altenmuller E. Focal dystonia: advances in brain imaging and understanding of fine motor control in musicians. J Hand Clin. 2003;19:523–538xi
  73. Candia V, Elbert T, Altenmuller E, et al. Constraint-induced movement therapy for focal hand dystonia in musicians. Lancet. 1999;353:42
  74. Candia V, Wienbruch C, Elbert T, Rockstroh B, Ray W. Effective behavioral treatment of focal hand dystonia in musicians alters somatosensory cortical organization. Proc Natl Acad Sci U S A. 2003;100:7942–7946
  75. Candia V, Rossset-Llobet J, Elbert T. Changing the brain through therapy for musicians' hand dystonia. Ann N Y Acad Sci. 2005;335–342
  76. Watson A. What can studying musicians tell us about motor control of the hand?. J Anat. 2006;208:527–542
  77. Elbert T, Pantev C, Wienbruch C, Rockstroh B, Taub E. Increased cortical representation of the fingers of the left hand in string players. Science. 1995;270:305–312
  78. Pascual-Leone A. The brain that plays music is changed by it. Ann N Y Acad Sci. 2001;930:315–329
  79. Nordstrom MA, Butler SL. Reduced intracortical inhibition and facilitation of corticospinal neurons in musicians. Exp Brain Res. 2002;144:336–342
  80. Bonnard M, Galléa C, De Graaf JB, Pailhous J. Corticospinal control of the thumb-index grip depends on precision of force control: a transcranial magnetic stimulation and functional magnetic resonance imagery study in humans. Eur J Neurosci. 2007;25:872–880
  81. Rosenkranz K, Williamon A, Butler K, Cordivari C, Lees AJ, Rothwell JC. Pathophysiological differences between musician's dystonia and writer's cramp. Brain. 2005;128:918–931
  82. Rosenkranz K, Butler K, Williamon A, Cordivari C, Lees AJ, Rothwell JC. Sensorimotor reorganization by proprioceptive training in musician's dystonia and writer's cramp. Neurology. 2008;70:215–304
  83. Tsui J, Bhatt M, Calne S, Calne D. Botulinum toxin in the treatment of writer's cramp: a double-blind study. Neurology. 1993;43:183–185
  84. Behari M. Botulinum toxin in the treatment of writer's cramp. J Assoc Physicians India. 1999;47:694–698
  85. Chen R, Karp B, Goldstein S, Bara-Jinenez W, Yaseen Z, Hallett M. Effect of muscle activity immediately after botulinum toxin injection for writer's cramp. Mov Disord. 1999;14:307–312
  86. Schuele S, Lederman RJ. Long-term outcome of focal dystonia in string instrumentalists. Mov Disord. 2004;19:43–48
  87. Schuele S, Jabusch H-C, Lederman RJ, Altenmuller E. Botulinum toxin injections in the treatment of musician's dystonia. Neurology. 2005;64:341–343
  88. Kruisdijk JJ, Koelman JHTM, Ongerboer de Visser BW, de Haan RJ, Speelman JD. Botulinum toxin for writer's cramp: a randomized, placebo-controlled trial and 1-year follow-up. J Neurol Neurosurg Psychiatry. 2007;78:264–270
  89. Priori A, Pesenti A, Cappellari A, Scarlato G, Barbieri S. Limb immobilization for the treatment of focal occupational dystonia. Neurology. 2001;57:405–409
  90. Espay AJ, Hung SW, Sanger TD, Moro E, Fox SH, Lang AE. A writing device improves writing in primary writing tremor. Neurology. 2005;64:1648–1650
  91. Zeuner KE, Bara-Jimenez W, Noguchi PS, et al. Sensory training for patients with focal hand dystonia. Ann Neurol. 2002;51:593–598
  92. Zeuner K, Shill HA, Sohn YH, et al. Motor training as treatment in focal hand dystonia. Mov Disord. 2005;20:335–341
  93. Fung S, Byl N, Melnick M, et al. Functional outcomes: the development of a new instrument to monitor the effectiveness of physical therapy. Eur J Phys Med Rehabil. 1997;7(2):31–41
  94. Ayres A. Sensory Integration and Praxis Test (SIPT) Manual. Los Angeles, CA: Western Psychological Association; 1989;
  95. Bohannon RW. Stopwatch for measuring thumb-movement time. Percept Mot Skills. 1995;81:211–216
  96. Byl N. Focal hand dystonia may result from aberrant neuroplasticity. Adv Neurol. 2004;4:19–28
  97. Zuener KE, Mollow FM. Abnormal reorganization in focal hand dystonia—sensory and motor training programs to retrain cortical function. NeuroRehabilitation. 2008;23:43–53
  98. Elbert T, Rockstrich B. Reorganization of human cerebral cortex: the range of changes following use and injury. Neuroscientist. 2004;10:129–141
  99. Homberg V. Biomechanical abnormalities in musicians with occupational cramp/focal dystonia. J Hand Ther. 1993;6(4):298–307
  100. Leijnse JN. Anatomical factors predisposing to focal dystonia in the musician's hand—principles, theoretical examples, clinical significance. J Biomech. 1997;30:659–669
  101. Nowak DA, Rosenkranz K, Topka H, Rothwell J. Disturbances of grip force behaviour in focal hand dystonia: evidence for a generalized impairment of sensory-motor integration?. J Neurol Neurosurg Psychiatry. 2005;76:953–959
  102. Prodoehl J, MacKinnon CD, Comella C, Corcos D. Strength deficits in primary focal hand dystonia. Mov Disord. 2006;21:18–27

PII: S0894-1130(09)00002-7

doi: 10.1016/j.jht.2008.12.006

Journal of Hand Therapy
Volume 22, Issue 2 , Pages 172-182 , April 2009

Article Tools

* Image Usage & Resolution