Hand Conditions

Nerve / Tendon:
Carpal Tunnel Syndrome
Focal Dystonia Syndrome
Guyon's Canal Syndrome
Hypothenar Hammer Syndrome
Trigger Finger/Tenosynovitis

Bone / Joint:
Arthritis of the Hand
Arthritis of the Thumb (Basilar Joint)
Dupuytren's Disease
Navicular Avascular Necrosis (and Kienböck's disease)


Focal Dystonia Syndrome

Focal Dystonia is a musculotendinous overuse or repetitive use condition which is called "simple" if resultant of a single task, such as playing the piano or writing, and "dystonic" if it affects other activities requiring similar hand posture. The condition is believed to result from the improper functioning of the basal ganglia, which are deep brain structures involved in controlling movement. Sometimes the disorder progresses to include the elevation of shoulders or retraction of the arm while writing.

Also commonly referred to as "writer's cramp" or graphospasm, the exact cause of this improper functioning is unknown though thought to be the result of muscular overuse in posture-specific activities involving the hand. Symptoms include cramping or a slight aching in the fingers, wrist or forearm. Symptoms usually occur when performing the task that requires fine motor movements -initially only during specific tasks and eventually spreading to other tasks requiring similar hand positioning.

Unlike other over-use conditions prompting muscle cramps and pain, such as Carpal Tunnel Syndrome - a condition for which it is often mistaken, Focal Dystonia Syndrome is more likely to affect coordination and cause only mild discomfort.

Risk Factors
The condition affects both men and women between the ages of 30 and 50, who are involved in specific activities requiring the repetitive use of unique hand posture - such as musicians (pianists, violinists) writers, typists, and some athletes involved in such sports as golf.

Diagnosis and Treatment
A thorough physical examination, detailed patient history review and possibly a neurological examination will confirm Focal Dystonia Syndrome. An electromyogram (EMG) can also help determine which muscles are overactive and the degree of stress imposed.

Treatment options generally focus on alleviating the symptoms and consist of a period of rest and refrain from the activity that prompted the condition. In chronic cases, either oral medication, or botulinum toxin injections may be indicated. More severe cases may require surgery. Physical therapy and muscular retraining may also be beneficial, depending on the form and degree of severity of the condition.