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to the clinic with a year long history of having difficulty holding and using a writing instrument. He reports that he develops right hand and forearm spasms when writing, so that he cannot "bend his wrist the right way". He has been healthy all his life and is on no medications. He denies any dizziness or loss of consciousness or any history suggestive of a seizure. Which of the following is the most likely diagnosis?
A. Benign essential tremor
B. Carpal tunnel syndrome
C. Cervical radiculopathy
D. Focal dystonia
E. Parkinson Disease
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focal dystonia treat with anticholinergics
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The correct answer is
D. Such a writing cramp would be an example of focal dystonia of unknown cause. In this condition, the patient develops cramps with altered hand and arm posture when attempting a specific task such as writing. The other conditions may cause problems with writing as well but are usually not seen in isolation.
Benign essential tremor (choice A) features a distal upper extremity tremor during a task.
Carpal tunnel syndrome (choice B) is caused by median nerve compression and leads to hand weakness, which may affect writing.
Cervical radiculopathy (choice C) can lead to hand numbness and hyporeflexia.
Parkinson disease (choice E) presents with micrographia, bradykinesia, and often, a slow, "pill-rolling" tremor.
