Writer's Cramp

WRITER'S CRAMP (syn.: graphospasm, mography), a typical form of occupational neurosis, i.e., motor disorders that appear exclusively during the specific complex of movements required for writing, while the same muscle groups can properly perform any work requiring a different coordinative setup. - Symptoms. In the developed stage, W.C. is expressed by spasms of muscle groups in the hand that appear during the act of writing; the spasms can be both tonic and clonic (tic-like); initial symptoms include a feeling of awkwardness, pain, paresthesia, as well as tremor phenomena. Depending on the predominance of one or another of the indicated symptoms, it is customary to divide the clinical picture of W.C. into spastic, paretic, tremor, and neuralgic forms. In the initial stages, W.C. impairs handwriting, disfiguring letters with additional strokes, and later, when spastic spasms appear, makes the writing process altogether impossible. - Etiology and pathogenesis. Most often, W.C. develops directly as a result of excessive occupational load with insufficient rest for the working muscle groups. Contributing conditions that favor the development of W.C. include both incorrect hand positions during writing and the irrational design of writing instruments (too thin a pen, too sharp or stiff a nib, a hard pencil, etc.). A constitutional factor may also have certain significance. A number of questions very important for the study of the etiology of W.C. are extremely poorly illuminated, since the still young science - the statistics of occupational diseases - does not have material nosologically detailed by the department of nervous diseases. It is still impossible to form a clear, indisputable concept of the significance of racial, hereditary, sexual, and age factors; in these areas, one has to rely only on foreign literature, which also has limited material. According to American authors, no special racial predisposition to W.C. diseases is observed; there are cases of familial W.C. with hereditary neuropathic predisposition; these authors state that among patients with W.C., there are usually twice as many men as women. As for age, Gowers, using his observations and data from other authors, in only 151 cases, obtained the following statistical summary: in the age group from 10 to 20 years, 2 cases of W.C. were recorded; from 20 to 30 years - 52 cases; from 30 to 40 years - 50 cases; from 40 to 50 years - 32 cases; from 50 to 60 years - 12 cases; and over 60 years - 5 cases. These data are unconvincing both due to the small number of observations in general and due to the uneven distribution across age groups. - The transition to typing has undoubtedly reduced the cases of W.C., but at the same time has created a new type of occupational neurosis - the spasm of typists; occupational statistics is required to illuminate the results of this reform, taking into account the possibility of diagnostic errors with respect to the semiotically similar to W.C. disease - myositis (see), which is very common among typists. As for the question of the pathogenesis of W.C., a considerable literature has accumulated, but among researchers in this respect, unanimity has not been achieved. At present, with the expansion of clinical observations on occupational neuroses in general, the main theories of their pathogenesis are undergoing careful analysis. - Diagnosis. The main sign - the occurrence of a painful syndrome exclusively during the act of writing - significantly facilitates the recognition of W.C. In clinical analysis, it is necessary to consider myopathies, neuritis, as well as various diseases of the central nervous system, in the symptom complexes of which there are coordination disorders and hyperkineses (e.g., post-encephalitic parkinsonism). - The prognosis is generally unfavorable: restoration of full working capacity after W.C. is doubtful; therefore, it is rational to raise the question of changing professions already at the beginning of treatment. - Treatment must be carried out with the patient exempt from work. General strengthening treatment and the use of local physical therapy procedures, chosen according to the data of an objective examination of the neuromuscular apparatus of the patient's hand, can give a positive effect in the early stages of the disease. It is necessary to carefully analyze the position of the patient's hand during writing and eliminate the noted irregularities; special adaptations for holding writing instruments can provide substantial help: a very thick pen held with extended fingers, rings attached to the pen into which the fingers are inserted, and finally a special prosthesis (Nussbaum's bracelet) worn on the last four fingers. - Prevention. As with other occupational neuroses, preventive measures should be at the center of attention of health care and labor protection agencies; the organizational aspect of this matter should provide for a properly organized medical and professional selection upon employment through examination in psychotechnical laboratories, as is already practiced with respect to a number of professions (streetcar conductors, locomotive engineers, drivers, etc.). Proper teaching of writing is a matter of the school, of pedagogical and medical observation, firmly united at the present time by the principles of scientific pedagogy! In the future, systematic observation of the work regime and the state of health is necessary in order to detect the very earliest symptoms of the disease, observation of timely reduction of load, introduction of regular breaks in work, etc.

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A. Surtsov.