Writer’s cramp (graphospasm):
Writer’s cramp is psychological disorder of occupational neurosis. Writer’s cramp is defined as occupational neurosis characterised by involuntary contraction of muscles of hand,when attempting to write,resulting in local pain,spasm of muscles concerned,and loss of control of movements.
Mechanism of Writer’s cramp
- Initially all fine movements in learning stage require conscious control to carry them out.
- Later on these becomes automatic,while performer’s thoughts are concentrated on other aspects of his work,activity needs no conscious attention.
- Occupational neurosis is disorder in which the person who has learned and mastered particular intricate activity,finds it difficult to carry out the same,even with conscious effort.
- The mechanism behind Writer’s cramp-occupational conflicts create subconscious state of frustration,anxiety,disinterest,displeasure. As a result,there is psychological resistance,brteakdown of smooth execution of stereotyped movements and ultimately faulty habits.
- Multifactorial-psychological and physical factors act in summation.
Occurs in those who,by their profession and temperament,must perform accurately repeated minute movements almost indefinitely eg: typists,manual writers,telegraphists,musicians,painters.
- Common in males compared to females.
- Common occurence in middle aged adults.
- Onset of Writer’s cramp is insidious.
- Writer’s cramp is first manifested when individual is expected to exceed certain level of performance.
After any psychological or physical event,the capacity of patient is reduced.
- Initially only one set of stereotyped movements of writing are affected. other activities like shaving,eating..etc remains normal.
- Early features of Writer’s cramp are discomfort and pain during writing and variable degree,sense of fatigue,muscle spasm,abnormal movements in effort to avoid pain and spasm.
- As the condition progresses movement of pen becomes difficult and irregular,efforts are made to write properly,by holding the pen firm,hands begins to ache and feels heavy and tired.
- With the passage of time symptoms becomes more in intensity and writing becomes more irregular,tip of pen is driven firmly into paper,which it penetrates.
- As the condition worsens,pain which was localised to small muscles of hand,involves the whole arm,cramps appear more and more readily when writing is started,cramp even by holding the pen,tremors may develop in hand,pen may suddenly fly from hand due to holding the pen firmer and firmer which results in slipping off of the pen out from the hand.
- Prognosis is good with change of occupation.
- Reassurance is the first step,followed by supportive therapy.
- Change of occupation is advisable to avoid the progression of the condition.
- Avoid all type of strained work which would harm one’s health,long hours and speeding up of work to be avoided,work in comfortable and healthy environment where the work load is less.
- Absolute rest from writing for atleast 6 months.
- Re-education with writing after break from work.