A Focal Dystonia
"The chief disturbance is usually from spasm. . . the pen does not move quite as (the patient) intended it to do. . . a slight involuntary movement causes an unintended mark. . . (the subject) finds he is clasping the pen too tightly, and cannot help doing so. . . the first finger (the index finger) has a tendency to slip off the pen. . . now and then there is a distinct spasm, which cannot be controlled. . . there is a tendency for the wrist to become flexed, or extended or supinated."
|Robert Shumann (1810-1856), an early Romantic
composer, demonstrated great ability as a pianist. Originally
planning to become a concert pianist, those plans were destroyed by the
end of 1832, due to a mysterious hand disorder. Personal
statements from Shumann indicated numbness, convulsive twitching, and
pulling of the fingers towards the back of the hand. Doctors of
the day were puzzled by his symptoms. Shumann began using a
different position of his hand to play the piano, with the wrist
elevated. He also began using a Cigarrenmechanik, or
cigar-mechanism, a commonly used finger stretcher. Under the
advice of his doctor, treatments eventually come to include the Tierbader,
or animal baths, a procedure in which Shumann would place his hand in
the abdominal cavity of a freshly slaughtered pig or other animal until
it was cold. He also used electrotherapy or galvanic stimulation,
as well as medicinal powders and dietary restrictions. None of
these treatments provided significant relief of his symptoms.
What was the source of Robert Shumann's disability? Although there can be no definitive answers, it is possible that Shumann suffered from what is commonly known as writer's cramp, a form of focal dystonia. Also called scrivener's palsy, this little-known disorder is characterized by abnormal movements and posturing of the hand and fingers, particularly when a task necessitating fine motor control is involved. Patients with writer's cramp often have difficulty with writing, sometimes extending to other tasks such as playing an instrument or handling eating utensils. Most patients do not report pain as a specific symptom, although pain may occur as a result of abnormal posturing of the hand and arm. Of those who are afflicted with writer's cramp, many have occupations or hobbies which require a large amount of fine motor control, such as writing or playing an instrument. Writer's cramp was once thought to be due to stress, unhappiness, or dissatisfaction. Although the exact pathophysiology of this disease is not well understood, it is now clear that patients with writer's cramp show abnormalities of the thalamus, basal ganglia, motor cortex, and somatosensory cortex. As these areas are all tightly interconnected, disruptions in any part of the circuitry has widespread effects within this system.