This protocol applies to patients presenting with writer's cramp or upper limb dystonia — focal or segmental forms of dystonia characterised by involuntary muscle contractions affecting the hand or arm during voluntary tasks.
Writer's cramp is the most common task-specific variant, impairing fine motor control during writing. Upper limb dystonia encompasses related presentations involving the forearm or arm more broadly. Both represent distinct management considerations within the focal dystonia spectrum.
First-line management for writer's cramp and upper limb dystonia involves targeted intervention at the affected muscles. The approach includes an established neurotoxin-based injection therapy and, as an alternative, a non-invasive peripheral nerve stimulation technique applied to the forearm.