I. Cramp or Spasm (Spastic Form).—The first form of this disease to be considered is that in which cramp or spasm is present. This is one of the most frequent symptoms, and when present usually attracts the most attention. In most of the articles written upon these affections great importance has been given to this symptom, which, however, may be absent during the whole history of the case, but when it does appear it usually indicates an advanced stage. The term writers' cramp is an evidence of the widespread opinion of the importance of this symptom.
The cases that present themselves to the physician have usually been affected for some time, and where cramp is present an earlier examination would probably have resulted in the discovery of premonitory signs before the appearance of the spasm or cramp; and in fact it may be stated that this symptom is always preceded, or at least accompanied, by one or two more. The muscular contraction may be so slight as to amount to a mere occasional awkwardness, in writers' cramp an abnormal grasp of the pen-holder being all that is noticed; or it may be so severe as to cause a tonic contraction of the muscles affected, which may continue for some time after the exciting cause has been removed, as in the cases reported by Poore30 and S. Weir Mitchell.31
30 Electricity in Medicine and Surgery, London, 1876, p. 209.
31 “Functional Spasm,” Amer. Journ. Med. Sciences, Oct., 1876, pp. 322, 323.
As might be supposed, these spasms affect most usually the upper extremities, although they may affect the lower, as is occasionally seen in workers on the lathe and in pedestrians. Other muscles than those necessary to perform the act that has become difficult may also be seized with spasm coinstantaneous with the spasm of the affected part; thus the left arm may be the seat of associated movements while the right is being used: these are, however, most frequently seen in the affected arm when the other is being used to relieve it; they may also be noticed in the legs, although much more rarely.
Gallard32 reports a case of a street-pavior who had associated spasm of both sterno-cleido-mastoid muscles, which came on only when using the instrument to settle the stones. Dally33 reports a case of a woman who had spasm of the left sterno-cleido-mastoid muscle at the time the right hand was seized with cramp in writing. More rarely all the muscles on one side of the body may be affected. Reynolds34 reports such a case.
32 “Crampe des Écrivains,” Progrès médical, v., 1877, p. 505.
33 “Traitement des Spasms professionnels,” Journ. de Thérapeutique, No. 3, 10 Fèvrier, 1882.
34 System of Medicine, “Writers' Cramp,” vol. ii. p. 287.
In the spastic form of the disease an early investigation usually shows a rigidity or spasm of one or more of the fingers, coming on when an attempt is made to perform the act which originated the trouble, and occasionally only on performing that act; but this statement, so strongly insisted upon by some authors as a diagnostic symptom, does not universally obtain.