How Do I Evaluate and Inject for Writer's Cramp?

Writer's cramp is a disabling focal dystonia, often accompanied by tremor, for which botulinum toxin injections are now the therapy of choice. However, the success of this treatment relies on the correct clinical selection of muscles responsible for the dystonic movements and the subsequent accurate administration of botulinum toxin into what are often very small and difficult to palpate muscles. In order to obtain the best possible outcomes, and to minimize side effects, it is necessary to use guidance from ultrasound or electromyography (EMG). In this video, we will explain how we evaluate patients with writer's cramp and demonstrate how we treat them with EMG guidance.