Diagnosis and management of focal hand dystonia in a rheumatology practice.

PURPOSE OF REVIEW: This article reviews current evidence on etiology, diagnosis and clinical management of patients with a challenging movement disorder referred to as focal hand dystonia (FHd).

RECENT FINDINGS: Patients who present to a rhematologist with a history of repetitive overuse, weakness, pain and involuntary, end-range posturing of the digits when performing a target task may have FHd. The etiology is considered idiopathic and multifactorial. There are no specific laboratory or clinical tests to 'rule in' or 'rule out' the diagnosis. Comparative neuroimaging studies report inadequate inhibition and aberrant sensory and motor processing in patients with FHd. This movement disorder can be recalcitrant to recovery. Current research evidence supports the benefit of quieting muscle contractions with botulinum toxin injections, modifying ergonomics, performance biomechanics, lifestyle, stress, health, personality and practice behaviors and simultaneously beginning a progressive brain-retraining program.

SUMMARY: Rheumatologist can facilitate effective management of patients with FHd by making an early, accurate diagnosis, providing patient education about the etiology and risk factors associated with the disorder, managing medications and identifying a team to oversee learning-based sensory and motor retraining.