Focal Hand Dystonia


What is FHD?

A movement disorder characterized by involuntary muscle contractions and postures affecting extensively trained movements.

e.g. musician’s dystonia, writer’s cramp

How does it present?

  • Typical age: 30-40
  • Men & women can be affected
  • Painless
  • Absence of other signs & symptoms
  • Little variation each day
  • No sensory deficit
  • Loss of motor co-ordination in specific tasks only

How is it treated?

  • Specific, individualised retraining programmes
  • Repetitive sequential finger exercises
  • Relearning correct motor patterns
  • Slow tempo of writing/playing
  • Often involves splinting one or more fingers
  • Participant specific exercises- 2 hours per day
  • Can play own pieces, very slowly, if no FHD triggered

General points

  • 1st session is often just education, making a plan, write to GP/uni/orchestra
  • Consider a work cover plan
  • Must stop doing aggravating activity- may be 1-3 years
  • General exercises are important, e.g. physical fitness
  • Wellness behaviours, e.g. love of instrument, positive reinforcement
  • Understanding of longevity of treatment, realistic expectations- may not be 100% recovery
  • Try playing another instrument?


  • Often unknown cause or trigger
  • Must initially stop playing/writing
  • Treatment is lengthy & tedious for individual
  • Treatment & exercise programmes are often trial & error
  • Slow tempo of playing, repetition of correct motor patterns
  • Earlier presentation much better outcome than late

For further information regarding FHD please call us today on 02 9907 0321 and ask to speak with Jane Leathwood our Hand Physiotherapy Specialist.

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