What are the different types of hand contractions (muscle spasms or cramps), their causes, and treatments?

Hand Contractions: Types, Causes, and Management

Hand contractions refer to various types of muscle movements in the hand that can be normal physiological responses or pathological conditions, including muscle cramps, spasms, and contractures, each with distinct causes and treatments.

Types of Hand Contractions

Physical Counterpressure Maneuvers

• Hand gripping: Involves maximal squeezing of a rubber ball (approximately 5-6 cm in diameter) or similar soft object with the dominant hand for the maximum tolerated time until symptoms disappear 1
• Arm tensing: Achieved by gripping one hand with the other and simultaneously abducting (pulling away) the arms with maximum isometric contraction 1
• These maneuvers are primarily used to prevent syncope by increasing blood pressure when experiencing presyncope symptoms 1

Pathological Hand Contractions

Muscle Cramps

• Painful, sudden, involuntary muscle contractions that are generally self-limiting 2
• Often part of normal human physiology but can be associated with various acquired and inherited conditions 2, 3
• Characterized by co-contraction of agonist and antagonist muscles in the affected area 4

Contractures

• Defined as shortenings of the muscle resulting in an inability to relax normally 2
• Generally myogenic in origin (originating from the muscle tissue itself) 2
• After stroke with hemiparesis, 60% of patients develop joint contractures on the affected side within the first year, with wrist contractures being most common in patients without functional hand recovery 1

Focal Hand Dystonia (Occupational Hand Cramps)

• Includes specific types like writer's cramp, typist's cramp, and musician's cramps 4
• Characterized by excessive muscle activity and defective fine motor control 4
• Results from rapid, stereotypical repetitive fine motor movements that degrade sensory representation of the hand 5

Causes of Hand Contractions

Physiological Causes

• Normal response to prevent syncope during presyncope episodes 1
• Part of normal muscle function during certain activities 2

Pathological Causes

• Post-stroke spasticity: Leading to contractures, especially in patients who do not recover functional hand use 1
• Repetitive hand use: Leading to focal hand dystonia in occupations requiring fine motor skills 5, 4
• Neurological origin: Changes in motor neuron excitability (central origin) or spontaneous discharges of motor nerves (peripheral origin) 6

Management of Hand Contractions

For Contractures After Stroke

• Prevention strategies:

  • Daily stretching of hemiplegic limbs with proper techniques to avoid injury 1
  • Positioning of hemiplegic shoulder in maximum external rotation for 30 minutes daily 1
  • Standing on a tilt table for 30 minutes daily 1

• Treatment options:

  • Antispastic positioning, range of motion exercises, stretching, and splinting 1
  • Consider resting hand/wrist splints for patients lacking active hand movement 1
  • Serial casting or static adjustable splints may reduce mild to moderate elbow and wrist contractures 1

• Pharmacological management:

  • Consider tizanidine, dantrolene, or oral baclofen for spasticity causing pain or decreased function 1
  • Botulinum toxin injections for wrist and finger flexors may be beneficial 1
  • Avoid diazepam or other benzodiazepines during stroke recovery due to potential negative effects on recovery 1

For Focal Hand Dystonia

• Sensory discriminative retraining:

  • Heavy schedules of sensory training with and without biofeedback to restore sensory representation of the hand 5
  • Instructions in stress-free hand use, mirror imagery, mental rehearsal, and mental practice techniques 5

• Pharmacological management:

  • Cyclobenzaprine may be used as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions 7
  • Should be used only for short periods (up to 2-3 weeks) 7
  • Not effective for spasticity associated with cerebral or spinal cord disease 7

For Hand Gripping as a Counterpressure Maneuver

• Used to prevent syncope by increasing blood pressure during presyncope symptoms 1
• Technique: Maximal squeezing of a rubber ball or similar soft object with the dominant hand 1
• Should be maintained until symptoms disappear 1
• Not recommended when symptoms of heart attack or stroke accompany presyncope 1

Special Considerations

For Patients with Hepatic Impairment

• Cyclobenzaprine should be used with caution in patients with mild hepatic impairment 7
• Start with 5 mg dose and titrate slowly upward 7
• Not recommended for patients with moderate to severe hepatic impairment 7

For Patients with Hand Osteoarthritis

• Education about joint protection and ergonomic principles 1
• Consider splints and orthoses for thumb base involvement 1
• Local application of heat before exercise can provide symptomatic relief 1

Common Pitfalls and Caveats

• Misdiagnosing the type of hand contraction can lead to inappropriate treatment 2
• Overuse of medications like cyclobenzaprine beyond the recommended 2-3 weeks is not supported by evidence 7
• Failure to address underlying causes of contractures can lead to permanent disability 1
• Resting hand splints for post-stroke patients have conflicting evidence regarding effectiveness 1