Writer's cramp—or, properly speaking, occupation neurosis— is a complaint to which writers, telegraphists, knitters, painters, pianists, violinists, watchmakers, and others who continually use the muscles of the forearm and the small muscles of the hand in one way, are liable. Cases differ very much. There is not always actual cramp : there may be trembling, rigidity, paresis. In some cases when writing the thumb gives way, and the hand suddenly pronates without pain or spasm. The index-finger may be the only one affected. In other cases the palm contracts and the hand takes on permanently the position used in writing or whatever the occupation is. In all cases there is wasting of muscle ; sometimes there is neuritis, when the pain and tenderness are very great.

The whole limb is massed, from finger-tips to above the shoulder, also the side of the neck and the upper part of the spine. The finger-joints, thenar and hypothenar eminences, and the incerossei are well manipulated and the palm stretched.

All movements described in Chapter VI. are given to the wrist, elbow, shoulder, forearm, and arm. The muscles most wasted are given special care.

Exercises.—As it is a fatigue disease, the exercises are at first passive. Flexion and extension of each finger-joint ; abduction of fingers, drawing each one as far as possible from its neighbour ; all movements of wrist, elbow, and shoulder-joints. Abduction and circumduction of the arm, with fingers extended, are useful, being the reverse of the positions assumed in writing or whatever occupation has caused the trouble. Resistance is given to abduction of the fingers by the operator's thumb and middle finger being placed on the patient's thumb and little finger, or an elastic band may be placed over the fingers, against which the patient abducts them. The strength. of the band is increased as the fingers get stronger. Rest is essential, and it is the thing most difficult to get, the affected limb being the means of livelihood. It is imperative that the arm should have rest while being massed. It must be placed in such a position and so supported that there will be no dragging from the shoulder-joint and no discomfort. Inexperienced workers are apt to forget the comfort and support of a cushion.