Rockstar hands: a complex pattern of hand dystonia in Wilson's disease

A 27-year-old man presented with subacute generalized dystonia, low ceruloplasmin levels, and increased copper urinary excretion which were consistent with the diagnosis of Wilson's disease (WD). Following initial treatment, the dystonia improved significantly, but hand involvement persisted ([Figure 1]). Dystonia affecting the hands may present in various forms. Complex patterns previously reported include starfish hand,[1] claw hand,[2] and task-specific dystonias, comprising musician's dystonia, writer's cramp, and hairdresser's dystonia,[3] among others.[4] Dystonia in young patients warrants prompt investigation to rule out reversible conditions including WD.[5] Accurate recognition of the muscles involved in dystonia is important for optimal treatment with botulinum toxin.

Figure 1 Rockstar hand refers to a specific dystonic posture in a patient diagnosed with Wilson disease. The posture of the hands resembles the finger and hand positions commonly seen in guitar players playing rock songs with major barre chords. The fingers exhibit a distinctive pattern, with the left 3^rd and 4^th flexed, while the 2^nd and 5^th digit are extended. This pattern suggests coactivation of the flexor digitorum superficialis, flexor digitorum profundus, flexor carpi ulnaris, flexor carpi radialis, extensor digitorum communis, and extensor digiti minimi.

Conflict of Interest

The authors have no conflict of interest to declare.

Editor-in-chief

Ayrton Roberto Massaro.

Associate Editor

José Luiz Pedroso.

Authors' Contributions

LEBMZ: investigation, conceptualization, data curation, methodology, and writing – editing and review; RCA, FMBG: conceptualization, investigation, supervision, validation, visualization, writing – original draft, and writing – review & editing; HAGT: conceptualization, investigation, supervision, validation, visualization, and writing – review & editing.

• References

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• 2 Deguchi K, Takata T, Kobara H, Masaki T. Claw Hand as a Manifestation of Fixed Dystonia. Intern Med 2021; 60 (17) 2875 Doi: 10.2169%2Finternalmedicine.6592-20
• 3 Giorelli M, Zimatore GB. Hairdresser's Dystonia: An Unusual Occupational Dystonia. Tremor Other Hyperkinet Mov (N Y) 2013;3:tre-03-204-4640-2. Doi: 10.7916%2FD87S7MGH
• 4 Pandey S. A practical approach to management of focal hand dystonia. Ann Indian Acad Neurol 2015; 18 (02) 146-153 Doi: 10.4103%2F0972-2327.156563
• 5 Dusek P, Litwin T, Czlonkowska A. Wilson disease and other neurodegenerations with metal accumulations. Neurol Clin 2015; 33 (01) 175-204 DOI: 10.1016/j.ncl.2014.09.006.

Publication History

Received: 02 May 2024

Accepted: 21 July 2024

Article published online:
02 October 2024