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 3rd and 4th flexed, while the 2nd and 5th 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.
Bibliographical Record
Luis Eduardo Borges de Macedo Zubko, Renata Cristine Alves, Francisco Manoel Branco
Germiniani, Hélio Afonso Ghizoni Teive. Rockstar hands: a complex pattern of hand
dystonia in Wilson's disease. Arq Neuropsiquiatr 2024; 82: s00441790573.
DOI: 10.1055/s-0044-1790573
