While narrating an incident of a 45-year-old hairdresser, Srinu, Dr Sudhir Kumar, Neurologist, Apollo Hospitals, Hyderabad, stated that the barber's fingers and arm twisted painfully, particularly when he held scissors for hair cutting. Srinu is an expert in his work and popular among his clients, which is evident from the fact that people wait for hours to get a haircut from him. After observing symptoms, Dr Kumar stated that the barber had haircutting dystonia, which is task-specific dystonia characterised by excessive muscle contractions that produce abnormal postures during motor activities involving highly-skilled and repetitive movements. Srinu was given oral medications and subsequently received a botox injection, after which he returned to work normally.
About The Incident
Everything was fine until six months back, when he began to experience unusual spasms in his fingers while cutting hair. According to Dr Kumar, his index and ring fingers would hyperextend as soon as he held the scissors with his right hand, causing them to painfully spasm.
A barber whose fingers & arm painfully twisted while holding scissors for hair cutting— Dr Sudhir Kumar MD DM🇮🇳 (@hyderabaddoctor) February 13, 2023
1. 45-year old Srinu started cutting hair in his teens after learning the trick from his father. He was experienced & popular among his clients. People waited for hours to get haircut by him.
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He changed the scissors used for haircutting on four or five occasions, but that did not make any difference in his symptoms. Over time, abnormal spasms of the fingers worsened, and a month later, the arm also started going into painful spasms while cutting hair, reported Dr Kumar.
Dr Kumar added that he had no difficulty using his hand for other activities. He could neatly write, draw nicely, and lift heavy weights with his affected hand. On this, Srinu's wife suspected that he was bored with his job (as he had been doing it for 30 years). So, she suggested a change of job.
Writing further, Dr Kumar said that Srinu vehemently denied that, and as per him, he was as passionate about his haircutting job as he was three decades ago. Thereafter, he consulted a local physician who found no neurological abnormality on examination and labelled it as a psychological disease. But Srinu was not convinced by the diagnosis.
Instead of consulting a psychiatrist, he decided to consult a neurologist. Dr Kumar stated that one thing was obvious. Srinu’s hands were normal at other times, and symptoms occurred only when he held scissors for haircutting.
6. Instead on consulting a psychiatrist, he decided to consult a neurologist. I listened to the entire history and one thing that was obvious- symptoms occurred "only" while holding scissors for hair cutting and he was normal at all other times.— Dr Sudhir Kumar MD DM🇮🇳 (@hyderabaddoctor) February 13, 2023
Now, the diagnosis was obvious.
On observing this, Dr Kumar asked Srinu to hold the scissors and mimic his job at the salon to demonstrate the symptoms. The doctor observed hyper-extension of the index and ring fingers on the right side with abnormal posturing, along with the extension of the arm that made him look clumsy and slower.
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After observing Srinu's symptoms, Dr Kumar stated that no tests were needed. He says, "The diagnosis was haircutting dystonia, a task-specific dystonia." This is characterised when excessive muscle contractions produce abnormal postures during particular motor activities involving highly-skilled and repetitive movements.
8. No tests were needed.— Dr Sudhir Kumar MD DM🇮🇳 (@hyderabaddoctor) February 13, 2023
The diagnosis was: Hair cutting dystonia, a type of task-specific dystonia (these are characterized by excessive muscle contractions producing abnormal postures during selective motor activities that often involve highly skilled, repetitive movements).
Srinu was given oral medications and subsequently received a botox injection, which gave excellent relief from symptoms. "He was able to enjoy his haircutting work as before, and the smile on his face returned," wrote Dr Kumar.
The message from Dr Kumar was that focal dystonia may be indicated by aberrant hand (or leg or other muscle) contractions or spasms that only happen when executing precise or skilled tasks. Many of them can give outstanding results if they are identified and treated.