In February, 2010, a 50-year-old man was referred to our physiotherapy clinic with an extension movement of his right index finger and simultaneous contraction of the corresponding flexor muscles. He was a guitar player and had seen various medical specialists (rheumatologist, orthopaedic surgeon, neurologist, psychiatrist) and alternative healers. On presentation, he had an uncontrolled movement of the right index finger that interfered with the highly skilled coordination required for playing the guitar. The extension movement of his right index finger was prevented by a simultaneous co-contraction of the flexor muscles, and the strong contraction bent the finger into the palm. The other fingers and wrist had normal movement. Mirror dystonia of the affected finger was seen while he played with the opposite unaffected finger. The loss of control had been gradual, but within 4 months he could not play at all. Complete blood count, serum concentrations of electrolytes, glucose, calcium, magnesium, creatine phosphokinase, and caeruloplasmin, ESR, antinuclear antibody screen, and syphilis screen were normal, as were kidney, liver, and thyroid function. Examination of the index finger showed no anatomical limitations, triggering tendons, or ligament or joint damage. Our patient had CT and MRI of the brain, and transcranial magnetic stimulation to exclude a central nervous disease. No evidence of nerve compression or muscloskeletal conditions were found and all joints were normal and pain free.
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