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Tremor Other Hyperkinet Mov (N Y). 2018 Dec 3;8:607. doi: 10.7916/D8B00NRV. eCollection 2018.

"Spooning": A Subtle Sign of Limb Dystonia.

Kim CY1,2, Louis ED1,2,3.

Author information

Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.
Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.



The diagnosis of dystonia can be clinically challenging due to its heterogeneous presentation; essential tremor (ET) is a more common neurological disorder, but may be mimicked by other movement disorders, including dystonia, leading to misdiagnosis.

Phenomenology Shown:

In three patients with hand tremor, two with prior diagnoses of ET, we present examples of "spooning" of the hands, characterized by wrist flexion and metacarpophalangeal hyperextension.

Educational value:

Subtle dystonic features such as "spooning" may be present during the evaluation of patients with tremor and aid in the diagnosis of dystonia.


Dystonia; essential tremor

Conflict of interest statement

Funding: None. Conflicts of Interest: The authors report no conflict of interest. Ethics Statement: All patients that appear on video have provided written informed consent; authorization for the videotaping and for publication of the videotape was provided.

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