Focal shoulder-elevation dystonia

We describe 13 cases of isolated focal dystonia of the shoulder with dystonic elevation but without clinically obvious cervical dystonia. All had significant trapezius muscle hypertrophy and limitation of shoulder movement causing substantial morbidity. In nine, this developed in the immediate aftermath of shoulder region trauma, most often a motor vehicle accident; clinically significant head trauma was not a factor. In two other cases this developed in the context of chronic heavy labor (suggesting possible overuse) and in one other it developed concurrent with the symptoms of discogenic cervical (C6-7) radiculopathy. In the one remaining case, no precipitating factors were identified. Preexisting risk factors for dystonia, such as dopamine antagonist drug use, family history of dystonia, or prior brain injury, were not identified in these patients. Administration of medications used to treat dystonia was unsuccessful but botulinum toxin therapy was beneficial in all six treated cases.