“Spooning”: A subtle sign of limb dystonia

Background: 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.