Muscle Cramps
Original Editors - Habibu Salisu Badamasi
Top Contributors - Habibu Salisu Badamasi, Lucinda hampton, Ewa Jaraczewska and Matt Huey
Introduction
Muscle cramps cause continuous, involuntary, painful, and local contraction of an entire muscle group, a single muscle, or some muscle fibers. The palpation reveals a strong tension, which can involve the entire muscular district or a localized node. It has a sudden onset and is associated with an increase in frequency of motor action potentials. It can cause persistent muscle soreness and swelling with a variable rate of improvement, often terminated by stretching.[1] [2]
- The etiology is not well understood[3].
- Passive and/or active stretching of the affected muscle(s) is by far the most effective and safest non-pharmacology management for most acute idiopathic muscle cramps.[1]
Epidemiology
Epidemiological survey, shows that approximately 37% of the healthy population per year are affected by muscle cramps, forming the frequently reported complain to general practitioners and neurologists.[4]
Pathophysiology
The pathophysiology of muscle cramps depends on the patient's pathological condition and is not always clear eg .
- In healthy athletes there exists no direct relationship between the depletion of fluids and the alteration of electrolyte balance.
- Despite the depletion of electrolytes during treatment in patients with dialysis, there is no direct relationship between the presence of cramps and dialysis. Despite this, the phenomenon of cramps is very common in this population of patients.[1]
Risk Factors
Etiology
- Primary cramps:(Idiopathic) They are cramps that occur without any apparent cause, often nocturnal. Common in particular circumstances, at night or during pregnancy.
- Exercise-induced:( physiological) for example during or after strenuous exercise
- Secondary cramps: They occurs as a consequences of particular neurological or metabolic disorders.eg Multiple sclerosis; Haemodialysis; Cirrhosis; Metabolic or electrolyte disturbances; Other chronic diseases
Assessment
Most people presenting with cramps have idiopathic cramps, which are usually diagnosed following clinical exam. Further investigations are only required if the cramp has atypical features or other associated conditions are suspected.[1]
- Past medical history- Consider patient past medical that may increase suspicion of an organic cause.
- Blood test- serum or urine hCG, fasting serum metabolic panel, thyroid-stimulating hormone (TSH), HbA1c, serum liver function tests, prothrombin time (PT) and INR, serum myoglobin and urinalysis.
- Neurological examinations: may indicate nerve involvement with muscle wasting, weakness, fasciculations etc.
- other investigations: electromyogram, nerve conduction test, muscle biopsy, genetic studies etc.
Management
The easiest conservative treatment for healthy subjects and patients is performing stretching to the affected part, being the most effective and quickest management to counteract the involuntary contractions.
For the different pathologies also characterized by the appearance of cramps, there are no accepted guidelines as valid on the pharmacological approach in any pathological state.[3]
Prevention
Preventing nocturnal cramps by stretching in subjects with no neurological pathologies could decrease their onset, in people between 50 and 60, but the evidence is low.
Magnesium supplementation in healthy people, in neurological patients or in pregnant women, is not confirmed in the literature.[3]
References
- ↑ 1.0 1.1 1.2 1.3 BMJ best practice.Muscle Cramps. Available from: https://bestpractice.bmj.com/topics/en-gb/569 (accessed on 30July 2023).
- ↑ Katzberg HD. Case studies in management of muscle cramps. Neurologic clinics. 2020 Aug 1;38(3):679-96.
- ↑ 3.0 3.1 3.2 Bordoni B, Sugumar K, Varacallo M. Muscle CrampAvailable:https://www.ncbi.nlm.nih.gov/books/NBK499895/ (accessed 14.1.2025)
- ↑ Dijkstra JN, Boon E, Kruijt N, Brusse E, Ramdas S, Jungbluth H, van Engelen BG, Walters J, Voermans NC. Muscle cramps and contractures: causes and treatment. Practical Neurology. 2023 Feb 1;23(1):23-34.