Cramp: Wikis

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For the heraldic device, see cramp (heraldry); for the band, see The Cramps

Cramp
ICD-10 R25.2
ICD-9 729.82
DiseasesDB 3151
MedlinePlus 003193
MeSH D009120

Cramps are unpleasant, often painful sensations caused by muscle contraction or overshortening. The common causes of skeletal muscle cramps are muscle fatigue and a sodium imbalance. Smooth muscle cramps may be due to menstruation or Gastroenteritis.

Contents

Differential diagnosis

Causes of cramping include[1] hyperflexion, hypoxia, exposure to large changes in temperature, dehydration, or low blood salt. Muscle cramps may also be a symptom or complication of pregnancy, kidney disease, thyroid disease, hypokalemia, or hypocalcemia (as conditions), restless-leg syndrome, varicose veins,[2] and multiple sclerosis.[3]

Electrolyte disturbance may cause cramping and muscle tetany, particularly hypokalaemia and hypocalcaemia. This disturbance arises as the body loses large amounts of interstitial fluid through sweat. This interstitial fluid comprises mostly water and table salt (sodium chloride). The loss of osmotically active particles outside of muscle cells leads to a disturbance of the osmotic balance and swelling of muscle cells, as these contain more osmotically active particles. This causes the calcium pump between the muscle lumen and sarcoplasmic reticulum to short circuit; the calcium ions remain bound to the troponin, continuing muscle contraction. This may occur when lactic acid is high in the cells.

As early as 1965, researchers observed that leg cramps and restless-leg syndrome result from excess insulin, sometimes called hyperinsulinemia.[4] Hypoglycemia & reactive hypoglycemia are associated with excess insulin [or insufficient glucagon], and avoidance of low blood glucose concentration may help to avoid cramps.

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Smooth muscle cramps

Smooth muscle contractions lie at the heart of the cramping (or colicky) pain of internal organs. These include the intestine, uterus, ureter (in kidney stone pain), and various others.

Menstrual cramps

Menstruation is also likely to cause abdominal cramps of varying severity that may radiate to the lower back and thighs. Menstrual cramps can be treated with ibuprofen, acetaminophen (paracetamol), stretching exercises, or the application of heat through means such as warm baths or heating pads. Menstrual cramps that do not respond to self treatment may be symptomatic of endometriosis or other health problems.

Skeletal muscle cramps

Skeletal muscles can be voluntarily controlled. Among skeletal muscles, those which cramp the most often are the calves, thighs, and arches of the foot. These cramps are seemingly associated with strenuous activity and can be intensely painful.

Nocturnal leg cramps

Nocturnal leg cramps are involuntary muscle contractions that occur in the calves, soles of the feet, or other muscles in the body during the night or (less commonly) while resting. Only a few fibers of a muscle may be activated.[5] The duration of nocturnal leg cramps is variable with cramps lasting anywhere from a few seconds to several minutes. Muscle soreness may remain endure after the cramp ends. These cramps are erroneously believed to be more common in older people. They happen quite frequently in teenagers and in some people while exercising at night. Usually, putting some pressure on the affected leg by walking some distance will end the cramp.[6]

The precise cause of these cramps is unclear. Potential contributing factors include dehydration, low levels of certain minerals (magnesium, potassium, calcium, and sodium), and reduced blood flow through muscles attendant in prolonged sitting or lying down. Less common causes include more serious conditions or drug use.

Nocturnal leg cramps may sometimes be relieved by stretching the affected leg and pointing the toes upward. Quickly standing up and walking a few steps may also shorten the duration of a cramp.[6]

Nocturnal leg cramps (almost exclusively calf cramps) are considered to be 'normal' during the late stages of pregnancy. They can, however, vary in intensity from mild to incredibly painful.

Iatrogenic causes

Statins cause myalgia and cramps among other possible side effects, including substantially lowering blood glucose concentration.[7] Additional factors, which increase the probability for these side effects, are physical exercise, age, female gender, history of cramps, and hypothyroidism. Up to 80% of athletes using statins suffer significant adverse muscular effects, including cramps;[8] the rate appears to be approximately 10-25% in a typical statin-using population.[9][10] In some cases, adverse effects disappear after switching to a different statin; however, they should not be ignored if they persist, as they can, in rare cases, develop into more serious problems. Coenzyme Q10 supplementation can be helpful to avoid some statin-related adverse effects, but currently there is not enough evidence to prove the effectiveness in avoiding myopathy or myalgia.[11]

Pathophysiology

Skeletal muscles work as antagonistic pairs. Contracting one skeletal muscle requires the relaxation of the opposing muscle in the pair. Cramps can occur when muscles are unable to relax properly due to myosin fibers not fully detaching from actin filaments. In skeletal muscle, both ATP (energy) and magnesium must attach to the myosin fibers in order for them to disassociate from the muscle and allow relaxation — the absence of either of these in sufficient quantities means that the myosin remains attached to actin.[12] An attempt to force a muscle cramped in this way to extend (by contracting the opposing muscle) can relax muscle tissue and relieve the pain. The muscle must then be allowed to recover (take in Mg and resynthesize ATP), before action is continued.

Treatment

Conservative

Muscle cramps due to fatigue can be treated by stretching and massage.[13] With exertional heat cramps due to electrolyte abnormalities (primarily sodium loss and not calcium, magnesium, and potassium ) appropriate fluids and sufficient salt improves symptoms.[13]

Medication

Vitamin B complex, naftidrofuryl, and calcium channel blockers may be effective for muscle cramps. Quinine is likely effective for this indication however due to side effects its use should only be considered if other treatments have failed and in light of these concerns.[14]

References

  1. ^ http://www.medicinenet.com/muscle_cramps/page2.htm#2whatare
  2. ^ Bergin J. The Vein Book, Hardcover text, Editor Bergin J , 2007.
  3. ^ Muscle Cramps at WebMD
  4. ^ http://www.ncbi.nlm.nih.gov/pubmed/14300967
  5. ^ http://www.medicinenet.com/muscle_cramps/article.htm
  6. ^ a b Ray, C. Claiborne (2009-06-09). "Q & A - A Charley Horse in Bed". New York Times. http://www.nytimes.com/2009/06/09/health/09qna.html. Retrieved 2009-06-09. 
  7. ^ [1]
  8. ^ Sinzinger H, O'Grady J (2004). "Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems". Br J Clin Pharmacol 57 (4): 525–8. doi:10.1111/j.1365-2125.2003.02044.x. PMID 15025753. 
  9. ^ Bruckert E, Hayem G, Dejager S, Yau C, Bégaud B (2005). "Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients--the PRIMO study". Cardiovasc Drugs Ther 19 (6): 403–14. doi:10.1007/s10557-005-5686-z. PMID 16453090. 
  10. ^ Dirks, A. J. (2006). "Statin-induced apoptosis and skeletal myopathy". Am. J. Physiol., Cell Physiol. 291 (6): C1208–12. doi:10.1152/ajpcell.00226.2006. PMID 16885396. 
  11. ^ Lamperti C, Naini AB, Lucchini V, et al. (2005). "Muscle coenzyme Q10 level in statin-related myopathy". Arch. Neurol. 62 (11): 1709–12. doi:10.1001/archneur.62.11.1709. PMID 16286544. 
  12. ^ [2]
  13. ^ a b "Muscle Cramps during Exercise-Is It Fatigue or Electrolyte Deficit?". http://journals.lww.com/acsm-csmr/Abstract/2008/07001/Muscle_Cramps_during_Exercise_Is_It_Fatigue_or.9.aspx. 
  14. ^ Katzberg HD, Khan AH, So YT (February 2010). "Assessment: Symptomatic treatment for muscle cramps (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology 74 (8): 691–6. doi:10.1212/WNL.0b013e3181d0ccca. PMID 20177124. 

External links


1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

CRAMP, a painful spasmodic contraction of muscles, most frequently occurring in the limbs, but also apt to affect certain internal organs. This disorder belongs to the class of diseases known as local spasms, of which other varieties exist in such affections as spasmodic asthma and colic. The cause of these painful seizures resides in the nervous system, and operates either directly from the great nerve centres, or, as is generally the case, indirectly by reflex action, as, for example, when attacks are brought on by some derangement of the digestive organs.

In its most common form, that of cramp in the limbs, this disorder comes on suddenly, often during sleep, the patient being aroused by an agonizing feeling of pain in the calf of the leg or back of the thigh, accompanied in many instances with a sensation of sickness or faintness from the intensity of the suffering. During the paroxysm the muscular fibres affected can often be felt gathered up into a hard knot. The attack in general lasts but a few seconds, and then suddenly departs, the spasmodic contraction of the muscles ceasing entirely, or, on the other hand, relief may come more gradually during a period of minutes or even hours. A liability to cramp is often associated with a rheumatic or gouty tendency, but occasional attacks are common enough apart from this, and are often induced by some peculiar posture which a limb has assumed during sleep. Exposure of the limbs to cold will also bring on cramp, and to this is probably to be ascribed its frequent occurrence in swimmers. Cramp of the extremities is also well known as one of the most distressing accompaniments of cholera. It is likewise of frequent occurrence in the process of parturition, just before delivery.

This painful disorder can be greatly relieved and often entirely removed by firmly grasping or briskly rubbing the affected part with the hand, or by anything which makes an impression on the nerves, such as warm applications. Even a sudden and vigorous movement of the limb will often succeed in terminating the attack.

What is termed cramp of the stomach, or gastralgia, usually occurs as a symptom in connexion with some form of gastric disorder, such as aggravated dyspepsia, or actual organic disease of the mucous membrane of the stomach.

The disease known as Writer's Cramp, or Scrivener's Palsy, is a spasm which affects certain muscles when engaged in the performance of acts, the result of education and long usage, and which does not occur when the same muscles are employed in acts of a different kind. This disorder owes its name to the relative frequency with which it is met in persons who write much, although it is by no means confined to them, but is liable to occur in individuals of almost any handicraft. It was termed by Dr Duchenne Functional Spasm. The symptoms are in the first instance a gradually increasing difficulty experienced in conducting the movements required for executing the work in hand. Taking, for example, the case of writers, there is a feeling that the pen cannot be moved with the same freedom as before, and the handwriting is more or less altered in consequence. At an early stage of the disease the difficulty may be to a large extent overcome by persevering efforts, but ultimately, when the attempt is persisted in, the muscles of the fingers, and occasionally also those of the forearm, are seized with spasm or cramp, so that the act of writing is rendered impossible. Sometimes the fingers, instead of being cramped, move in a disorderly manner and the pen cannot be grasped, while in other rare instances a kind of paralysis affects the muscles of the fingers, and they are powerless to make the movements necessary for holding the pen. It is to be noted that it is only in the act of writing that these phenomena present themselves, and that for all other movements the fingers and arms possess their natural power. The same symptoms are observed and the same remarks apply mutatis mutandis in the case of musicians, artists, compositors, seamstresses, tailors and many mechanics in whom this affection may occur. Indeed, although actually a rare disease, no muscle or group of muscles in the body which is specially called into action in any particular occupation is exempt from liability to this functional spasm.

The exact pathology of writer's cramp has not been worked out, but it is now generally accepted that the disease is not a local one of muscles or nerves, but that it is an affection of the central nervous system. The complaint never occurs under thirty years of age, and is more frequent in males than females. Occasionally there is an inherited tendency to the disease, but more usually there is a history of alcoholism in the parents, or some neuropathic heredity. In its treatment the first requisite is absolute cessation from the employment which caused it. Usually, however, complete rest of the arm is undesirable, and recovery takes place more speedily if other actions of a different kind are regularly practised. If a return to the same work is a necessity, then Sir W. R. Gowers insists on some modification of method in performing the act, as writing from the shoulder instead of the wrist.


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