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. Common causes of skeletal muscle cramps may include muscle fatigue, low sodium, low potassium, and/or low magnesium.[citation needed] Smooth muscle cramps may be due to menstruation or gastroenteritis.
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[edit] 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, hypomagnesemia 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 therefore shrinking 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.
As early as 1965, researchers observed that leg cramps and restless-leg syndrome result from excess insulin, sometimes called hyperinsulinemia.[4] Hypoglycemia and reactive hypoglycemia are associated with excess insulin (or insufficient glucagon), and avoidance of low blood glucose concentration may help to avoid cramps.
[edit] Smooth muscle cramps
Smooth muscle contractions may be symptomatic of endometriosis or other health problems. Menstrual cramps may also occur before and during a female menstrual cycle.
[edit] Skeletal muscle cramps
Skeletal muscles can be voluntarily controlled. Skeletal muscles that cramp the most often are the calves, thighs, and arches of the foot. Sometimes known as a Charley horse or corkie, this kind of cramp is associated with strenuous activity and can be intensely painful—though skeletal cramps can occur while relaxing. Around 40% of people who experience skeletal cramps are likely to endure extreme muscle pain, and may be unable to use the affected limb. It may take up to seven days for the muscle to return to a pain-free state. See also Exercise Associated Muscle Cramps.
[edit] 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. The duration of nocturnal leg cramps is variable with cramps lasting anywhere from a few seconds to several minutes. Muscle soreness may remain after the cramp itself ends. These cramps are more common in older people.[5] They happen quite frequently in teenagers and in some people while exercising at night. 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. Nocturnal leg cramps (almost exclusively calf cramps) are considered 'normal' during the late stages of pregnancy.[citation needed] They can, however, vary in intensity from mild to extremely painful.
Lactic acid can build up around the muscles which can trigger cramps; however, these happen during anaerobic respiration which happens when a person is exercising or engaging in an activity where the heart beat speeds up. Medical conditions associated with leg cramps are cardiovascular disease, cirrhosis, pregnancy, and lumbar canal stenosis.
Various medications may cause nocturnal leg cramps:[6]
- Diuretics, especially potassium sparing
- Long acting adrenergic beta-agonists (LABAs)
- Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins)
Besides being painful, a nocturnal leg cramp can cause much distress and anxiety.[7]
Gentle stretching and massage, putting some pressure on the affected leg by walking or standing, or taking a warm bath or shower may help to end the cramp.[8] If the cramp is in the calf muscle, pulling the big toe gently backwards will stretch the muscle and, in some cases, cause almost immediate relief.
[edit] Iatrogenic causes
Statins sometimes cause myalgia and cramps among other possible side effects. Raloxifene (Evista) is a medication associated with a high incidence of leg cramps. 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;[9] the rate appears to be approximately 10–25% in a typical statin-using population.[10][11] 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.[12]
[edit] 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, ATP must attach to the myosin heads for them to disassociate from the actin and allow relaxation — the absence of ATP in sufficient quantities means that the myosin heads remains attached to actin. An attempt to force a muscle cramped in this way to extend (by contracting the opposing muscle) can tear muscle tissue and worsen the pain. The muscle must be allowed to recover (resynthesize ATP), before the myosin fibres can detach and allow the muscle to relax.
[edit] Treatment
Stretching and drinking plenty of fluids, such as water or Gatorade, may be helpful in treating simple muscle cramps.[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.[14]
[edit] Medication
Quinine is likely to be effective. However, due to side effects its use should only be considered if other treatments have failed and in light of these concerns.[15] Vitamin B complex, naftidrofuryl, lidocaine, and calcium channel blockers may be effective for muscle cramps.[15] Research has also shown that pickle juice can be an effective remedy based on its high sodium and electrolyte content.[16]
[edit] Prevention
Adequate conditioning, stretching, mental preparation, and adequate fluid/electrolyte balance are likely helpful in preventing muscle cramps.[13]
[edit] References
- ^ Muscle Cramps Symptoms, Causes, Treatment – Do all muscle cramps fit into the above categories on MedicineNet. Medicinenet.com. Retrieved on 2011-02-13.
- ^ Bergin J. The Vein Book, Hardcover text, Editor Bergin J , 2007.
- ^ Muscle Cramps at WebMD
- ^ Roberts, HJ (1965). "Spontaneous Leg Cramps and "restless Legs" Due to Diabetogenic Hyperinsulinism: Observations on 131 Patients". Journal of the American Geriatrics Society 13: 602–38. PMID 14300967.
- ^ Night leg cramps - Mayo Clinic
- ^ Garrison, Scott R.; Colin R. Dormuth, Richard L. Morrow, Greg A. Carney, Karim M. Khan (2011-12-12). "Nocturnal Leg Cramps and Prescription Use That Precedes Them: A Sequence Symmetry Analysis". Arch Intern Med: archinternmed.2011.1029. doi:10.1001/archinternmed.2011.1029. Retrieved 2011-12-13.
- ^ Weiner, Israel H. "Nocturnal Leg Muscle Cramps". JAMA. Retrieved 26 October 2011.
- ^ Ray, C. Claiborne (2009-06-09). "Q & A – A Charley Horse in Bed". New York Times. Retrieved 2009-06-09.
- ^ 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. PMC 1884475. PMID 15025753.
- ^ 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.
- ^ Dirks, A. J.; Jones, KM (2006). "Statin-induced apoptosis and skeletal myopathy". Am. J. Physiol., Cell Physiol. 291 (6): C1208–12. doi:10.1152/ajpcell.00226.2006. PMID 16885396.
- ^ 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.
- ^ a b PMID 8784961
- ^ doi:10.1016/S1440-2440(03)80005-1
- ^ a b Katzberg HD, Khan AH, So YT (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.
- ^ Reynolds, Gretchen. "Phys Ed: Can Pickle Juice Stop Muscle Cramps?". Retrieved 9/11/2012.
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