Cramp - Wikipedia

A cramp is a sudden, involuntary muscle contraction or overshortening; while generally temporary and non-damaging, they can cause significant pain and a ... Cramp FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Pathological,oftenpainful,involuntarymusclecontraction Forotheruses,seeCramp(disambiguation). NottobeconfusedwithSeizuresorSpasm. MedicalconditionCrampCrampsarecommoninathleteswhentheydonotwarmup.Symptomssuddenmusclepainandaparalysis-likeimmobilityTreatmentquinine,Stretching,massage,anddrinkingliquids Acrampisasudden,involuntarymusclecontractionorovershortening;whilegenerallytemporaryandnon-damaging,theycancausesignificantpainandaparalysis-likeimmobilityoftheaffectedmuscle.Musclecrampsarecommonandareoftenassociatedwithpregnancy,physicalexerciseoroverexertion,age(commoninolderadults),ormaybeasignofamotorneurondisorder.[1]Crampsmayoccurinaskeletalmuscleorsmoothmuscle.Skeletalmusclecrampsmaybecausedbymusclefatigueoralackofelectrolytessuchassodium(aconditioncalledhyponatremia),potassium(calledhypokalemia),ormagnesium(calledhypomagnesemia[2]).Someskeletalmusclecrampsdonothaveaknowncause.[1]Crampsofsmoothmusclemaybeduetomenstruationorgastroenteritis.Motorneurondisorders(e.g.,amyotrophiclateralsclerosis),metabolicdisorders(e.g.,liverfailure),somemedications(e.g.,diureticsandinhaledbeta‐agonists),andhaemodialysismayalsocausemusclecramps.[1] Acrampusuallystartssuddenlyanditalsousuallygoesawayonitsownoveraperiodofseveralseconds,minutes,orhours.Restlesslegsyndromeandrestcrampsarenotconsideredthesameasmusclecramps.[1] Contents 1Pathophysiology 2Differentialdiagnosis 2.1Skeletalmusclecramps 2.1.1Nocturnallegcramps 2.2Smoothmusclecramps 2.3Crampscausedbytreatments 3Treatment 3.1Medication 4Prevention 5References 6Externallinks Pathophysiology[edit] Thissectiondoesnotciteanysources.Pleasehelpimprovethissectionbyaddingcitationstoreliablesources.Unsourcedmaterialmaybechallengedandremoved.(July2019)(Learnhowandwhentoremovethistemplatemessage) Skeletalmuscle,withmyofibrilslabeledatupperrightandsarcoplasmicreticulumatbottom Mainarticle:Musclecontraction Musclecontractionbeginswiththebrainsettingoffactionpotentials,whicharewavesintheelectricalchargesthatextendalongneurons.Thewavestraveltoagroupofcellsinamuscle,lettingcalciumionsoutfromthecells'sarcoplasmicreticula(SR),whicharestorageareasforcalcium.Thereleasedcalciumletsmyofibrilscontractunderthepowerofenergy-carryingadenosinetriphosphate(ATP)molecules.Meanwhile,thecalciumisquicklypumpedbackintotheSRbyfastcalciumpumps.Eachmusclecellcontractsfully;strongercontractionofthewholemusclerequiresmoreactionpotentialsonmoregroupsofcellsinthemuscle.Whentheactionpotentialsstop,thecalciumstopsflowingfromtheSRandthemusclerelaxes.Thefastcalciumpumpsarepoweredbythesodium-potassiumgradient.Thesodium-potassiumgradientismaintainedbythesodium-potassiumpumpandtheirassociatedionchannels.Alackofpotassiumorsodiumwouldpreventthesodium-potassiumgradientfrombeingstrongenoughtopowerthecalciumpumps;thecalciumionswouldremaininthemyofibrils,forcingthemuscletostaycontractedandcausingacramp.Thecrampeventuallyeasesasslowcalciumpumps,poweredbyATPinsteadofthesodiumgradient,pushthecalciumbackintostorage.[citationneeded] Crampscanoccurwhenmusclesareunabletorelaxproperlyduetomyosinproteinsnotfullydetachingfromactinfilaments.Inskeletalmuscle,ATPlevelsmustbelargeenoughtobindtothemyosinheadsforthemtoattachordetachfromtheactinandallowcontractionorrelaxation;theabsenceofenoughlevelsofATPmeansthatthemyosinheadsremainsattachedtoactin.Themusclemustbeallowedtorecover(resynthesizeATP),beforethemyosinproteinscandetachandallowthemuscletorelax.Skeletalmusclesworkasantagonisticpairs.Contractingoneskeletalmusclerequirestherelaxationoftheopposingmuscleinthepair.[relevant?] Differentialdiagnosis[edit] Causesofcrampinginclude[3]hyperflexion,hypoxia,exposuretolargechangesintemperature,dehydration,orlowbloodsalt.Musclecrampscanalsobeasymptomorcomplicationofpregnancy;kidneydisease;thyroiddisease;hypokalemia,hypomagnesemia,orhypocalcaemia(asconditions);restlesslegssyndrome;varicoseveins;[4]andmultiplesclerosis.[5] Asearlyas1965,researchersobservedthatlegcrampsandrestlesslegssyndromecanresultfromexcessinsulin,sometimescalledhyperinsulinemia.[6] Skeletalmusclecramps[edit] Seealso:Exercise-associatedmusclecramps Undernormalcircumstances,skeletalmusclescanbevoluntarilycontrolled.Skeletalmusclesthatcrampthemostoftenarethecalves,thighs,andarchesofthefoot,andaresometimescalleda"Charleyhorse"ora"corky".Suchcrampingisassociatedwithstrenuousphysicalactivityandcanbeintenselypainful;however,theycanevenoccurwhileinactiveandrelaxed.Around40%ofpeoplewhoexperienceskeletalcrampsarelikelytoendureextrememusclepain,andmaybeunabletousetheentirelimbthatcontainsthe"locked-up"musclegroup.Itmaytakeuptoaweekforthemuscletoreturntoapain-freestate,dependingontheperson'sfitnesslevel,age,andseveralotherfactors.[citationneeded] Nocturnallegcramps[edit] Seealso:Charleyhorse Nocturnallegcrampsareinvoluntarymusclecontractionsthatoccurinthecalves,solesofthefeet,orothermusclesinthebodyduringthenightor(lesscommonly)whileresting.Thedurationofnocturnallegcrampsisvariable,withcrampslastinganywherefromafewsecondstoseveralminutes.Musclesorenessmayremainafterthecrampitselfends.Thesecrampsaremorecommoninolderpeople.[7]Theyhappenquitefrequentlyinteenagersandinsomepeoplewhileexercisingatnight.Besidesbeingpainful,anocturnallegcrampcancausemuchdistressandanxiety.[8]Theprecisecauseofthesecrampsisunclear.Potentialcontributingfactorsincludedehydration,lowlevelsofcertainminerals(magnesium,potassium,calcium,andsodium,althoughtheevidencehasbeenmixed),[9][10][11]andreducedbloodflowthroughmusclesattendantinprolongedsittingorlyingdown.Nocturnallegcramps(almostexclusivelycalfcramps)areconsidered"normal"duringthelatestagesofpregnancy.[12]Theycan,however,varyinintensityfrommildtoextremelypainful.[citationneeded] Alacticacidbuilduparoundmusclescantriggercramps;however,theyhappenduringanaerobicrespirationwhenapersonisexercisingorengaginginanactivitywheretheheartbeatrises.Medicalconditionsassociatedwithlegcrampsarecardiovasculardisease,hemodialysis,cirrhosis,pregnancy,andlumbarcanalstenosis.Differentialdiagnosesincluderestlesslegssyndrome,claudication,myositis,andperipheralneuropathy.Allofthemcanbedifferentiatedthroughcarefulhistoryandphysicalexamination.[11] Gentlestretchingandmassage,puttingsomepressureontheaffectedlegbywalkingorstanding,ortakingawarmbathorshowermayhelptoendthecramp.[13]Ifthecrampisinthecalfmuscle,dorsiflexingthefootwillstretchthemuscleandprovidealmostimmediaterelief.Thereislimitedevidencesupportingtheuseofmagnesium,calciumchannelblockers,carisoprodol,andvitaminB12.[11] Quinineisnolongerrecommendedfortreatmentofnocturnallegcrampsduetopotentialfatalhypersensitivityreactionsandthrombocytopenia.Arrhythmias,cinchonism,andhemolyticuremicsyndromecanalsooccurathigherdosages.[11] Smoothmusclecramps[edit] Smoothmusclecontractionsmaybesymptomaticofendometriosisorotherhealthproblems.Menstrualcrampsmayalsooccurduringamenstrualcycle,asaresultofuterinecontractionsastheuterusshedsitslining.Menstrualpainiscommonandmostmenstruatingwomenexperienceitatsomepoint,withmorethan40%experiencingpaineveryperiod.Severepainislesscommon,butstillsignificant.[14] Crampscausedbytreatments[edit] Variousmedicationsmaycausenocturnallegcramps:[11][15] Diuretics,especiallypotassiumsparing Intravenous(IV)ironsucrose Conjugatedestrogens Teriparatide Naproxen Raloxifene Longactingadrenergicbeta-agonists(LABAs) Hydroxymethylglutaryl-coenzymeAreductaseinhibitors(HMG-CoAinhibitorsorstatins) Statinsmaysometimescausemyalgiaandcrampsamongotherpossiblesideeffects.Raloxifene(Evista)isamedicationassociatedwithahighincidenceoflegcramps.Additionalfactors,whichincreasetheprobabilityforthesesideeffects,arephysicalexercise,age,historyofcramps,andhypothyroidism.Upto80%ofathletesusingstatinssuffersignificantadversemusculareffects,includingcramps;[16]therateappearstobeapproximately10–25%inatypicalstatin-usingpopulation.[17][18]Insomecases,adverseeffectsdisappearafterswitchingtoadifferentstatin;however,theyshouldnotbeignorediftheypersist,astheycan,inrarecases,developintomoreseriousproblems.CoenzymeQ10supplementationcanbehelpfultoavoidsomestatin-relatedadverseeffects,butcurrentlythereisnotenoughevidencetoprovetheeffectivenessinavoidingmyopathyormyalgia.[19] Treatment[edit] Stretching,massage,anddrinkingplentyofliquidsmaybehelpfulintreatingsimplemusclecramps.[20] Medication[edit] Theantimalarialdrugquinineisatraditionaltreatmentthatmaybeslightlyeffectiveforreducingthenumberofcramps,theintensityofcramps,andthenumberofdaysapersonexperiencescramps.Quininehasnotbeenshowntoreducetheduration(length)ofamusclecramp.[1]Quininetreatmentmayleadtohaematologicandcardiactoxicity.Duetoitsloweffectivenessandnegativesideeffects,itsuseasamedicationfortreatingmusclecrampsisnotrecommendedbytheFDA.[21] Magnesiumiscommonlyusedtotreatmusclecramps.Moderatequalityevidenceindicatesthatmagnesiumisnoteffectivefortreatingorpreventingcrampsinolderadults.[1]Itisnotknownifmagnesiumhelpscrampsduetopregnancy,livercirrhosis,othermedicalconditions,orexercising.[1]Oralmagnesiumtreatmentdoesnotappeartohavesignificantmajorsideeffects,however,itmaybeassociatedwithdiarrheaandnauseain11-37%ofpeoplewhousethismedicine.[1] Withexertionalheatcrampsduetoelectrolyteabnormalities(primarilypotassiumlossandnotcalcium,magnesium,andsodium),appropriatefluidsandsufficientpotassiumimprovessymptoms.[22]VitaminBcomplex,naftidrofuryl,lidocaine,andcalciumchannelblockersmaybeeffectiveformusclecramps.[21] Prevention[edit] Adequateconditioning,stretching,mentalpreparation,hydration,andelectrolytebalancearelikelyhelpfulinpreventingmusclecramps.[20] References[edit] ^abcdefghGarrison,ScottR.;Korownyk,ChristinaS.;Kolber,MichaelR.;Allan,G.Michael;Musini,VijayaM.;Sekhon,RavneetK.;Dugré,Nicolas(September2020)."Magnesiumforskeletalmusclecramps".TheCochraneDatabaseofSystematicReviews.2020(9):CD009402.doi:10.1002/14651858.CD009402.pub3.ISSN 1469-493X.PMC 8094171.PMID 32956536. ^Gragossian,Alin;Bashir,Khalid;Friede,Rotem(September6,2020)."Hypomagnesemia".NationalCenterforBiotechnologyInformation(NCBI).PMID 29763179.RetrievedOctober14,2020.Hypomagnesemiaisanelectrolytedisturbancecausedwhenthereisalowlevelofserummagnesium[...]intheblood ^MuscleCrampsSymptoms,Causes,Treatment–DoallmusclecrampsfitintotheabovecategoriesonMedicineNetArchived2008-08-24attheWaybackMachine.Medicinenet.com.Retrievedon2011-02-13. ^BerginJ.TheVeinBook,Hardcovertext,EditorBerginJ,2007. ^MuscleCrampsatWebMDArchived2007-10-15attheWaybackMachine ^Roberts,HJ(1965)."SpontaneousLegCrampsand"restlessLegs"DuetoDiabetogenicHyperinsulinism:Observationson131Patients".JournaloftheAmericanGeriatricsSociety.13(7):602–38.doi:10.1111/j.1532-5415.1965.tb00617.x.PMID 14300967.S2CID 28096190. ^Nightlegcramps-MayoClinicArchived2011-09-23attheWaybackMachine ^Weiner,IsraelH(1980)."NocturnalLegMuscleCramps".JAMA.244(20):2332–3.doi:10.1001/jama.1980.03310200066033.PMID 7431559.Archivedfromtheoriginalon28December2010.Retrieved26October2011. ^SchwellnusMP,NicolJ,LaubscherR,NoakesTD(2004)."Serumelectrolyteconcentrationsandhydrationstatusarenotassociatedwithexerciseassociatedmusclecramping(EAMC)indistancerunners".BrJSportsMed.38(4):488–492.doi:10.1136/bjsm.2003.007021.PMC 1724901.PMID 15273192. ^SulzerNU,SchwellnusMP,NoakesTD(July2005)."SerumelectrolytesinIronmantriathleteswithexercise-associatedmusclecramping".MedSciSportsExerc.37(7):1081–5.doi:10.1249/01.mss.0000169723.79558.cf.PMID 16015122. ^abcdeAllenRE,KirbyKA(2012)."NocturnalLegCramps".AmericanFamilyPhysician.86(4):350–355.PMID 22963024.Archivedfromtheoriginalon2016-03-29. ^WickM."Whatcauseslegcrampsduringpregnancy,andcantheybeprevented?".MayoClinic.Retrieved2018-04-03. ^Ray,C.Claiborne(2009-06-09)."Q&A–ACharleyHorseinBed".NewYorkTimes.Archivedfromtheoriginalon2013-04-07.Retrieved2009-06-09. ^Grandi,Giovanni;Ferrari,Serena;Xholli,Anjeza;Cannoletta,Marianna;Palma,Federica;Romani,Cecilia;Volpe,Annibale;Cagnacci,Angelo(2012-06-20)."Prevalenceofmenstrualpaininyoungwomen:whatisdysmenorrhea?".JournalofPainResearch.5:169–174.doi:10.2147/JPR.S30602.ISSN 1178-7090.PMC 3392715.PMID 22792003. ^GarrisonSR,DormuthCR,MorrowRL,CarneyGA,KhanKM(January2012)."Nocturnallegcrampsandprescriptionusethatprecedesthem:asequencesymmetryanalysis".Arch.Intern.Med.172(2):120–6.doi:10.1001/archinternmed.2011.1029.PMID 22157068. ^ SinzingerH,O'GradyJ(2004)."Professionalathletessufferingfromfamilialhypercholesterolaemiararelytoleratestatintreatmentbecauseofmuscularproblems".BrJClinPharmacol.57(4):525–8.doi:10.1111/j.1365-2125.2003.02044.x.PMC 1884475.PMID 15025753. ^ BruckertE,HayemG,DejagerS,YauC,BégaudB(2005)."Mildtomoderatemuscularsymptomswithhigh-dosagestatintherapyinhyperlipidemicpatients—thePRIMOstudy".CardiovascDrugsTher.19(6):403–14.doi:10.1007/s10557-005-5686-z.PMID 16453090.S2CID 24525127. ^ Dirks,A.J.;Jones,KM(2006)."Statin-inducedapoptosisandskeletalmyopathy".Am.J.Physiol.,CellPhysiol.291(6):C1208–12.doi:10.1152/ajpcell.00226.2006.PMID 16885396.S2CID 13313618. ^LampertiC,NainiAB,LucchiniV,et al.(2005)."MusclecoenzymeQ10levelinstatin-relatedmyopathy".Arch.Neurol.62(11):1709–12.doi:10.1001/archneur.62.11.1709.PMID 16286544. ^abBentleyS(June1996)."Exercise-inducedmusclecramp.Proposedmechanismsandmanagement".SportsMed.21(6):409–20.doi:10.2165/00007256-199621060-00003.PMID 8784961.S2CID 24366112. ^abKatzbergHD,KhanAH,SoYT(2010)."Assessment:Symptomatictreatmentformusclecramps(anevidence-basedreview):ReportoftheTherapeuticsandTechnologyAssessmentSubcommitteeoftheAmericanAcademyofNeurology".Neurology.74(8):691–6.doi:10.1212/WNL.0b013e3181d0ccca.PMID 20177124. ^BergeronMF(March2003)."Heatcramps:fluidandelectrolytechallengesduringtennisintheheat".JSciMedSport.6(1):19–27.doi:10.1016/S1440-2440(03)80005-1.PMID 12801207. Externallinks[edit] ClassificationDICD-10:R25.2ICD-9-CM:729.82MeSH:D009120DiseasesDB:3151ExternalresourcesMedlinePlus:003193PatientUK:Cramp MuscleCramps(ofSkeletalMuscles) vteSymptomsandconditionsrelatingtomusclePain Myalgia Fibromyalgia Acute Delayedonset Inflammation Myositis Pyomyositis Destruction Muscleweakness Rhabdomyolysis Muscleatrophy/Amyotrophy Other Myositisossificans Fibrodysplasiaossificansprogressiva Compartmentsyndrome Anterior Diastasisofmuscle Diastasisrecti Musclespasm vteSignsandsymptomsrelatingtomovementandgaitGait Gaitabnormality CNS Scissorgait Cerebellarataxia Festinatinggait Marcheàpetitpas Propulsivegait Stompinggait Spasticgait Magneticgait Truncalataxia Muscular Myopathicgait Trendelenburggait Pigeongait Steppagegait Antalgicgait Coordination Ataxia Cerebellarataxia Dysmetria Dysdiadochokinesia Pronatordrift Dyssynergia Sensoryataxia Asterixis Abnormalmovement Athetosis Tremor Fasciculation Fibrillation Posturing Abnormalposturing Opisthotonus Spasm Trismus Cramp Tetany Myokymia Jointlocking Paralysis Flaccidparalysis Spasticparaplegia Spasticdiplegia Spasticparaplegia Syndromes Monoplegia Diplegia/Paraplegia Hemiplegia Triplegia Tetraplegia/Quadruplegia Generalcauses Uppermotorneuronlesion Lowermotorneuronlesion Weakness Hemiparesis Other Rachiticrosary Hyperreflexia Clasp-kniferesponse Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Cramp&oldid=1070817137" Categories:MusculardisordersSymptomsandsigns:musculoskeletalsystemHiddencategories:WebarchivetemplatewaybacklinksArticleswithshortdescriptionShortdescriptionmatchesWikidataShortdescriptionisdifferentfromWikidataArticlesneedingadditionalreferencesfromJuly2019AllarticlesneedingadditionalreferencesAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromJune2017Allarticlesthatmayhaveoff-topicsectionsWikipediaarticlesthatmayhaveoff-topicsectionsfromOctober2018ArticleswithunsourcedstatementsfromAugust2021 Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English expanded collapsed Views ReadEditViewhistory More expanded collapsed Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Inotherprojects WikimediaCommons Languages AfrikaansالعربيةAzərbaycancaCatalàCymraegDanskDeutschEestiEmiliànerumagnòlEspañolفارسیFrançaisGaeilge한국어IdoBahasaIndonesiaItalianoMagyarМакедонскиမြန်မာဘာသာNorskbokmålଓଡ଼ିଆPortuguêsРусскийСрпски/srpskiSrpskohrvatski/српскохрватскиSuomiSvenskaไทยTürkçeУкраїнськаTiếngViệt粵語中文 Editlinks