Cramp
410401
225704503
2008-07-15T00:12:15Z
64.81.18.202
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{{two other uses|muscular pain|the band|the Cramps|the tool|Clamp (tool)}}
{{Infobox_Disease
| Name = Cramp
| Image =
| Caption =
| DiseasesDB = 3151
| ICD10 = {{ICD10|R|25|2|r|25}}
| ICD9 = {{ICD9|729.82}}
| ICDO =
| OMIM =
| MedlinePlus = 003193
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D009120
}}
'''Cramps''', sometimes called [[Charley horse]]s, are unpleasant, often painful, sensations caused by contraction or over shortening of [[muscle]]s. Cramps can be caused by cold, overexertion or low [[calcium]] level in blood (especially for adolescents where they need calcium for both blood and bone maturing). Illness or poisoning can also cause cramps, particularly in the [[stomach]], which is referred to as [[colic]] if it fits particular characteristics. '''See also''' [[Delayed onset muscle soreness]].
==Causes==
{{Refimprove|date=October 2007}}
There are six basic causes of cramping: [[hyperflexion]]; inadequate [[oxygenation]]; exposure to large changes in temperature; dehydration; low blood [[salt]]; or low blood [[calcium]]. Muscle cramps may also be a symptom/complication of pregnancy, kidney disease, thyroid disease, [[hypokalemia]] or [[hypocalcemia]] (as conditions), [[restless legs syndrome]], [[varicose veins]]<ref> Bergin J. The Vein Book, Hardcover text, Editor Bergin J , 2007.</ref>, and [[multiple sclerosis]].<ref name="test2">[http://www.webmd.com/hw-popup/Muscle-cramps Muscle Cramps at WebMD]</ref>
[[Electrolyte]] disturbance may cause cramping and [[tetany (medical sign)|tetany]] of muscles, particularly [[hypokalaemia]] (a low level of [[potassium]]) and [[hypocalcaemia]] (a low level of [[calcium in biology|calcium]]). This disturbance arises as the body loses large amounts of [[interstitial fluid]] through sweat. This interstitial fluid is composed mostly of water and table salt (NaCl). The loss of osmotically active particles outside muscle cells(NaCl) 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 and the calcium ions remain bound to the [[troponin]] and the [[muscle contraction]] is continued. This may occur when the [[lactic acid]] is high in the cells.
===Iatrogenic causes===
[[Statin]]s are known to cause [[myalgia]] and cramps among other side effects. Additional factors increasing probability for this adverse side effects are physical exercise, age, female gender, history of cramps and [[hypothyroidism]]. Up to 80% of athletes using statins suffer significant muscular adverse effects including cramps <ref>{{cite journal |author=Sinzinger H, O'Grady J |title=Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems |journal=Br J Clin Pharmacol |volume=57 |issue=4 |pages=525–8 |year=2004 |pmid=15025753 |doi=10.1111/j.1365-2125.2003.02044.x}}</ref>, the rate appears to be approximately 10-25% in typical population using statins <ref>{{cite journal |author=Bruckert E, Hayem G, Dejager S, Yau C, Bégaud B |title=Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients--the PRIMO study |journal=Cardiovasc Drugs Ther |volume=19 |issue=6 |pages=403–14 |year=2005 |pmid=16453090 |doi=10.1007/s10557-005-5686-z}}</ref><ref>{{cite journal |author=Dirks AJ, Jones KM |title=Statin-induced apoptosis and skeletal myopathy |journal=Am. J. Physiol., Cell Physiol. |volume=291 |issue=6 |pages=C1208–12 |year=2006 |pmid=16885396 |doi=10.1152/ajpcell.00226.2006}}</ref>. In some cases these adverse effects will disappear after switching to a different statin, however they should not be ignored if they persist as they can rarely develop into a more serious problem. Coenzyme Q10 supplementation can be helpful to avoid some statin related adverse effects but currently there is not enough evidence to prove effectiveness in avoiding myopathy or myalgia <ref>{{cite journal |author=Lamperti C, Naini AB, Lucchini V, ''et al'' |title=Muscle coenzyme Q10 level in statin-related myopathy |journal=Arch. Neurol. |volume=62 |issue=11 |pages=1709–12 |year=2005 |pmid=16286544 |doi=10.1001/archneur.62.11.1709}}</ref>.
==Treatment==
Muscle cramps can be treated by applying a soft massage on the cramped muscle,stretching your hands up above you and breathing in deeply through the mouth, stretching the muscle and applying heat or cold. Heat improves superficial blood circulation and makes muscles more flexible, so some people find that heat is more soothing for muscle cramps. Application of excessive heat or cold to sore muscles may bring on cramps. Pounding on a cramped muscle can increase soreness.
*In the case of inadequate oxygenation, excess lactic acid, produced by [[anaerobic respiration]], builds up and stresses the muscle. In addition to the methods described above, cramps from poor oxygenation can be improved by rapid deep breathing.
*Cramps from lack of water and/or salt can be treated by drinking water and/or increasing salt intake, respectively.
There is no scientific evidence to support the widely held claim by the sports nutrition industry that intake of specially composed electrolyte drinks has any advantage over intake of plain table salt (via drink or food) and water to counter these electrolyte disturbances and muscle cramps in people with a well-functioning renal system.
Eating foods high in [[potassium]] can help prevent muscle cramps.<ref name="test1">[http://extension.osu.edu/~news/story.php?id=2470 Ohio State University Extension: News] Chow Line: Potassium-rich foods deter muscle cramps</ref> Foods with high sources of potassium include, in order from highest to lowest: [[avocado]]s, [[potato]]es, [[banana]]s, [[broccoli]], [[orange juice]], [[soybeans]] and [[apricot]]s, although it is also common in most [[fruit]]s, [[vegetable]]s and [[meat]]s.
{{Expand-section|date=June 2008}}
Leg cramps may also be due to vitamin D deficiency (also needed for calcium absorption). Due to change in diet, shunning milk because of high cholesterol content, or, in children, preference for soft drinks, and decreased sun exposure, vitamin D deficiency is widespread. Correcting this deficiency will in many cases also eliminate, or reduce, frequency of leg cramps.
In the case of cramps caused by varicose veins, treatment of the affected veins with sclerotherapy, endovenous laser or surgery usually provides relief.
[[Quinine]] has been prescribed for the treatment of leg cramps. However, because of the drug's risks, the United States [[FDA]] has declared it should not be used to prevent or treat leg cramps.<ref>{{cite web | author=United States Food and Drug Administration | date=2006 December 11 | title=FDA Orders Unapproved Quinine Drugs from the Market and Cautions Consumers About Off-Label Use of Quinine to Treat Leg Cramps | url=http://www.fda.gov/bbs/topics/NEWS/2006/NEW01521.html | accessdate=2008-02-15}}</ref>
==Specific types of cramps==
===Smooth muscle cramps===
[[Smooth muscle]] contractions lie at the heart of the cramping (or [[colic]]ky) pain of internal organs. These include the [[intestine]], [[uterus]], ureter (in [[kidney stone]] pain), and various others.
====Menstrual cramps====
{{Main|Dysmenorrhea}}
[[Menstrual cycle|Menstruation]] is also highly likely to cause cramps of varying severity in the [[abdomen]] that may radiate to the lower back and thighs. Menstrual cramps can be treated with [[ibuprofen]], [[paracetamol|acetaminophen]] or [[paracetamol]], stretching exercises, or the application of heat through such means as warm baths or heating pads. Menstrual cramps that do not respond to self-treatment can be a symptom of [[endometriosis]] or other health problems.
===Skeletal muscle cramps===
[[Skeletal muscle]]s are muscles that can be voluntarily controlled. Of the skeletal muscles, those which cramp the most often are the [[Calf muscle|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 [[Calf muscle|calves]], [[soles]] of the [[Foot|feet]], or other muscles in the body during the night or (less commonly) while resting. The duration of nocturnal leg cramps is highly variable with cramps sometimes only lasting a few seconds and other times several minutes. Soreness in the muscles may remain for some time after the cramp ends. These cramps are more common in older people but may happen to anyone. They can happen quite frequently in teenagers and in some people while they are exercising at night. Nocturnal leg cramps can be very painful, especially if the person is dehydrated.
The precise cause of these cramps is unclear. Potential contributing factors are believed to include [[dehydration]], low levels of certain minerals ([[magnesium]], [[potassium]], [[calcium]], and [[sodium]]), and the reduced blood flow through the muscles attendant in prolonged sitting or lying down. Less common causes include more serious conditions or the use of drugs.
Nocturnal leg cramps may be relieved by stretching the affected leg straight out and pointing the toes upward. People report that quickly standing up and walking a few steps may also shorten the duration of a cramp.
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. Although unproved, a commonly accepted treatment is a starchy foodstuff before bedtime such as porridge or rice.
====Self-induced cramp====
Self-induced cramp is brought on purposefully by individuals for the purpose of stretching muscle in a position where standing or greater movement is difficult or impossible. For instance, certain workers or craftsmen may find inducing cramp in the lower legs enables them to stretch desirable muscle groups without the need to physically stand in tight spaces.
==See also==
*[[Trigger points]]
*[[Side Stitch]]
==References==
{{reflist}}
==External links==
* [http://www.disabled-world.com/artman/publish/what-are-cramps.shtml What are Cramps?]
* [http://www.patient.co.uk/showdoc/40000075 Cramps at Patient UK]
* [http://www.digitalnaturopath.com/cond/C466089.html Leg cramps at night]
* [http://www.rxinsider.com/monographs/leg_cramps.htm About leg cramps]
* [http://www.nolegcramps.com/2008/06/11/leg-cramps-what-causes-them-and-what-to-do-about-it/ What causes leg cramps and what to do about it]
* [http://www.wellsphere.com/wellmix360/Muscle-cramps Muscle Cramps overview]
* [http://www.medicinenet.com/muscle_cramps/article.htm Muscle Cramps (Of Skeletal Muscles)]
[[Category:Medical signs]]
[[Category:Muscular system]]
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