Muscle Cramps

Excerpt

Muscle cramps, presenting as involuntary and localized contraction of a muscle or entire muscle group, are quite painful and can be debilitating. Although they are often idiopathic, certain factors such as dehydration, electrolyte imbalances, some medications, and overexertion can predispose patients to developing this painful condition. Cramps typically last from seconds to a few minutes, and the affected muscle may be visibly distorted, twitching, and feel hard to the touch or like a knot. Muscle cramps are primarily caused by dysregulated signals from the nervous system, causing an involuntary and sustained muscle contraction, rather than a muscular origin. Risk factors for developing lower extremity cramps are repetitive lower extremity stress, medications, peripheral vascular disease, fluid depletion, sleep disorders, pregnancy, metabolic disorders, radiculopathy, and some neurologic disorders.

Although most muscle cramps are benign and idiopathic, clinicians must obtain a detailed history and perform a thorough physical examination to rule out any alternative causes of the patient's symptoms. Laboratory tests, imaging, polysomnography, and nerve conduction studies are typically unnecessary unless findings on the history or physical examination suggest an underlying diagnosis.

Muscle cramps may cause disrupted sleep and overall poor quality of life. Acute treatment focuses on forceful stretching of the affected muscle, whereas daily stretching serves as the cornerstone of preventive management. Additionally, patients should stay well hydrated, limit alcohol and caffeine, and avoid exercise in extreme heat or on hard surfaces such as concrete floors. Patients prone to electrolyte shifts, such as those on dialysis and athletes who experience exercise-associated muscle cramps, should ensure they replenish their electrolytes appropriately. Patients who fail conservative measures can consider pharmacologic interventions such as calcium channel blockers, gabapentin, and baclofen. Although quinine is effective in the treatment of muscle cramps, its use is no longer recommended due to the risk of severe adverse effects. The overall prognosis for muscle cramps is favorable, with most patients finding relief using conservative measures.