Editing Cramp

{{Short description|Pathological, often painful, involuntary muscle contraction}}
{{Other uses}}
{{Distinguish|seizure|spasm}}
{{Infobox medical condition
| name            = Cramp
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| symptoms        = sudden muscle pain and a paralysis-like immobility
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| treatment       = quinine, stretching, massage, and drinking liquids
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A '''cramp''' is a sudden, involuntary, painful [[skeletal muscle|skeletal]] [[muscle contraction]]<ref name=":2">{{Cite journal |last1=Minetto |first1=Marco Alessandro |last2=Holobar |first2=Aleš |last3=Botter |first3=Alberto |last4=Farina |first4=Dario |date=Jan 2013 |title=Origin and development of muscle cramps |url=https://journals.lww.com/acsm-essr/fulltext/2013/01000/origin_and_development_of_muscle_cramps.3.aspx |journal=Exercise and Sport Sciences Reviews |volume=41 |issue=1 |pages=3–10 |doi=10.1097/JES.0b013e3182724817 |issn=1538-3008 |pmid=23038243|s2cid=15263712 |doi-access=free }}</ref><ref name=":3">{{Cite journal |last1=Marotta |first1=P. J. |last2=Graziadei |first2=I. W. |last3=Ghent |first3=C. N. |date=Nov 2000 |title=Muscle cramps: a 'complication' of cirrhosis |journal=Canadian Journal of Gastroenterology |volume=14 Suppl D |pages=21D–25D |doi=10.1155/2000/214916 |issn=0835-7900 |pmid=11110608 |doi-access=free}}</ref> or overshortening associated with electrical activity.<ref>{{Cite book |last1=Benzon |first1=Honorio |url=https://books.google.com/books?id=9UuAWD2FTFsC&pg=PA141 |title=Essentials of Pain Medicine E-book |last2=Raja |first2=Srinivasa N. |last3=Fishman |first3=Scott E. |last4=Liu |first4=Spencer S. |last5=Cohen |first5=Steven P. |date=2011-06-30 |publisher=Elsevier Health Sciences |isbn=978-1-4377-3593-2 |language=en}}</ref> While generally temporary and non-damaging, they can cause significant [[pain]] and a [[paralysis]]-like immobility of the affected muscle. A cramp usually goes away on its own over several seconds or (sometimes) minutes.<ref>{{Cite web |title=Muscle Cramps |url=https://medlineplus.gov/musclecramps.html |access-date=2022-09-15 |website=medlineplus.gov}}</ref> Cramps are common and tend to occur at rest, usually at night (nocturnal leg cramps).<ref name=":3" /><ref>{{Cite web |title=Nocturnal leg cramps |url=https://www.uptodate.com/contents/nocturnal-leg-cramps |access-date=2022-09-21 |website=UpToDate}}</ref> They are also often associated with [[pregnancy]], [[exercise-associated muscle cramps|physical exercise]] or overexertion, and age (common in older adults); in such cases, cramps are called [[idiopathic]] because there is no underlying pathology. In addition to those benign conditions cramps are also associated with many [[pathological]] conditions.<ref name=":3" /><ref name=":1">{{Cite journal|last1=Garrison|first1=Scott R.|last2=Korownyk|first2=Christina S.|last3=Kolber|first3=Michael R.|last4=Allan|first4=G. Michael|last5=Musini|first5=Vijaya M.|last6=Sekhon|first6=Ravneet K.|last7=Dugré|first7=Nicolas|date=September 2020|title=Magnesium for skeletal muscle cramps|journal=The Cochrane Database of Systematic Reviews|volume=2020|issue=9|pages=CD009402|doi=10.1002/14651858.CD009402.pub3|issn=1469-493X|pmid=32956536|pmc=8094171}}</ref>

Cramp definition is narrower than the definition of muscle [[spasm]]: spasms include any involuntary abnormal muscle contractions, while cramps are sustained and painful.<ref name=":2" /><ref>{{Cite web |title=Muscle Cramps (Charley Horse) and Muscle Spasm Remedies |url=https://www.emedicinehealth.com/slideshow_pictures_muscle_cramps_and_muscle_spasms/article_em.htm |access-date=2022-09-25 |website=eMedicineHealth |language=en}}</ref> True cramps can be distinguished from other cramp-like conditions. Cramps are different from [[muscle contracture]], which is also painful and involuntary, but which is electrically silent. The main distinguishing features of cramps from [[dystonia]] are suddenness with acute onset of pain, involvement of only one muscle, and spontaneous resolution of cramps or their resolution after stretching the affected muscle.<ref name=":3" /> [[Restless legs syndrome|Restless leg syndrome]] is not considered the same as muscle cramps and should not be confused with rest cramps.<ref name=":1" />

==Causes==
Skeletal muscle cramps may be caused by [[muscle fatigue]] or a lack of [[electrolyte]]s{{Citation needed|date=March 2023}} such as [[sodium]] (a condition called [[hyponatremia]]), [[potassium]] (called [[hypokalemia]]), or [[magnesium]] (called [[Magnesium deficiency|hypomagnesemia]]<ref>{{Cite journal|last1=Gragossian|first1=Alin|last2=Bashir|first2=Khalid|last3=Friede|first3=Rotem|date=September 6, 2020|title=Hypomagnesemia|url=https://www.ncbi.nlm.nih.gov/books/NBK500003/|access-date=October 14, 2020|website=National Center for Biotechnology Information (NCBI)|pmid=29763179|quote="Hypomagnesemia is an electrolyte disturbance caused when there is a low level of serum magnesium [...] in the blood"}}</ref>). Some skeletal muscle cramps do not have a known cause.<ref name=":1" /> Motor neuron disorders (e.g., [[amyotrophic lateral sclerosis]]), [[metabolic disorder]]s (e.g., [[liver failure]]), some medications (e.g., [[diuretic]]s and inhaled [[Beta-adrenergic agonist|beta‐agonists]]), and [[Hemodialysis|haemodialysis]] may also cause muscle cramps.<ref name=":1" />

Causes of cramping include<ref>[http://www.medicinenet.com/muscle_cramps/page2.htm#2whatare Muscle Cramps Symptoms, Causes, Treatment – Do all muscle cramps fit into the above categories on MedicineNet] {{webarchive|url=https://web.archive.org/web/20080824152442/http://www.medicinenet.com/muscle_cramps/page2.htm |date=2008-08-24 }}. Medicinenet.com. Retrieved on 2011-02-13.</ref> [[hyperflexion]], [[Hypoxia (medical)|hypoxia]], exposure to large changes in temperature, dehydration, or [[Hyponatremia|low blood salt]]. Muscle cramps can also be a symptom or complication of [[pregnancy]]; [[kidney]] disease; [[thyroid]] disease; [[hypokalemia]], [[hypomagnesemia]], or [[hypocalcaemia]] (as conditions); [[restless legs syndrome]]; [[varicose veins]];<ref>Bergan J. The Vein Book, Hardcover text, Editor Bergan J, 2007. {{isbn|9780195399639}}</ref> and [[multiple sclerosis]].<ref name="test2">[http://www.webmd.com/hw-popup/Muscle-cramps Muscle Cramps at WebMD] {{webarchive|url=https://web.archive.org/web/20071015073632/http://www.webmd.com/hw-popup/muscle-cramps |date=2007-10-15 }}</ref>

As early as 1965, researchers observed that leg cramps and restless legs syndrome can result from excess [[insulin]], sometimes called [[hyperinsulinemia]].<ref>{{cite journal|last1=Roberts|first1=HJ|title=Spontaneous Leg Cramps and "restless Legs" Due to Diabetogenic Hyperinsulinism: Observations on 131 Patients|journal=Journal of the American Geriatrics Society|volume=13|issue=7|pages=602–38|year=1965|pmid=14300967|doi=10.1111/j.1532-5415.1965.tb00617.x|s2cid=28096190}}</ref>

===Skeletal muscle cramps===
{{See also|Exercise-associated muscle cramps}}

Under normal circumstances, [[skeletal muscle]]s can be voluntarily controlled. Skeletal muscles that cramp the most often are the [[Calf muscle|calves]], [[thighs]], and [[arches of the foot]], and in North America are sometimes called a "[[Charley horse]]" or a "corky". Such cramping is associated with strenuous physical activity and can be intensely painful; however, it can occur while inactive and relaxed. Around 40% of people who experience skeletal cramps are likely to endure extreme muscle pain and may be unable to use the entire limb that contains the "locked-up" muscle group. It may take up to a week for the muscle to return to a pain-free state, depending on the person's fitness level, age, and several other factors.{{citation needed|date=August 2021}}

====Nocturnal leg cramps====
{{see also|Charley horse}}
[[Nocturnal]] leg cramps are involuntary muscle contractions that occur in the [[Gastrocnemius muscle|calves]], [[Sole (foot)|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.<ref name="mayo">[http://www.mayoclinic.com/health/night-leg-cramps/MY00410 Night leg cramps - Mayo Clinic] {{webarchive|url=https://web.archive.org/web/20110923231142/http://www.mayoclinic.com/health/night-leg-cramps/MY00410 |date=2011-09-23 }}</ref> They happen quite frequently in teenagers and some people while exercising at night. Besides being painful, a nocturnal leg cramp can cause much [[Distress (medicine)|distress]] and [[anxiety]].<ref>{{cite journal|last=Weiner|first=Israel H|title=Nocturnal Leg Muscle Cramps|year=1980|volume=244|issue=20|pages=2332–3|url=http://jama.ama-assn.org/content/244/20/2332.short|journal=JAMA|doi=10.1001/jama.1980.03310200066033|pmid=7431559|access-date=26 October 2011|url-status=live|archive-url=https://web.archive.org/web/20101228162905/http://jama.ama-assn.org/content/244/20/2332.short|archive-date=28 December 2010|url-access=subscription}}</ref> The precise cause of these cramps is unclear. Potential contributing factors include [[dehydration]], low levels of certain minerals ([[magnesium]], [[potassium]], [[calcium]], and [[sodium]], although the evidence has been mixed),<ref>{{cite journal |vauthors=Schwellnus MP, Nicol J, Laubscher R, Noakes TD |title=Serum electrolyte concentrations and hydration status are not associated with exercise associated muscle cramping (EAMC) in distance runners |journal=Br J Sports Med |year=2004 |volume=38 |issue=4 |pages=488–492 |doi=10.1136/bjsm.2003.007021|pmid=15273192 |pmc=1724901 }}</ref><ref name="pmid16015122">{{cite journal | vauthors = Sulzer NU, Schwellnus MP, Noakes TD | title = Serum electrolytes in Ironman triathletes with exercise-associated muscle cramping | journal = Med Sci Sports Exerc | volume = 37 | issue = 7 | pages = 1081–5 | date = July 2005 | pmid = 16015122 | doi = 10.1249/01.mss.0000169723.79558.cf| s2cid = 12582883 | doi-access = free }}</ref><ref name=":0"/> 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.<ref>{{cite web |url=https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/leg-cramps-during-pregnancy/faq-20057766 |title=What causes leg cramps during pregnancy, and can they be prevented? |vauthors = Wick M  |website=Mayo Clinic |access-date=2018-04-03 }}</ref>

A lactic acid buildup around muscles can trigger cramps; however, they happen during anaerobic respiration when a person is exercising or engaging in an activity where the heartbeat rises. Medical conditions associated with leg cramps are cardiovascular disease, hemodialysis, cirrhosis, pregnancy, and lumbar canal stenosis. Differential diagnoses include [[restless legs syndrome]], [[claudication]], [[myositis]], and [[peripheral neuropathy]]. All of them can be differentiated through careful history and physical examination.<ref name=":0">{{cite journal |url=http://www.aafp.org/afp/2012/0815/p350.html |title=Nocturnal Leg Cramps |journal=American Family Physician |vauthors=Allen RE, Kirby KA |year=2012 |volume=86 |issue=4 |pages=350–355 |pmid=22963024 |url-status=live |archive-url=https://web.archive.org/web/20160329134250/http://www.aafp.org/afp/2012/0815/p350.html |archive-date=2016-03-29 }}</ref>

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.<ref name="nytimes-ray">{{cite news|url=https://www.nytimes.com/2009/06/09/health/09qna.html|title=Q & A – A Charley Horse in Bed|last=Ray|first=C. Claiborne|date=2009-06-09|work=[[The New York Times]]|access-date=2009-06-09|url-status=live|archive-url=https://web.archive.org/web/20130407063441/http://www.nytimes.com/2009/06/09/health/09qna.html|archive-date=2013-04-07}}</ref> If the cramp is in the calf muscle, dorsiflexing the foot (lifting the toes back toward the shins) will stretch the muscle and provide almost immediate relief. There is limited evidence supporting the use of magnesium, [[calcium channel blocker]]s, [[carisoprodol]], and [[vitamin B12|vitamin B<sub>12</sub>]].<ref name=":0"/>

[[Quinine]] is no longer recommended for the treatment of nocturnal leg cramps due to potential fatal hypersensitivity reactions and [[thrombocytopenia]]. [[Cardiac arrhythmia|Arrhythmias]], [[cinchonism]], and [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] can also occur at higher dosages.<ref name=":0"/>

===Cramps caused by treatments===
Various medications may cause nocturnal leg cramps:<ref name=":0"/><ref name="pmid22157068">{{cite journal | vauthors = Garrison SR, Dormuth CR, Morrow RL, Carney GA, Khan KM | title = Nocturnal leg cramps and prescription use that precedes them: a sequence symmetry analysis | journal = Arch. Intern. Med. | volume = 172 | issue = 2 | pages = 120–6 | date = January 2012 | pmid = 22157068 | doi = 10.1001/archinternmed.2011.1029 | doi-access =  }}</ref>
* [[Diuretics]], especially potassium-sparing
* Intravenous (IV) [[iron sucrose]]
* [[Conjugated estrogens]]
* [[Teriparatide]]
* [[Naproxen]]
* [[Raloxifene]]
* Long-acting [[adrenergic beta-agonists]] (LABAs)
* Hydroxymethylglutaryl-coenzyme A reductase inhibitors (HMG-CoA inhibitors or [[statins]])

[[Statin]]s may 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, that increase the probability of these side effects, are physical exercise, age, history of cramps, and [[hypothyroidism]]. Up to 80% of athletes using statins experience significant adverse muscular effects, including cramps;<ref>
{{cite journal |vauthors=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 |pmc=1884475}}</ref> the rate appears to be approximately 10–25% in a typical statin-using population.<ref>
{{cite journal |vauthors=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|s2cid=24525127 }}</ref><ref>
{{cite journal |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 |author=Dirks, A. J. |last2=Jones |first2=KM|s2cid=13313618 }}</ref> 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 help avoid some statin-related adverse effects, but currently, there is not enough evidence to prove its effectiveness in avoiding myopathy or myalgia.<ref>{{cite journal |vauthors=Lamperti C, Naini AB, Lucchini V |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|display-authors=etal|doi-access= }}</ref>

==Treatment==
Stretching, massage, and drinking plenty of liquids may help treat simple muscle cramps.<ref name="PMID 8784961">{{cite journal | pmid = 8784961 | volume=21 | issue=6 | title=Exercise-induced muscle cramp. Proposed mechanisms and management | date=June 1996 | author=Bentley S | pages=409–20 | journal=Sports Med | doi=10.2165/00007256-199621060-00003| s2cid=24366112 }}</ref>

===Medication===
The antimalarial drug [[quinine]] is a traditional treatment that may be slightly effective for reducing the number of cramps, the intensity of cramps, and the number of days a person experiences cramps. Quinine has not been shown to reduce the duration (length) of a muscle cramp.<ref name=":1" /> Quinine treatment may lead to hematologic and cardiac toxicity. Due to its low effectiveness and negative side effects, its use as a medication for treating muscle cramps is not recommended by the FDA.<ref name=Katzberg>{{cite journal |vauthors=Katzberg HD, Khan AH, So YT |title=Assessment: Symptomatic treatment for muscle cramps (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology |journal=Neurology |volume=74 |issue=8 |pages=691–6 |year=2010 |pmid=20177124 |doi=10.1212/WNL.0b013e3181d0ccca|doi-access=free }}</ref>

Magnesium is commonly used to treat muscle cramps. Moderate-quality evidence indicates that magnesium is not effective for treating or preventing cramps in older adults.<ref name=":1" /> It is not known if magnesium helps with cramps due to pregnancy, liver [[cirrhosis]], other medical conditions, or exercise.<ref name=":1" /> Oral magnesium treatment does not appear to have significant major side effects, however, it may be associated with diarrhea and nausea in 11–37% of people who use this medicine.<ref name=":1" />

With exertional heat cramps due to [[electrolyte abnormalities]] (primarily potassium loss and not calcium, magnesium, and sodium), appropriate fluids and sufficient potassium improve symptoms.<ref name="pmid12801207">{{cite journal|vauthors=Bergeron MF|date=March 2003|title=Heat cramps: fluid and electrolyte challenges during tennis in the heat|journal=J Sci Med Sport|volume=6|issue=1|pages=19–27|doi=10.1016/S1440-2440(03)80005-1|pmid=12801207}}</ref> [[B vitamins|Vitamin B complex]], [[naftidrofuryl]], [[lidocaine]], and [[calcium channel blocker]]s may be effective for muscle cramps.<ref name="Katzberg" />

==Prevention==
Adequate conditioning, stretching, mental preparation, hydration, and electrolyte balance are likely helpful in preventing muscle cramps.<ref name="PMID 8784961"/>

== See also ==
* [[Spasm]]

==References==
{{Reflist}}

== External links ==
* [http://www.medicinenet.com/muscle_cramps/article.htm Muscle Cramps (of Skeletal Muscles)]

{{Medical resources
|  DiseasesDB     = 3151
|  ICD10          = {{ICD10|R|25|2|r|25}}
|  ICD9           = {{ICD9|729.82}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    = 003193
|  eMedicineSubj  =
|  eMedicineTopic =
|  MeshID         = D009120
}}
{{Myopathy}}
{{Nervous and musculoskeletal system symptoms and signs}}
{{Underwater diving|divmed}}

[[Category:Muscular disorders]]
[[Category:Symptoms and signs: musculoskeletal system]]