Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Anyone who has experienced a muscle cramp (charley horse) can attest to the fact that it can
be quite painful. Muscle cramps occur when muscles involuntarily contract and
cannot relax.
The skeletal muscles (those over which we have voluntary
control) are most prone to cramping. The skeletal muscles in the calf, thigh,
and arch of the foot
are most notorious sites of cramps.
Cramps can be perceived as mild twitches or may be excruciatingly painful.
Typically, cramps cause an abrupt, intense pain in the involved muscle.
Often a muscle that is cramping feels harder than normal to the touch or may
even show visible signs of twitching. Most cramps resolve spontaneously within a
few seconds to minutes.
It is not known exactly why muscle cramps develop. Insufficient stretching
before exercise, exercising in the heat, and muscle fatigue may all play a role
in their causation. Imbalances in the levels of electrolytes (sodium, potassium,
chloride, calcium and phosphate) in the blood
can also lead to muscle cramps.
A muscle cramp is an involuntarily and forcibly contracted muscle that does not relax. When we use the muscles that can be controlled voluntarily, such as those of our arms and legs, they alternately contract and relax as we move our limbs. Muscles that support our head, neck, and trunk contract similarly in a synchronized fashion to maintain our posture. A muscle (or even a few fibers of a muscle) that involuntarily (without consciously willing it) contracts is in a "spasm." If the spasm is forceful and sustained, it becomes a cramp. Muscle cramps cause a visible or palpable hardening of the involved muscle.
Muscle cramps can last anywhere from a few seconds to a quarter of an
hour or occasionally longer. It is not uncommon for a cramp to
recur multiple times until it finally goes away. The cramp may
involve a part of a muscle, the entire muscle, or several muscles
that usually act together, such as those that flex adjacent fingers.
Some cramps involve the simultaneous contraction of muscles that
ordinarily move body parts in opposite directions.
Cramps are extremely common. Almost everyone (one estimate is about
95%) experiences a cramp at some time in their life. Cramps are
common in adults and become increasingly frequent with aging.
However, children also experience cramps.
Any of the muscles that are under our voluntary control (skeletal
muscles) can cramp. Cramps of the extremities, especially the legs
and feet, and most particularly the calf (the classic "charley
horse"), are very common. Involuntary muscles of the various organs
(uterus, blood vessel wall, bowels, bile and urine
passages, bronchial tree, etc.) are also subject to cramps. Cramps
of the involuntary muscles will not be further considered in this
review. This article focuses on cramps of skeletal muscle.
What are the types and causes of muscle cramps?
Skeletal muscle cramps can be categorized into four major types. These include "true" cramps, tetany, contractures, and dystonic cramps. Cramps are categorized according to their different causes and the muscle groups they affect.
True cramps
True cramps involve part or all of a single muscle or a group of muscles that
generally act together, such as the muscles that flex several adjacent fingers.
Most authorities agree that true cramps are caused by hyperexcitability of the
nerves that stimulate the muscles. They are overwhelmingly the most common type
of skeletal muscle cramps. True cramps can occur in a variety of circumstances
as follows.
Injury: Persistent muscle spasm may occur as a protective
mechanism following an injury, such as a broken bone. In this
instance, the spasm tends to minimize movement and stabilize the area
of injury. Injury of the muscle alone may cause the muscle to spasm.
Vigorous activity: True cramps are commonly associated
with the vigorous use of muscles and muscle fatigue (in sports or
with unaccustomed activities). Such cramps may come during the
activity or later, sometimes many hours later. Likewise, muscle
fatigue from sitting or lying for an extended period in an awkward
position or any repetitive use can cause cramps. Older adults are
at risk for cramps when performing vigorous or strenuous physical activities.
Rest cramps: Cramps at rest are very common, especially in older adults, but may be experienced at any age, including childhood. Rest cramps often occur during the night. While not life-threatening, night cramps (commonly known as nocturnal cramps) can be painful, disruptive of sleep, and they can recur frequently (that is, many times a night, and/or many nights each week). The actual cause of night cramps is unknown. Sometimes, such cramps are initiated by making a movement that shortens the muscle. An example is pointing the toe down while lying in bed, which shortens the calf muscle, a common site of cramps.
Dehydration: Sports and other vigorous activities can cause excessive fluid loss from
perspiration. This kind of dehydration increases the likelihood of true
cramps. These cramps are more likely to occur in warm weather and can be an early sign of
heat stroke. Chronic volume depletion of body fluids from diuretics (medicine that
promote urination) and poor fluid intake may act
similarly to predispose to cramps, especially in older people. Sodium depletion has
also been associated with cramps. Loss of sodium, the most abundant
chemical constituent of body fluids outside the cell, is usually a
function of dehydration.
Body fluid shifts: True cramps also may be experienced in
other conditions that feature an unusual distribution of body
fluids. An example is cirrhosis of the liver, which leads to the accumulation of fluid in the
abdominal cavity (ascites). Similarly, cramps are a relatively
frequent complication of the rapid body fluid changes that occur
during dialysis for kidney failure.
Low blood calcium, magnesium: Low blood levels of either
calcium or magnesium directly increase the excitability of both the
nerve endings and the muscles they stimulate. This may be a
predisposing factor for the spontaneous true cramps experienced by
many older adults, as well as for those that are commonly noted
during pregnancy. Low levels of calcium and magnesium are common in
pregnant women unless these minerals are supplemented in the
diet. Cramps are seen in any circumstance that decreases the
availability of calcium or magnesium in body fluids, such as taking
diuretics, hyperventilation (overbreathing), excessive vomiting,
inadequate calcium
and/or magnesium in the diet, inadequate calcium absorption due to
vitamin D deficiency, poor function of the parathyroid glands (tiny
glands in the neck that regulate calcium balance), and
other conditions.
Low potassium: Low potassium levels occasionally cause muscle cramps, although it is more common for low potassium to be associated with muscle weakness.
Tetany
In tetany, all of the nerve cells in the body are activated, which
then stimulate the muscles. This reaction causes spasms or cramps
throughout the body. The name tetany is derived from the effect of
the tetanus toxin on the nerves. However, the name is now commonly
applied to muscle cramping from other conditions, such as low blood
levels of calcium and magnesium. Low calcium and low magnesium,
which increase the activity of nerve tissue nonspecifically, also
can produce tetanic cramps. Often, such cramps are accompanied by
evidence of hyperactivity of other nerve functions in addition to
muscle stimulation. For instance, low blood calcium not only causes spasm of the muscles of the hands and wrists, but it can also cause a sensation of numbness and tingling around the mouth and other areas.
Sometimes, tetanic cramps are indistinguishable from true cramps. The accompanying changes of sensation or other nerve functions that occurs with tetany may not be apparent because the cramp pain is masking or distracting from it.
Contractures
Contractures result when the muscles are unable to relax for an even more extended period than a common muscle cramp. The
constant spasms are caused by a depletion of adenosine triphosphate
(ATP), an energy chemical within the cell. This prevents muscle
fiber relaxation. The nerves are inactive in this form of muscle
spasm.
Contractures can result from inherited (for example, McArdle's disease, which is a defect of
the breakdown of glycogen to sugar within the muscle cell) or
from acquired conditions (for example, hyperthyroid myopathy, which is a muscle disease that is
associated with an overactive thyroid). Cramps of this category are
uncommon.
Dystonic cramps
The final category is dystonic cramps, in which muscles that are not
needed for the intended movement are stimulated to contract. Muscles
that are affected by this type of cramping include those that
ordinarily work in the opposite direction of the intended movement,
and/or others that exaggerate the movement. Some dystonic cramps
usually affect small groups of muscles (eyelids, jaws, neck, larynx,
etc.). The hands and arms may be affected during the performance of
repetitive activities such as those associated with handwriting
(writer's cramp), typing, playing certain musical instruments, and
many others. Each of these repetitive activities may also
produce true cramps from muscle fatigue. Dystonic cramps are not
as common as true cramps.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Parkinson's disease is a slowly progressive neurologic disease characterized by a fixed inexpressive face, a tremor at rest, slowing of voluntary movements, a gait with short accelerating steps, peculiar posture and muscle weakness, caused by degeneration of an area of the brain called the basal ganglia, and by low production of the neurotransmitter dopamine. Most patients are over 50, but at least 10 percent are under 40.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
Potassium is an essential electrolyte necessary for cell function. Low potassium (hypokalemia) may be caused by diarrhea, vomiting, ileostomy, colon polyps, laxative use, diuretics, elevated corticosteroid levels, renal artery stenosis, and renal tubular acidosis, or other medications. Symptoms of low potassium include weakness, aches, and cramps of the muscles. Treatment is dependant upon the cause of the low potassium (hypokalemia).
Shin splints result from inflammation from injury to the tendon and adjacent tissues in the front of the outer leg. Shin splints commonly occur in runners or aggressive walkers, causing pain and discomfort. An increase in workout intensity, weak ankles and pronation may be to blame for shin splints. Stretching, strengthening, and icing the affected area are effective treatments for shin splints. Rest and anti-inflammatory medications are also advised.
Myofascial pain syndrome is muscle pain in the body's soft tissues due to injury or strain. Symptoms include muscle pain with tender points and fatigue. Treatment usually involves physical therapy, massage therapy, or trigger point injection.
Hamstring injuries may range from minor strains to major ruptures. A hamstring injury causes spasm, tightness, and tenderness. More severe injuries may cause swelling and bruising. While most hamstring injuries heal without surgery, a complete rupture would require surgery.
The shoulder is the most often dislocated joint in the body due to its mobility. Dislocation occurs when the head of the humerus is dislocated from its socket. Symptoms and signs of a shoulder dislocation include nausea and vomiting, lightheadedness, weakness, and sweating. There are various methods of reducing a dislocation and returning the humeral head to its normal place. The method for reduction of a shoulder dislocation depends upon the type of dislocation, the patient, the situation, and the clinician's experience. Intravenous narcotics and muscle relaxants are often administered to relax the muscles and relieve pain.
Cholera is an infectious disease characterized by intense vomiting and profuse watery diarrhea and that rapidly lease to dehydration and often death. Cholera is caused by infection with the bacteria Vibrio cholerae, which may be transmitted via infected fecal matter, food, or water.
Patients with celiac disease are required to eat a gluten-free diet. Gluten is found in rye, barley, and wheat. Gluten damages the intestine in patients with celiac disease. Some mediations contain gluten, so careful monitoring of products consumed is imperative. Patients with celiac disease are also at risk for developing nutritional deficiencies. The information in this article contains both foods that contain gluten, and foods that do not contain gluten.
Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For women undergoing natural menopause, the process is described in three stages: perimenopause, menopause, and postmenopause.
However, not all women undergo natural menopause. Some women experience induced menopause as a result of surgery or medical treatments, such as chemotherapy and pelvic radiation therapy.
In hypoparathyroidism, the parathyroid gland does not produce enough parathyroid hormone. Causes of hypoparathyroidism include injury to the parathyroid glands, autoimmune disorder association, or may be present ab birth. Symptoms of hypoparathyroidism include: tingling fingers, toes, and lips, brittle nails, dry, coarse skin, dry hair; memory loss, headaches, severe muscle cramps, cataracts, malformed teeth, and convulsions. Treatment of hypoparathyroidism is to restore the calcium and phosphorus to normal levels in the body.
Stiff-Person syndrome is a neurological disorder associated with features of an autoimmune disease. Signs and symptoms of Stiff-Person syndrome include a heightened sensitivity to stimuli (noise, touch, emotional distress) and fluctuating muscle rigidity of the trunk and limbs. Conditions associated with Stiff-Person syndrome include thyroiditis, vitiligo, pernicious anemia, and diabetes. Treatment for Stiff-Person syndrome is generally medication to control symptoms.
Cholera is an acute infectious disease caused by a
bacterium, Vibrio cholerae (V. cholerae), which results in a painless, watery
diarrhea in humans. Some affected individuals have copious amounts of diarrhea
and develop dehydration so severe it can lead to death. Most people who get the
disease ingest the organisms through food or water sources contaminated with V.
cholerae. Although symptoms may be mild, approximately 5%-10% of previously
healthy people will develop a copious diarrhea within about one to five days after
ingesting the bacteria. Severe disease requires prompt medical care. Hydration
(usually by IV for the very ill) of the patient is the key to surviving the
disease.
The term cholera has a long history (see history section below) and
has been assigned to several other diseases. For example, fowl or chicken
cholera is a disease that can rapidly kill chickens and other avian species
ra...
Anyone who has experienced a muscle cramp (
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