How are muscle spasms diagnosed?
Most people have experienced a skeletal muscle spasm due to overexertion, especially in a warm environment, and are able to self-diagnose. However, if the spasms are severe, last a long time, or keep recurring, it is reasonable to see a health-care professional for evaluation.
The diagnosis usually begins with history and physical examination. It is helpful to know the circumstances surrounding the muscle spasms.
- When did they begin? How long do they last? How frequently do they occur? Are they rhythmic or more random? Is it always the same muscle group of the body involved?
- Other information that is helpful includes understanding the general health of the patient and whether there have been any recent illnesses or whether any medications have been taken, including prescription medications, over-the-counter medications, food supplements, and herbal remedies.
- Past medical history may give a clue as to the reason for the muscle cramps. These may include a history of diabetes, hypothyroidism, kidney disease, and spinal cord injury.
- Work or exercise history may be of importance.
- Environment is also an important information regarding heat exposure and associated signs and symptoms of dehydration.
Sometimes the physical examination may be normal since the muscle spasms may not be present during the visit. However, the physical examination may useful in detecting underlying health issues that may be helpful in making the diagnosis. For example, if the patient is complaining of leg muscle cramps, the examination may include palpating or feeling for pulses in the feet. Atherosclerosis, or hardening of the arteries, may be associated with the loss of arterial pulse in the involved extremity.
For those having pain from smooth muscle spasm, the pain may be severe enough to present to an emergency department. The history and physical examination will be directed to finding the source of the pain, while at the same time trying to control the symptoms. Kidney stone pain (renal colic) and gallbladder pain sometime require anti-inflammatory or narcotic pain medication. They are often associated with nausea and vomiting and these symptoms may also require treatment. Some patients with irritable bowel condition may also present with significant intestinal spasm, abdominal pain, and constipation or diarrhea.
For patients with recurrent muscle spasm where the cause is not easily diagnosed by history and physical examination, testing may be necessary to give direction as to potential causes. Blood tests may or may not be indicated depending upon the situation and whether or not the diagnosis can be adequately attained by history and physical examination. Blood tests may include a complete blood count (CBC) looking for anemia, electrolytes (especially sodium, potassium, calcium and magnesium), glucose, and creatinine (to check for kidney function). Thyroid function tests may also be considered.
If muscle spasms are prolonged and ongoing, there may be a concern that muscle breakdown and damage is occurring. A creatine phosphokinase (CPK) blood test can be used to detect this. It is an enzyme released into the bloodstream by irritated or damaged muscle tissue. Rhabdomyolysis can lead to kidney failure.
If there is concern that the spasms are due to a nerve or muscle disorder, electromyography (EMG) may be done to determine whether there may be an abnormality of the muscle, of the nerves, or both.
If there is concern about the potential for peripheral artery disease, tests of blood flow to the legs may be considered, including an ankle-brachial index (ABI) which compares blood pressures in the arms and legs and ultrasound and angiography (often using CT or MRI) to directly assess the blood vessels.
If nocturnal leg cramps are thought to be associated with a sleep disturbance, sleep studies might be indicated.