neurologic disorders
Muscle Cramps
Evaluation of Muscle Cramps
Evaluation of muscle cramps focuses on recognition of what is treatable. In many cases, a disorder contributing to cramps has already been diagnosed or causes other symptoms that are more troublesome than cramps. Cramps must be differentiated from Symptoms and Signs and History of present illnessshould elicit a description of cramps, including their duration, frequency, location, apparent triggers, and any associated symptoms. Symptoms that may be related to neurologic or muscle disorders can include muscle stiffness, weakness, pain, and loss of sensation. Factors that can contribute to dehydration or electrolyte or body fluid imbalances (eg, vomiting, diarrhea, excessive exercise and sweating, recent dialysis, diuretic use, pregnancy) are recorded. Review of systemsshould seek symptoms of possible causes, including the following: Amenorrhea or menstrual irregularity: Pregnancy-related leg cramps Cold intolerance with weight gain and skin changes: Hypothyroidism None Weakness : Neurologic disorders Pain or loss of sensation: Peripheral Neuropathy or Past medical historyshould include any disorders that can cause cramps. A complete history of medication and other substance use (eg, alcohol) is taken. General examination should include the skin, looking for stigmata of Alcohol Use Disorder and Rehabilitation , nonpitting edema or loss of eyebrow hair (suggesting hypothyroidism), and changes in skin moisture or turgor. A Pulses should be palpated, and blood pressure measured in all extremities. A weak pulse or low ankle:brachial blood pressure ratio in an affected limb may indicate ischemia. In patients with muscle cramps, the following findings are of particular concern: Upper extremity or truncal involvement Hyperreflexia or hyporeflexia Muscle weakness Fasciculations Signs of Alcohol Use Disorder and Rehabilitation None Hypovolemia Pain or loss of sensation in a peripheral nerve, plexus, or root distribution Focal cramps suggest benign idiopathic leg cramps, exercise-associated muscle cramping, musculoskeletal abnormalities, peripheral nervous system causes, or an early degenerative disorder that can be asymmetric, such as a motor neuron disorder. Focal hyporeflexia suggests a peripheral neuropathy, plexopathy, or radiculopathy. In patients with diffuse cramps (particularly those who are tremulous), hyperreflexia suggests a systemic cause (eg, ionized Hypocalcemia ; sometimes A normal examination and compatible history suggests benign idiopathic leg cramps or exercise-associated muscle cramping. Testing is done as indicated by abnormal clinical findings. No tests are routinely done. Blood glucose, renal function tests, and electrolyte levels, includingcalciumandmagnesium, should be measured if patients have diffuse cramps of unknown cause, particularly if hyperreflexia is present. Ionized calcium and arterial blood gases (ABGs) to confirm respiratory alkalosis are measured if patients have tetany. Electromyography is done if cramped muscles are weak. MRI of the brain and often spinal cord is done if muscle weakness or neurologic signs indicate that the central nervous system is involved. 