Muscle spasms [Muscle cramps]
Muscle spasms [Muscle cramps]: Excerpt from Handbook of Signs & Symptoms (Third Edition)
Muscle spasms are strong, painful contractions. They can occur in virtually any muscle, but are most common in the calf and foot. Muscle spasms typically occur from simple muscle fatigue, after exercise, and during pregnancy. However, they may also develop in electrolyte imbalances and neuromuscular disorders or as the result of certain drugs. They’re typically precipitated by movement, especially a quick or jerking movement, and can usually be relieved by slow stretching.
Emergency Interventions
If the patient complains of frequent or unrelieved spasms in many muscles, accompanied by paresthesia in his hands and feet, quickly attempt to elicit Chvostek’s and Trousseau’s signs. If these signs are present, suspect hypocalcemia. Evaluate respiratory function, watching for the development of laryngospasm; provide supplemental oxygen as necessary, and prepare to intubate the patient and provide mechanical ventilation. Draw blood for calcium and electrolyte levels and arterial blood gas analysis, and insert an I.V. line for administration of a calcium supplement. Monitor the patient’s cardiac status, and prepare to begin resuscitation if necessary.
History and physical examination
If the patient isn’t in distress, ask when the spasms began. Is there a particular activity that precipitates them? How long did they last? How painful were they? Did anything worsen or lessen the pain? Ask about other symptoms, such as weakness, sensory loss, or paresthesia.
Evaluate muscle strength and tone. Then, check all major muscle groups and note whether movements precipitate spasms. Test the presence and quality of all peripheral pulses, and examine the limbs for color and temperature changes. Test the capillary refill time (normal is less than 3 seconds), and inspect for edema, especially in the involved area. Observe for signs and symptoms of dehydration such as dry mucous membranes. Obtain a thorough drug and diet history. Ask the patient if he has had recent vomiting or diarrhea. Finally, test reflexes and sensory function in all extremities.
Medical causes
Amyotrophic lateral sclerosis (ALS)
With ALS, muscle spasms may accompany progressive muscle weakness and atrophy that typically begin in one hand, spread to the arm, and then spread to the other hand and arm. Eventually, muscle weakness and atrophy affect the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency. Other findings include muscle flaccidity progressing to spasticity, coarse fasciculations, hyperactive deep tendon reflexes (DTRs), dysphagia, impaired speech, excessive drooling, and depression.
Arterial occlusive disease
Arterial occlusion typically produces spasms and intermittent claudication in the leg, with residual pain. Associated findings are usually localized to the legs and feet and include loss of peripheral pulses, pallor or cyanosis, decreased sensation, hair loss, dry or scaling skin, edema, and ulcerations.
Cholera
Muscle spasms, severe water and electrolyte loss, thirst, weakness, decreased skin turgor, oliguria, tachycardia, and hypotension occur along with abrupt watery diarrhea and vomiting.
Dehydration
Sodium loss may produce limb and abdominal cramps. Other findings include a slight fever, decreased skin turgor, dry mucous membranes, tachycardia, orthostatic hypotension, muscle twitching, seizures, nausea, vomiting, and oliguria.
Hypocalcemia
The classic feature is tetany — a syndrome of muscle cramps and twitching, carpopedal and facial muscle spasms, and seizures, possibly with stridor. Chvostek’s and Trousseau’s signs may be elicited. Related findings include paresthesia of the lips, fingers, and toes; choreiform movements; hyperactive DTRs; fatigue; palpitations; and cardiac arrhythmias.
Muscle trauma
Excessive muscle strain may cause mild to severe spasms. The injured area may be painful, swollen, reddened, or warm.
Respiratory alkalosis
The acute onset of muscle spasms may be accompanied by twitching and weakness, carpopedal spasms, circumoral and peripheral paresthesia, vertigo, syncope, pallor, and extreme anxiety. With severe alkalosis, cardiac arrhythmias may occur.
Spinal injury or disease
Muscle spasms can result from spinal injury, such as a cervical extension injury or spinous process fracture, or from spinal disease such as infection.
Other causes
Drugs
Common spasm-producing drugs include diuretics, corticosteroids, and estrogens.
Special considerations
Depending on the cause, help alleviate the patient’s spasms by slowly stretching the affected muscle in the direction opposite the contraction. If necessary, administer a mild analgesic.
Diagnostic studies may include serum calcium, sodium and carbon dioxide levels, thyroid function tests, and blood flow studies or arteriography.
Pediatric pointers
Muscle spasms rarely occur in children. However, their presence may indicate hypoparathyroidism, osteomalacia, rickets or, rarely, congenital torticollis.
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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