Muscle spasms

Muscle spasms, or muscle cramps, 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 Actions

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 cardiac status, and prepare to begin resuscitation, if necessary.

History

If the patient isn’t in distress, ask when the spasms began. Is there any 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. Obtain a thorough drug and diet history. Ask the patient if he has had recent vomiting or diarrhea.

Physical assessment

Evaluate muscle strength and tone. Then check all major muscle groups and note whether any movements precipitate spasms. Test the presence and quality of all peripheral pulses, and examine the limbs for color and temperature changes. Test 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. Finally, test reflexes and sensory function in all extremities.

Medical causes

Amyotrophic lateral sclerosis

With amyotrophic lateral sclerosis (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, 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.

Dehydration

Sodium loss may produce limb and abdominal cramps. Other findings in dehydration include a slight fever, decreased skin turgor, dry mucous membranes, tachycardia, orthostatic hypotension, muscle twitching, seizures, nausea, vomiting, and oliguria.

Fracture

Localized spasms and pain are mild if the fracture is nondisplaced, intense if it’s severely displaced. Other findings include swelling, limited mobility and, possibly, bony crepitation.

Hypocalcemia

The classic feature of hypocalcemia is tetany — a syndrome of muscle cramps and twitching, carpopedal and facial muscle spasms, and seizures, possibly with stridor. Both Chvostek’s and Trousseau’s signs may be elicited. Related findings include paresthesia of the lips, fingers, and toes; choreiform movements; hyperactive deep tendon reflexes; fatigue; palpitations; and cardiac arrhythmias.

Hypothyroidism

Muscle involvement may produce spasms and stiffness, along with leg muscle hypertrophy or proximal limb weakness and atrophy. Other findings include forgetfulness and mental instability; fatigue; cold intolerance; dry, pale, cool, doughy skin; puffy face, hands, and feet; periorbital edema; dry, sparse, brittle hair; bradycardia; and weight gain despite anorexia.

Muscle trauma

Excessive muscle strain may cause mild to severe spasms. The injured area may be painful, swollen, reddened, or warm. The patient may report hearing a snapping sound at the time of injury.

Respiratory alkalosis

With respiratory alkalosis, 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 cervical extension injury or spinous process fracture, or from spinal disease such as infection. The patient may report that the muscle spasms worsen with movement.

Other causes

Drugs

Common spasm-producing drugs include diuretics, corticosteroids, and estrogens.

Special considerations

Depending on the cause, help alleviate your 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.

Patient counseling

Teach the patient how to immobilize or wrap the injured area. Explain that taking analgesics and using treatments such as heat or cold can help relieve pain. If the patient requires traction or immobilization, suggest such diversionary activities as books, television, board games, and conversation. Demonstrate how to use assistive devices, if necessary.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Muscle spasms

Read excerpts from these other book chapters related to Muscle spasms:

Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.

More About Causes of Muscle spasms

• Back to symptom: Muscle spasms: Introduction (review 809 causes)
• Next Book Extract About Muscle spasms: Seizures, complex partial (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• All Book Extracts: All Online Book Extracts for Muscle spasms

More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

 » Next page: Seizures, complex partial (Signs & Symptoms: A 2-in-1 Reference for Nurses)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Seizures, complex partial (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Seizures, simple partial (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Seizures (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
• Fasciculations (Nursing: Interpreting Signs and Symptoms)
• Muscle weakness (Nursing: Interpreting Signs and Symptoms)

Tools & Services:

• Bookmark this page
• Take a survey relating to Muscle spasms
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City