Muscle cramps and contractures: causes and treatment

Abstract

Muscle cramps are painful, sudden, involuntary muscle contractions that are generally self-limiting. They are often part of the spectrum of normal human physiology and can be associated with a wide range of acquired and inherited causes. Cramps are only infrequently due to progressive systemic or neuromuscular diseases. Contractures can mimic cramps and are defined as shortenings of the muscle resulting in an inability of the muscle to relax normally, and are generally myogenic. General practitioners and neurologists frequently encounter patients with muscle cramps but more rarely those with contractures. The main questions for clinicians are: (1) Is this a muscle cramp, a contracture or a mimic? (2) Are the cramps exercise induced, idiopathic or symptomatic? (3) What is/are the presumed cause(s) of symptomatic muscle cramps or contractures? (4) What should be the diagnostic approach? and (5) How should we advise and treat patients with muscle cramps or contractures? We consider these questions and present a practical approach to muscle cramps and contractures, including their causes, pathophysiology and treatment options.

Muscle Cramps in Outpatients with Liver Diseases in Tokyo, Japan

“…We demonstrated that older age (equal to or more than 66 years) was the only factor associated with muscle cramps in patients with liver diseases. This prevalence may be smaller, as 37% of healthy people per year have muscle cramps as part of the spectrum of normal human physiology [ 15 ], although food and nutrition may affect the status of muscle cramps [ 16 ]. In this study, however, we observed that 67% of patients with muscle cramps had not yet received appropriate therapeutic options.…”

“…Motor neuron disease, spinobulbar muscular atrophy, spinal muscular atrophy, radiculopathy, motor, and sensory peripheral neuropathies, peripheral nerve hyperexcitability, and neuromyotonia are neurogenic causes of symptomatic muscle cramps. Electrolyte imbalance, hepatic and renal dysfunction, vitamin deficiency, diabetes mellitus, (para)thyroid dysfunction, and chronic venous insufficiency, are non-neuromuscular causes of symptomatic muscle cramps [ 15 ]. If muscle cramps are observed in patients with liver diseases, we should rule out the diseases above.…”

“…Caffeine, alcohol, and illicit drugs are known to be exogeneous triggers of muscle cramps [ 15 ]. Among medications, lipid-lower medication (statins and fibrates), cardiovascular medication (diuretics, anti-arrhythmic medication, nifedipine, and amlodipine), antibiotics (cyclosporine and penicillin), lithium, cimetidine, methylphenidate, nicotinic acid, and others have been reported as exogeneous triggers of muscle cramps [ 15 ]. Statins activate the MAPK signaling pathway and can reduce the resting chloride channel conductance and lactate efflux in sarcoplasm, which are responsible for muscle cramps [ 66 ].…”