Muscle cramps are prolonged involuntary muscle contractions that can be painful. Muscle cramping represents motor unit hyperactivity leading to prolonged involuntary muscle contraction. Precipitants include unopposed contraction, electrolyte and volume shifts, and lower motor neuron disease. Ordinary cramps most commonly occur in the gastrocnemius muscle and the intrinsic muscles of the sole of the foot. Their nocturnal predilection appears to be related to unopposed foot plantar flexion while in bed, placing the muscles of the calves and feet in their most shortened and therefore most vulnerable position. Without modulation by opposing muscles, the sustained contraction produces the painful cramp, which is experienced as sudden severe calf pain, often with a palpable or visibly hardened muscle. In many instances, a voluntary contraction triggers the cramp. Passive stretching relieves it. Cheap soma.
Clinical Evaluation
History.
A detailed description of the cramping is essential and should include the setting in which the episodes occur. Those that develop at night or in the context of hemodialysis, hypoglycemia, or heavy sweating from prolonged exertion are likely to be true cramps, as are those coincident with use of calcium channel blockers or beta-agonists. Dystonic cramping is suggested by onset with occupation-related fine motor activity, and contracture by a lifelong onset with exercise. Associated symptoms should be reviewed for the paresthesias and carpopedal spasm of tetany, the weakness and fasciculations of lower motor neuron disease, and the cold or heat intolerance, skin changes, and related symptoms of thyroid disease. Location of the cramping is a less specific finding, but if calf pain is reported, one should include intermittent claudication in the differential diagnosis, particularly if pain is brought on by walking. Review of medications is always useful, but use of a potassium-wasting diuretic is not tantamount to an etiologic diagnosis, because hypokalemia is rarely responsible for true cramps (although it should be considered in the differential diagnosis of tetany). Also potentially pertinent in suspected tetany is any distant history of thyroidectomy (with coincident removal of the parathyroid glands). Canadian pharmacy health articles.