The symptoms include sudden spasms, or tightening, of muscles in the calf.
The patient history is the key to identifying the possible cause of leg cramps. Nocturnal occurrence, visible muscle tightening, and sudden, intense pain are typical manifestations. The description of symptoms should differentiate leg cramps from other common conditions
Restless legs syndrome is marked by an irresistible urge to move or shake the legs and does not cause pain or tight muscles. Despite these marked differences, studies have shown difficulty in distinguishing restless legs syndrome from leg cramps. Claudication is an aching, sometimes cramping, muscle symptom brought on by exercise and relieved with rest. Hypnic myoclonus is a sudden jerk that often occurs at the onset of sleep. Periodic limb movement disorder is a nonpainful, repetitive, rhythmic, slow dorsiflexion of the toes, knees, and hips during sleep. The movements last for seconds and recur at intervals of seconds to about one minute. Peripheral neuropathy is described primarily as numbness, tingling, and “electrical” pain, with possible secondary cramps. Myalgias and myositis, which sometimes occur with statin therapy, can manifest in any muscle group and lead to deep, aching pain, weakness, and poor exercise tolerance. Exercise-associated muscle cramping occurs during or immediately after exercise. Localized muscle fatigue is known to cause cramps, and may arise in a sedentary person with straining or exercise. Conversely, patients in good physical condition may experience leg cramps with a change in the intensity of their exercise routine.
The history must include a review of medications and existing medical conditions. Although associated medical conditions are important to identify and discuss, no data suggest that treatment of these conditions improves symptoms of leg cramps.
Physical examination rarely demonstrates leg cramps because they are involuntary, unpredictable, and usually nocturnal. Examination findings may indicate a potential underlying medical cause, such as peripheral vascular disease. Appropriate examination includes inspection of the legs and feet, palpation of pulses, and evaluation of touch and pinprick sensation, strength, and deep tendon reflexes. Blood pressure should be measured to assess cardiac and vascular risk factors. Neurologic disease may also manifest as tremor, gait disturbance, or asymmetry.
Routine blood tests are not helpful in the diagnosis because leg cramps have no proven association with electrolyte abnormalities, anemia, glucose levels, thyroid function, or kidney disease.7 In specific patients, selected blood tests may be indicated to identify underlying medical conditions, such as liver enzyme levels for cirrhosis, cholesterol levels for cardiovascular disease, and vitamin B12 levels for related neuropathy. Similarly, other diagnostic studies such as nerve conduction studies, ultrasonography, and angiography are not necessary unless indicated to confirm specific medical conditions.
If known, always try to treat the underlying cause first. Vitamin E supplements or Vitamin B complex may helpful. Magnesium supplements have also shown some benefit, mostly in pregnant women. Diphenhydramine and calcium channel blockers may be suggested by your doctor. Quinine was previously used for the treatment of nocturnal leg cramps. However, due to its potential for serious and life-threatening adverse effects (cardiac arrhythmias, thrombocytopenia, and hypersensitivity reactions), it is no longer recommended as a treatment option.
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