Via practica 1/2023

Muscle cramps – causes, diagnostics and treatment

Muscle cramps are characterized by a sudden, painful, involuntary contraction of muscle. Medical history, physical examination, and laboratory tests help to determine the various causes of muscle cramps. Primary (or idiopathic) muscle cramps, without a known cause, occur normally in healthy persons. Despite the „benign“ nature, many patients find idiopathic cramps very uncomfortable. They are frequent especially in elderly and pregnant women, presenting usually at night as nocturnal leg cramps. Secondary muscle cramps are not so frequent. They are caused by multiple diverse causes: 1. neurogenic disorders: amyotrophic lateral sclerosis, bulbospinal amyotrophy, polyneuropathies and radiculopathies of various etiology, acquired neuromyotonia; 2. muscle disorders: metabolic myopathies, inflammatory myopathies, muscular dystrophies, etc.; 3. systemic disorders: diabetes, hypothyroidism, cirrhosis, electrolyte disturbances, uremia, etc.; 4. drug and toxin induced cramps: statins, fibrates, diuretics, ethanol, etc. The first diagnostic step in a patient with muscle cramp is to find out if the cramps are of primary or secondary origin. Treatment of primary muscle cramps is empiric – gabapentin, pregabalin, carbamazepine, magnesium, stretching exercises. In patients with secondary muscle cramps the early recognition of underlying disease and subsequent pathogenic therapy are of crucial importance. This paper covers the causes, clinical presentation, diagnosis and treatment of muscle cramps.

Keywords: primary muscle cramps, secondary muscle cramps, causes, diagnostics, treatment