Muscle cramps

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Última revisão: 21 Jul 2025

Última atualização: 31 Jan 2025

Muscle cramps are mostly benign and self-limited, but may also be indicative of a wide variety of potentially serious systemic disorders.

Idiopathic (ordinary) muscle cramps are common, short-lived, and usually involve the calf muscle and/or foot.

The diagnostic approach for idiopathic muscle cramps is one of exclusion. Cramps due to known pathologies can be ruled out reasonably quickly and easily by medical history and targeted physical exam.

Nonpharmacologic therapy forms the cornerstone of management of muscle cramps in the acute phase. Passive and/or active stretching of the affected muscle(s) is by far the most effective and safest therapy for most acute idiopathic muscle cramps.

Data are extremely sparse regarding ongoing prevention of muscle cramps. With the exception of drug therapies targeted at underlying/precipitating conditions, there are no proven, specific, effective, and safe drug therapies for muscle cramps. Quinine is used in some countries for the prevention of idiopathic cramps, but is associated with serious side effects (e.g., cardiac arrhythmias, thrombocytopenia, hepatotoxicity, blindness). Therapeutic trialing of various medications used for symptomatic benefit is a reasonable approach.

Definição

A muscle cramp is a sudden, involuntary, painful muscle contraction or spasm, associated with an increase in frequency of motor action potentials.[1][2][3] Idiopathic (ordinary) muscle cramps are common.

About 80% of episodes involve the gastrocnemius, with a mean duration per episode of 8 to 9 minutes in adults and 2 minutes in children.

The focus of this topic is true cramps (motor unit hyperactivity). These are most commonly idiopathic cramps, but can be associated with other conditions.

História e exame físico

Principais fatores diagnósticos

concurrent hemodialysis (organic cause)
cirrhosis (organic cause)
pregnancy (idiopathic cramp)
strenuous exercise (idiopathic cramp)
medication use (idiopathic cramp)
nocturnal onset (idiopathic cramp)
gastrocnemius muscle involvement, with or without foot involvement (idiopathic cramp)
duration <10 minutes (idiopathic cramp)
unilateral (idiopathic cramp)
precipitation by both trivial movements and forceful contractions (idiopathic cramp)
visible or palpable muscular knotting
good response to passive/active stretching (idiopathic cramp)
normal neurologic exam (idiopathic cramp)
normal general physical exam (idiopathic cramp)
other local muscle involvement (neuromuscular disease cramp)
widespread muscle cramps (lower motor neuron disease)
duration >10 minutes (organic cause)
abnormal neurologic exam (organic cause)
abnormal musculoskeletal exam (organic cause)

Detalhes completos

Outros fatores diagnósticos

signs of a chronic medical condition (organic cause)

Detalhes completos

Fatores de risco

pregnancy
strenuous exercise
hemodialysis
cirrhosis
use of imatinib
use of beta-blockers with intrinsic sympathomimetic activity
age >60 years
female sex
family history of cramp
use of statins
use of other agents that may cause muscle cramps
hypoglycemia in patients with diabetes mellitus
chronic diseases
home parenteral nutrition

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis

Detalhes completos

Investigações a serem consideradas

serum or urine hCG
fasting serum metabolic panel
thyroid-stimulating hormone (TSH)
HbA1c
serum liver function tests
prothrombin time (PT) and INR
serum myoglobin and urinalysis
serum creatine kinase (CK)-MM
serum alpha-tocopherol (vitamin E)
serum zinc
EMG
nerve conduction studies
serum aldolase
muscle biopsy
genetic studies

Detalhes completos

Algoritmo de tratamento

CONTÍNUA

idiopathic cramps

exercise-associated

hypoglycemia-associated in diabetes mellitus

pregnancy-associated

dialysis-associated

cirrhosis-associated

multiple sclerosis- or lower motor neuron disease-associated

familial syndrome-associated

medication-associated

Colaboradores

Autores

Michael Rubin, MD, FRCP(C)

Professor of Clinical Neurology

Weill Cornell Medical College

Attending Neurologist

Director, Neuromuscular Service and EMG Laboratory

New York Presbyterian Hospital

New York

Declarações

MR states that he has no competing interests.

Agradecimentos

Dr Michael Rubin would like to gratefully acknowledge Dr Justin Mhoon and Dr David R.P. Guay, previous contributors to this topic. JM declares that he has no competing interests. DRPG is an author of a reference cited in this topic.

Revisores

Timothy M. Miller, MD, PhD

Assistant Professor of Neurology

Department of Neurology

Washington University School of Medicine

St. Louis

Declarações

TMM is an author of a reference cited in this topic.

Sami Khella, MD

Physician

Department of Neurology

Penn Presbyterian Medical Center

University of Pennsylvania Health System

Philadelphia

Declarações

SK declares that he has no competing interests.

Felicity Goodyear-Smith, MB CHB, DipObs, MGP, FRNZCGP, MFFLM, RCP

Professor and Goodfellow Postgraduate Chair

Department of General Practice & Primary Health Care

University of Auckland

Auckland

New Zealand

Declarações

FG-S declares that she has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Katzberg HD. Case studies in management of muscle cramps. Neurol Clin. 2020 Aug;38(3):679-96. Resumo

Leung AK, Wong BE, Chan PY, et al. Nocturnal leg cramps in children: incidence and clinical characteristics. J Natl Med Assoc. 1999;91:329-32.Texto completo Resumo

Maughan RJ, Shirreffs SM. Muscle cramping during exercise: causes, solutions, and questions remaining. Sports Med. 2019 Dec;49(suppl 2):115-24. Resumo

Zhou K, West HM, Zhang J, et al. Interventions for leg cramps in pregnancy. Cochrane Database Syst Rev. 2015;(8):CD010655.Texto completo Resumo

Maquirriain J, Merello M. The athlete with muscular cramps: clinical approach. J Am Acad Orthop Surg. 2007;15:425-431. Resumo

Garrison SR, Korownyk CS, Kolber MR, et al. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev. 2020 Sep 21;(9):CD009402.Texto completo Resumo

El-Tawil S, Al Musa T, Valli H, et al. Quinine for muscle cramps. Cochrane Database Syst Rev. 2015;(4):CD005044.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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Muscle cramps

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

idiopathic cramps

exercise-associated

hypoglycemia-associated in diabetes mellitus

pregnancy-associated

dialysis-associated

cirrhosis-associated

multiple sclerosis- or lower motor neuron disease-associated

familial syndrome-associated

medication-associated

Colaboradores

Autores

Michael Rubin, MD, FRCP(C)

Declarações

Agradecimentos

Revisores

Timothy M. Miller, MD, PhD

Declarações

Sami Khella, MD

Declarações

Felicity Goodyear-Smith, MB CHB, DipObs, MGP, FRNZCGP, MFFLM, RCP

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice