Muscle cramps

Last reviewed: 26 Apr 2022
Last updated: 25 Aug 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • 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 neurological examination (idiopathic cramp)
  • normal general physical examination (idiopathic cramp)
  • other local muscle involvement (neuromuscular disease cramp)
  • widespread muscle cramps (lower motor neuron disease)
  • duration >10 minutes (organic cause)
  • abnormal neurological examination (organic cause)
  • abnormal musculoskeletal examination (organic cause)
More key diagnostic factors

Other diagnostic factors

  • signs of a chronic medical condition (organic cause)
Other diagnostic factors

Risk factors

  • pregnancy
  • strenuous exercise
  • haemodialysis
  • cirrhosis
  • imatinib
  • beta-blockers with intrinsic sympathomimetic activity
  • age >60 years
  • female sex
  • family history of cramp
  • statins
  • other agents
  • hypoglycaemia in patients with diabetes mellitus
  • chronic diseases
  • home parenteral nutrition
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • 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
  • electromyogram
  • nerve conduction studies
  • serum aldolase
  • muscle biopsy
  • genetic studies
More investigations to consider

Treatment algorithm

ONGOING

idiopathic cramps

exercise-associated

hypoglycaemia-associated in diabetes mellitus

pregnancy-associated

dialysis-associated

cirrhosis-associated

multiple sclerosis- or lower motor neuron disease-associated

familial syndrome-associated

medication-associated

Contributors

Authors

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

NY

Disclosures

MR states that he has no competing interests.

Acknowledgements

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.

Peer reviewers

Timothy M. Miller, MD, PhD

Assistant Professor of Neurology

Department of Neurology

Washington University School of Medicine

St. Louis

MO

Disclosures

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

PA

Disclosures

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

Disclosures

FG-S declares that she has no competing interests.

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