II. Epidemiology
-
Incidence
- Adult: 50-60%
- Child: 7%
- Frequency
- May be daily in up to 20% of patients
III. Pathophysiology
- Idiopathic
- Postulated to have onset in hyperactive Lower Motor Neurons with involuntary discharges
- Factors that do NOT appear related to Leg Cramps
- Hypovolemia or Dehydration
- Electrolyte disturbance (Sodium, Potassium, Magnesium, Calcium, Glucose)
- Renal Function test abnormalities (Creatinine)
- Liver Function Test abnormalities (Bilirubin, albumin, ALT)
IV. Risk Factors
- See Medication Causes of Leg Cramps
- Muscle Fatigue (e.g. athletes after performing high intensity Exercise)
- Parkinsonism
- Peripheral Neuropathy
- Lumbar Spinal Stenosis
- Hemodialysis (especially with Hyperphosphatemia)
- Coronary Artery Disease
- Cirrhosis
- Hypokalemia (conflicting results)
- Venous Insufficiency
- Pregnancy
V. Symptoms
- Timing
- Nocturnal (may interfere with sleep)
- Duration may last 9 minutes or more per episode
- Episodes may recurr throughout night
- Distribution
- Characteristics
- Spasm or tightening (visible Muscle Contractions)
- Muscle Seizure or Tetany
- Muscle twinges
- Severity
- Intense pain
VI. Exam
- Nocturnal Leg Cramps will have no identifying physical findings
- Exam should focus on identifying another condition from the differential diagnosis
- Neurologic Exam
- Distal Sensation (Peripheral Neuropathy)
- Tremor or Gait Abnormality (e.g. Parkinsonism)
- Vascular exam
- Diminished pedal pulses or Ankle-Brachial Index (Claudication)
- Varicose Veins (Venous Insufficiency)
- Neurologic Exam
VII. Differential Diagnosis
- See Leg Pain
-
Peripheral Vascular Disease (Claudication)
- Exertional Muscle ache or cramp relieved with rest
-
Restless Leg Syndrome
- Does not cause Muscle tightening or pain
- Hypnic Myoclonus
- Jerking suddenly only at the onset of sleep
-
Periodic Limb Movements
- Painless, repetitive, brief (seconds) of slow leg movements (esp. foot dorsiflexion)
-
Peripheral Neuropathy
- Paresthesias or numbness type pain
-
Statin-Induced Myopathy
- Muscle aches or cramps without Muscle Contractions
VIII. Labs
- Typically normal in Nocturnal Leg Cramps
- Lab evaluation is only indicated if suspected cause on the differential diagnosis (e.g. Peripheral Neuropathy due to Vitamin B12 Deficiency)
IX. Complications
X. Management
- Identify and treat comorbid conditions
- Decrease dose or switch medications from potentially causative agents
- Preventive measures prior to bedtime
- Passive Stretching (specific gastrocnemius Muscle or calf stretches)
- Foot dorsiflexion may help to extinguish a cramp once it has occurred
- Deep massage
- Apply hot or cold packs
- Maintain adequate hydration
- Low-level Exercise for a few minutes prior to bed
- Stationary bike
- Treadmill
- Passive Stretching (specific gastrocnemius Muscle or calf stretches)
- Medications that may be considered (minimal evidence to support these)
- Medications not found helpful in Nocturnal Leg Cramps
- NSAIDs
- Calcium Supplementation
- Magnesium Supplementation
- Not found effective in idiopathic or pregnancy-related Nocturnal Leg Cramps at 60 days of use
- Magnesium Oxide may offer benefit at >60 days of use (limited evidence)
- Replace Magnesium in Magnesium Deficiency
- Kaufman (2023) Am Fam Physician 108(6): 619-20 [PubMed]
- Medications not recommended due to potential harm and marginal benefit
- Quinine sulfate
- Risk of serious Drug Interactions, Hypersensitivity Reactions and Thrombocytopenia
- FDA in 2010 recommended avoiding Quinine for Leg Cramps as risks outweigh benefits
- Quinine sulfate
XI. References
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Sign or Symptom (T184) |
SnomedCT | 102550009, 156778004, 203135001 |
English | CRAMPS LEGS, Leg cramp, Muscle cramps in leg, Cramp(s);leg, cramping leg, leg muscle cramp, cramping legs, leg cramp, leg muscle cramps, cramps in legs, muscle cramps in leg, Leg Cramps, Cramps - leg, Leg cramp (finding), Leg Cramp, Leg cramps, Cramps of lower extremities, Cramp legs, Cramps in legs, Cramps leg, Cramps legs, leg cramps |
Dutch | kramp van benen, kramp van onderste extremiteiten, kramp benen, kramp been, kramp in benen, beenkramp |
French | Crampes aux jambes, Crampes dans les jambes, Crampes des membres inférieurs, Crampe dans les jambes, CRAMPES DES MEMBRES INFERIEURS |
German | Kraempfe der unteren Extremitaeten, Beinkrampf, Kraempfe Bein, Kraempfe Beine, Krampf Beine, Kraempfe in den Beinen, BEINKRAEMPFE |
Italian | Crampi delle gambe, Crampi della gamba, Crampi alla gamba, Crampo delle gambe, Crampi degli arti inferiori |
Portuguese | Cãibra nas pernas, Cãibras na perna, Cãibra das pernas, Cãibras da perna, Cãibras das pernas, Cãibras das extremidades inferiores, CAIMBRAS NOS MEMBROS INFERIORES |
Spanish | Calambre en las piernas, Calambres en la pierna, Calambres en las piernas, Calambres en las extremidades inferiores, CALAMBRES EN EEII, calambres en la pierna, calambres musculares en la pierna (hallazgo), calambres musculares en la pierna |
Japanese | 下肢痙攣, 両下肢痙攣, カシケイレン, リョウカシケイレン |
Czech | Křeč dolních končetin, Křeče dolní končetiny, Křeče v dolních končetinách, Křeče dolních končetin, Křeče doních končetin |
Hungarian | Lábgörcs, Görcsök a lábakban, Alsó végtagok görcsei, Görcsök a lábban, Láb-görcsök, Láb görcsök |
Ontology: Charleyhorse (finding) (C0277823)
Concepts | Sign or Symptom (T184) |
ICD10 | M62.831 |
SnomedCT | 54981004 |
English | Charleyhorse (finding), Charley Horse, Charleyhorse, Charley-horse, Charley horse |
Dutch | spierkramp in een been |
French | Foulure du muscle quadriceps crural |
German | Muskelkater |
Italian | Contrattura muscolare da eccessi atletici |
Portuguese | Espasmo muscular |
Spanish | Contractura de masa muscular del muslo, inflamación muscular (hallazgo), inflamación muscular |
Japanese | チャーリーホース, チャーリーホース |
Czech | Namožení svalu |
Hungarian | Lábizomgörcs |
Ontology: Nocturnal leg muscle cramps (C0860058)
Concepts | Sign or Symptom (T184) |
Dutch | niet-ketotisch hyperglycaemisch hyperosmolair coma |
French | Crampes musculaires nocturnes aux jambes |
German | naechtliche Beinmuskelkraempfe |
Italian | Crampi muscolari notturni agli arti inferiori |
Portuguese | Cãibras nocturnas dos músculos das pernas |
Spanish | Calambres nocturnos en los músculos de las piernas |
Japanese | 夜間下肢痙攣, ヤカンカシケイレン |
Czech | Noční křeče svalů dolních končetin |
Hungarian | Nocturnalis láb-izomgörcsök |
English | Nocturnal leg muscle cramps |