A cramp is a sudden, spontaneous or over-shortened muscle contraction; while generally temporary and non-destructive, they can cause significant pain, and immobility such as paralysis-like muscles are affected. Onset is usually abrupt, and disappears by itself for a few seconds, minutes or hours. Cramps can occur in skeletal muscle or smooth muscle. Skeletal muscle skeletons can be caused by muscle fatigue or lack of electrolytes such as low sodium, low potassium or low magnesium. Muscle cramps may be due to menstruation or gastroenteritis.
Video Cramp
Pathophysiology
Muscle contraction begins with the arrangement of the brain from the action potential, which is a wave in the electrical charge that extends along the neuron. The wave travels to a group of cells in the muscle, letting the calcium ions out of the cell sarcoplasm reticula (SR), which is the storage of calcium. The removable calcium allows the myofibrils to contract under the power of adenosine triphosphate (ATP) molecules that carry energy. Meanwhile, quick calcium is pumped back to SR by a quick calcium pump. Every muscle cell contract completely; Stronger contractions of all muscles require more action potential in more muscle groups in the muscle. When the action potential stops, calcium stops flowing from the SR and relaxes the muscle. The quick calcium pump is supported by a sodium gradient, or a pent-up sodium ion coming out of the SR. The sodium gradient is maintained by a sodium-potassium pump. A lack of sodium will prevent the sodium gradient from becoming strong enough to drive the calcium pump; calcium ions will remain in the myofibrils, forcing the muscles to keep contracting and causing cramps. The cramp eventually slows down because the slow calcium pump, powered by ATP instead of the sodium gradient, pushes the calcium back into storage.
Electrolyte disturbances, especially hypokalemia and hypocalcaemia, can cause muscle cramps and tetany. This disorder can also be caused by the body that secretes large amounts of interstitial fluid, most of which is water and salt (sodium chloride). Since muscle cells contain more osmotic-active particles, the loss of osmotic-active sodium particles from muscle cells impairs the osmotic balance and therefore shrinks the muscle cells. This causes the calcium pump between the muscle sarcoplasm and the sarcoplasmic reticulum to be "shorted"; calcium ions remain bound to troponin, a continuous muscle contraction.
Cramps can occur when the muscles can not relax properly because myosin fibers do not completely break away from actin filaments. In the skeletal muscle, the ATP level should be large enough to bind to the myosin head so that they attach or release from the actin and allow for contraction or relaxation; the absence of adequate ATP levels means that the myosin head remains attached to the actin. Muscles should be allowed to recover (synthesize ATP), before the myosin fibers can be released and allow the muscles to relax. Skeletal muscle works as an antagonist pair. Contraction of one skeletal muscle requires muscle relaxation of the opponent in the pair. Attempts to force stiff muscles by low ATP to prolong (by contracting the opposing muscles) can tear muscle tissue and aggravate pain.
Maps Cramp
Differential diagnosis
Causes of cramps include hyperflexion, hypoxia, exposure to major changes in temperature, dehydration, or low blood salt. Muscle cramps can also be a symptom or complication of pregnancy; Kidney illness; thyroid disease; hypokalemia, hypomagnesemia, or hypocalcemia (as a condition); restless leg syndrome; varicose veins; and multiple sclerosis.
In early 1965, researchers observed that leg cramps and restless leg syndrome may result from excess insulin, sometimes called hyperinsulinemia.
Skeletal muscle skeleton
Under normal circumstances, skeletal muscle can be controlled voluntarily. Skeletal muscles most commonly experienced cramps are calves, thighs, and arches, and are sometimes called "Charley horses" or "corky". Such cramps are associated with severe physical activity and can be very painful; However, they can even occur when inactive and relaxed. About 40% of people who experience skeletal cramps tend to withstand extreme muscle pain, and may not be able to use all the limbs that contain "locked" muscle groups. It may take up to seven days for the muscles to return to the state of pain.
Nocturnal foot cramps
Nocturnal foot cramps are involuntary muscle contractions that occur in the calves, soles of the feet, or other muscles in the body during the night or (less frequently) at rest. Duration of nocturnal leg cramps varies, with cramps lasting from a few seconds to several minutes. Muscle pain may persist after the cramping itself ends. This cramps are more common in older people. They are quite common in teenagers and in some people while exercising at night. The exact cause of this cramp is unclear. Potential factors include dehydration, low levels of certain minerals (magnesium, potassium, calcium, and sodium, although the evidence has been mixed), and reduced blood flow through the officer's muscles in a sitting position or lying down the old. Nocturnal foot cramps (almost exclusively calf cramps) are considered "normal" during the late stages of pregnancy. They can, however, vary in intensity from mild to very painful.
The buildup of lactic acid around the muscles can trigger cramps; However, it occurs during anaerobic respiration when a person is exercising or engaging in an activity in which his heart rate accelerates. Medical conditions associated with leg cramps are cardiovascular disease, hemodialysis, cirrhosis, pregnancy, and lumbar canal stenosis. The differential diagnosis includes restless leg syndrome, claudication, myositis, peripheral neuropathy. All of this can be distinguished through careful history and physical examination.
Light stretching and massage, put pressure on the affected foot by walking or standing, or a bath or a warm bath can help end cramps. If cramps in the calf muscles, pulling your big toe gently backwards will stretch the muscles and, in some cases, cause immediate relief. There is limited evidence supporting the use of magnesium, calcium channel blockers, carisoprodol, and vitamin B12.
Quinine is no longer recommended for the treatment of leg cramps at night due to potential fatal hypersensitivity reactions and thrombocytopenia. Arrhythmias, cinchonism, hemolytic uremic syndrome may also occur at higher doses.
Smooth muscle cramp
Contraction of smooth muscle may be a symptom of endometriosis or other health problems. Menstrual cramps can also occur both before and during the menstrual cycle.
Iatrogenic Causes
Various drugs can cause nocturnal foot cramps:
- Diuretics, especially potassium sparing
- Intravenous iron sucrose (IV)
- Conjugate estrogen
- Teriparatide
- Naproxen
- Raloxifene
- Long-term beta-agonists (LABA) adrenergics
- Hydroxymethylglutaryl-coenzyme Inhibitor reductase (HMG-CoA inhibitor or statin)
In addition to being painful, nocturnal foot cramps can cause a lot of trouble and anxiety. Statins can sometimes cause myalgia and cramps among other possible side effects. Raloxifene (Evista) is a drug associated with a high incidence of leg cramps. Additional factors, which increase the likelihood of these side effects, are physical exercise, age, female gender, history of cramps, and hypothyroidism. Up to 80% of athletes using statins experience significant adverse muscle effects, including cramps; this figure appears to be about 10-25% in statin-typical populations. In some cases, side effects disappear after switching to different statins; However, they should not be ignored if they persist, because they can, in rare cases, develop into a more serious problem. Coenzyme Q10 supplementation may help to avoid some of the side effects of statins, but currently there is not enough evidence to prove the effectiveness of avoiding myopathy or myalgia.
Treatment
Stretching, massaging and drinking lots of fluids, such as water, can help in treating simple muscle cramps. With heat cramps during activity due to electrolyte abnormalities (especially loss of sodium and not calcium, magnesium, and potassium), proper fluid and sufficient salt improve symptoms.
Medication
Quinine is likely to be effective; However, due to side effects, its use should only be considered if other treatments fail. B complex vitamins, naphthyrofuryl, lidocaine, and calcium channel blockers may be effective for muscle cramps. Research also shows that pickled "juice" can be an effective drug based on high sodium and electrolyte content. Cyclobenzaprine (Flexeril) has been shown to be effective in preventing muscle cramps, although data show that effectiveness decreases when taken for more than a few weeks.
Prevention
Adequate conditioning, stretching, mental preparation, hydration, and electrolyte balance may be helpful in preventing muscle cramps.
References
External links
- Cramps in Patient UK
- Cramped Muscles (Skeletal Muscles)
Source of the article : Wikipedia
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