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Leg cramps - unknown cause - Management
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How should I assess someone with leg cramps to identify a cause?
- Idiopathic leg cramps are indicated by a history of sudden calf, thigh, or foot pain; most often in an elderly person, and at night (or when resting). The pain usually lasts for several minutes and there are no abnormal findings on physical examination.
- The following points in a history and examination may help exclude secondary causes (see Table 1) or other conditions which mimic leg cramps:
- Symptoms of calf pain with exercise, an urge to move the legs, or leg numbness or weakness.
- Signs of muscle wasting and fasciculations, skin pallor, calf swelling, or varicose veins. Abnormal leg pulses, capillary refill, loss of sensation or power, or altered reflexes.
- History (or symptoms) of an underlying condition (e.g. thyroid disease).
- Medication (e.g. diuretics, salbutamol, nifedipine).
- Investigations are usually not needed, unless an underlying cause is suspected (e.g. blood tests for electrolytes, calcium, thyroid function tests, fasting glucose, liver function tests, magnesium, and creatinine kinase).
Additional information
- Other conditions that may mimic leg cramps [Miller and Layzer, 2005]:
- Focal muscle pain:
- With swelling — trauma, ruptured tendon, Baker's cyst, deep vein thrombosis, thrombophlebitis, infection, inflammation (myositis).
- Without swelling — exertional myalgia, peripheral arterial disease, restless legs syndrome.
- Generalized muscle pain:
- With muscle weakness — inflammation (polymyositis), infection (toxoplasmosis), metabolic (alcohol, statins), Guillain–Barré syndrome.
- Without muscle weakness — polymyalgia rheumatica, collagen-vascular disease, Parkinsonism, fibromyalgia.
- Dystonia — involuntary muscle contractions that lead to abnormal movements. Can be generalized or focal (e.g. writer's, pianist's, or typist's cramp).
- Myoclonus — sudden, involuntary jerking of a muscle or group of muscles without pain. For example, while drifting off to sleep.
- Secondary causes of leg cramps are shown in Table 1.
Table 1. Secondary causes of leg cramps.
Cause | Conditions | Symptoms and signs |
|---|
Exercise | — | Cramp often occurs during rest after exercise. |
Lower motor neurone problems | Motor neurone disease Radiculopathy (e.g. peripheral nerve injury) Neuropathy (e.g. peripheral neuropathy) | Wasting muscles, power loss, and absent reflexes. |
Metabolic problems | Renal disease (50% of people with uraemia complain of leg cramps) Liver disease Hyperthyroidism Hypothyroidism (20–50% of people) | Hyperthyroidism may lead to myopathy and associated leg cramps. Hypothyroidism is associated with weakness, enlarged muscles, and painful muscle spasms. |
Acute volume depletion (possible low sodium levels) | Heat cramps (miners, firemen, athletes) Diarrhoea, vomiting Diuretics | — |
Medication | Diuretics, salbutamol, raloxifene, nifedipine, phenothiazines, penicillamine, nicotinic acid, statins | — |
Pregnancy | — | 30% in the third trimester. Cramps stop after delivery. |
|
Basis for recommendation
CKS did not identify any national guidelines on the assessment of leg cramps in primary care. These recommendations are based on expert opinion from review articles [Miller and Layzer, 2005; Shaker et al, 2005].
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