Muscle cramp: Main theories as to aetiology

Jansen, P. H. P.; Joosten, E.M.G.; Vingerhoets, H.M.

doi:10.1007/bf01735062

Cited by 46 publications

(31 citation statements)

References 27 publications

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“…3 Prior neurophysiologic studies have shown that cramps arise from spontaneous discharges of motor nerves rather than from within the muscle itself. 10 It was speculated that decreased intravascular volume associated with hypoalbuminemia in liver disease results in increased muscle membrane hyperexcitability by lowering the "threshold frequency" required for the induction of a muscle cramp. In the current study, cirrhotic patients with cramps had significantly lower serum albumin levels, although the magnitude of difference (3.1 ± 0.6 g/dL vs 3.3 ± 0.7 g/dL) does not seem to be clinically significant.…”

Section: Discussionmentioning

confidence: 99%

“…10 Potential primary hypotheses include neurologic, muscular, endocrine, or electrolyte imbalance. 2,4,[9][10][11] Diuretic use in cirrhotic patients also has been implicated as a cause of muscle cramps through its effects on serum electrolyte balance and plasma volume. However, Abrams et al 2 found that patients with congestive heart failure had a lower prevalence of cramps compared with patients with cirrhosis despite higher diuretic use, suggesting that diuretic use may not be the primary precipitating factor for muscle cramps.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…2,3,[7][8][9] The exact mechanism behind the occurrence of muscle cramps remains elusive. 10 Potential primary hypotheses include neurologic, muscular, endocrine, or electrolyte imbalance. 2,4,[9][10][11] Diuretic use in cirrhotic patients also has been implicated as a cause of muscle cramps through its effects on serum electrolyte balance and plasma volume.…”

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confidence: 99%

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Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Chatrath¹,

Ghabril²,

Tandra³

et al. 2011

Gastroenterology

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PURPOSE-Patients with cirrhosis often experience muscle cramps with varying severity. We investigated the factors associated with the prevalence and morbidity associated with muscle cramps.METHODS-A total of 150 adult patients with cirrhosis were enrolled consecutively. Cramp questionnaire with visual analogue scale for pain, Chronic Liver Disease Questionnaire (CLDQ), and blood for measurement of 25-(OH) vitamin D levels were obtained after informed consent.RESULTS-A total of 101 patients (67%) reported muscle cramps in the preceding 3 months. Patients with cramps had significantly lower serum albumin (3.1 ± 0.6 g/dL vs 3.3 ± 0.7 g/dL, P = .04) and CLDQ scores (107 ± 37 vs 137 ± 34, P < .0001) compared with those without cramps. The median composite symptom score, defined as product of frequency and severity of cramps, in the study cohort was 12 with a range of 0.3 to 200. There were no clinical or biochemical predictors for occurrence of any cramps or severe cramps (composite symptom score > 12). Muscle cramps (P < .001) and hepatic encephalopathy (P = .009) were associated independently with decreased CLDQ scores. Vitamin D deficiency was seen in 66% of the study cohort, but the serum 25-(OH) vitamin D levels were not significantly different between patients with and without cramps (18.0 ± 8.9 ng/mL vs 19.6 ± 9.5 ng/mL, P = .49).CONCLUSIONS-Muscle cramps are associated with significantly diminished quality of life in patients with cirrhosis. More research is needed to better understand their mechanism to develop effective treatment. KeywordsChronic liver disease questionnaire; Cirrhosis; Muscle crampsThe association of muscle cramps with cirrhosis was first reported by Konikoff and Theodor 1 in 1986 when they made their observation of repeated painful muscle cramps by patients with cirrhosis. They proposed that the strikingly high incidence and uniformity of the phenomenon may justify the inclusion of painful muscle cramps among the recognized symptoms of cirrhosis. 1 Subsequently, several studies have confirmed that muscle cramps are a common symptom of cirrhosis. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript them as sudden, uncomfortable squeezing or contraction of a muscle, lasting seconds to minutes. An electromyogram of a cramping muscle reveals involuntary repetitive firing of motor unit action potentials at high rates (up to 150 per second) producing a sustained muscle contraction. 5,6 These cramps are not associated with any progressive motor neuron disease or chronic neuromuscular disability and are different from muscle contracture, dystonia, and tetany. 5,6 The prevalence is varied and ranges from 29% to 88% depending on the inclusion criteria used by the investigators. 2,3,[7][8][9] The exact mechanism behind the occurrence of muscle cramps remains elusive. 10 Potential primary hypotheses include neurologic, muscular, endocrine, or electrolyte imbalance. 2,4,[9][10][11] Diuretic use in cirrhotic patients also has been implicated as a cause of muscle cramps thro...

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Section: Discussionmentioning

confidence: 99%

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

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Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Chatrath¹,

Ghabril²,

Tandra³

et al. 2011

Gastroenterology

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“…D uring th e tre a tm e n t period, participants were randomly assigned 300 mg daily dose of hydroquinine hydrobromide dihydrate (54 participants) or placebo (58). The frequency, severity (1)(2)(3)(4)(5)(6)(7)(8)(9)(10), duration, and location of muscle cramps, as well as any side-effects, were recorded by participants in daily diaries. The primary outcome measures were the number of muscle cramps and the number of days during which the participants had muscle cramps (cramp-days).…”

Section: Discussionmentioning

confidence: 99%

Randomised controlled trial of hydroquinine in muscle cramps

Jansen

Veenhuizen²,

Wesseling³

et al. 1997

The Lancet

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of the risk of gynaecomastia associated with cimetidine, omeprazole and other antiulccr medications. BM J 1994; 308: 503-06. Jick H, Jick SS, Gurewich V, Myers MW, Vasilakis C. Risk of idiopathic cardiovascular death and nonfatal venous thromboembolism in women using oral contraceptives with differing progestagen components. Lancet 1995; 346: 1589-93. Methods This randomised, double-blind, placebo-controlled, parallel-group trial consisted of three consecutive 2-week periods: qualification, treatment, and washout. 68 women and 44 men who had at least three muscie cramps per week w ere e n ro lle d . D uring th e tre a tm e n t period, participants were randomly assigned 300 mg daily dose of hydroquinine hydrobromide dihydrate (54 participants) or placebo (58). The frequency, severity (1-10), duration, and location of muscle cramps, as well as any side-effects, were recorded by participants in daily diaries. The primary outcome measures were the number of muscle cramps and the number of days during which the participants had muscle cramps (cramp-days).Findings We excluded five participants from both groups from the analysis. Thus, data from 49 hydroqulnine-group p a rticip a n ts and 53 placebo-group p a rtic ip a n ts were analysed. In both groups the to ta l number of muscle cramps and the number of cramp-days decreased during the tre a tm e n t period compared w ith the qualification period. However, these improvements were greater in the hydroquinine group th a n in th e placebo group. The Correspondence to: Prof A L M Verbeek hydroquinine-group participants reported a median of 8 (95% Cl 7-12) fewer cramps and median of 3 (1-4) fewer cramp-days, whereas those on placebo reported only 3 (0-5) fewer cramps and 1 (0-5) fewer cramp-days. 32 (65%) of participants in the hydroquinine group had a 50% or greater reduction in the number of muscle cramps. After the onset of cramps, hydroquinine did not reduce the severity or duration of cramps. We also found a sustained effect after treatment had stopped. Hydroquinine was well tolerated, and resulted in only mild side-effects. InterpretationIn our study, 300 mg hydroquinine was safe to take in the short-term and significantly more effective than placebo in the prevention of frequent, ordinary muscle cramps. This therapeutic effect outlasted the duration of treatment.

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“…Increased sweat rate causes water and electrolyte losses, which leads to both dehydration and sodium depletion (Wexler, 2002). The primary concern with sodium losses in athletes is the resultant hyperexcitability of specific motor nerve endings due to mechanical stress and changes in surrounding electrolyte concentrations (Jansen, Joosten, & Vingerhoets, 1990;Layzer, 1994). Serum sodium concentrations were decreased in tennis (Bergeron, 2003a;Bergeron, 1996) and football players (Stofan et al, 2005) after exercising in the heat.…”

Section: Possible Mechanisms Contributing To Eamcmentioning

confidence: 99%

Effect of Performance Feedback on Perceived Knowledge and Likelihood to Pursue Continuing Education

Eberman¹

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To all my family and friends, I am thankful for your patience and willingness to help, even when it seemed helpless. To my mother and father, thank you for instilling the need to learn and the desire to succeed. To Ryan, you remind me to be content with today, but give me hope for more tomorrow. To Blair, thank you for bringing out the child in me-we will always be young at heart if we have each other. To my running buddies Jenn and Pattie, thank you for helping me find a way to relieve the anxiety to this seemingly impossible obstacle. To all those that helped in my many times of need, you know who you are and I am indebted to you always. The purpose of this study was to assess the effect of performance feedback on Athletic Trainers' (ATs) perceived knowledge (PK) and likelihood to pursue continuing education (CE). The investigation was grounded in the theories of "the definition of the situation" (Thomas & Thomas, 1928) and the "illusion of knowing," (Glenberg, Wilkinson, & Epstein, 1982) suggesting that PK drives behavior. This investigation measured the degree to which knowledge gap predicted CE seeking behavior by providing performance feedback designed to change PK.A pre-test post-test control-group design was used to measure PK and likelihood to pursue CE before and after assessing actual knowledge. ATs (n=103) were randomly sampled and assigned to two groups, with and without performance feedback. Two independent samples t-tests were used to compare groups on the difference scores of the dependent variables. Likelihood to pursue CE was predicted by three variables using multiple linear regression: perceived knowledge, pre-test likelihood to pursue CE, and knowledge gap. In this investigation, performance feedback significantly increased participants' likelihood to pursue CE. Pre-test knowledge gap was a significant predictor of likelihood to pursue CE, regardless if performance feedback was provided. ATs may have selfassessed and engaged in internal feedback as a result of their test-taking experience.These findings indicate that feedback, both internal and external, may be necessary to trigger CE seeking behavior.

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Muscle cramp: Main theories as to aetiology

Cited by 46 publications

References 27 publications

Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Prevalence and Morbidity Associated With Muscle Cramps in Patients With Cirrhosis

Randomised controlled trial of hydroquinine in muscle cramps

Effect of Performance Feedback on Perceived Knowledge and Likelihood to Pursue Continuing Education

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