A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin, mucous membranes, extremities [due topossible cause of cramps: edema (water retention in tissues)][Leading symptoms Muscle cramp: involuntary and painful muscle contraction (often at night and at rest), affects mainly extremities
- Is accompanied by a hardening of the affected muscle
- Usually lasts only a short time
- Self-limiting, that is, it stops by itself again]
[Leading symptoms spasm: at time intervals repetitive cramping contraction of individual muscles or muscle groups.
- Uniform and static contraction, usually lasting for a relatively long time interval (tonic spasm).
- Involuntary, rhythmic contractions of muscles or muscle groups, i.e., alternating contraction and relaxation of muscle fibers. This often occurs in short temporal succession (clonic spasm, clonus)]
[Associated symptoms spasm:
- Increased reflexes/pathological reflexes.
- Muscle paresis (paralysis)
- Slowed movement]
- Skin, mucous membranes, extremities [due topossible cause of cramps: edema (water retention in tissues)][Leading symptoms Muscle cramp: involuntary and painful muscle contraction (often at night and at rest), affects mainly extremities
- Inspection and palpation (palpation) of the thyroid gland [due topossible cause of spasms: thyroid dysfunction] [due todifferential diagnosis: hypothyroidism (underactive thyroid)].
- Auscultation (listening) of the heart.
- Auscultation of the lungs [due topossible cause: hyperventilation (increased breathing)].
- Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knock pain?, cough pain?, defensive tension?, hernial orifices?, kidney bearing knock pain?)
- Inspection (viewing).
- Neurological examination – including strength testing, triggering of reflexes, etc.[due topossible causes of the spasms:
- Amyotrophic lateral sclerosis (ALS) – fatal systemic disease leading to muscle atrophy.
- Neuromyotonia – disease that leads to sudden and episodic muscle activity with permanent tension of the muscles.
- Polyneuropathy]
[due todifferential diagnoses to convulsions:
- Dystonia – disorder of the state of tension of the musculature, unspecified.
- Neuromyotonia – disorder leading to sudden and episodic muscle activity with permanent tension of the musculature.
- Spastic tone increase
- Stiff-man syndrome – condition leading to increasing trunk and limb stiffness]
[due toPossible causes or differential diagnoses to spasticity:
- Apoplexy (stroke)
- Hereditary spastic spinal paralysis (HSP; paraplegia) – genetic condition that leads to increasing spasticity and paralysis of the legs; the disease can start in early childhood, but even 70-year-olds can still develop it. Men suffer from it twice as often as women.
- Hypoxic brain injury – brain damage that is due to a lack of oxygen to the brain.
- Multiple sclerosis (MS)
- Spinal cord lesion, unspecified
- Traumatic brain injury (TBI)]
- Orthopedic examination [due todifferential diagnoses to convulsions:
- Brody syndrome – pseudomyotonic dysfunction of skeletal muscles.
- Contracture, unspecified – involuntary permanent muscle shortening leading to joint constraint.
- Metabolic myopathies – muscle changes caused by metabolic disorders]
- Health Check
Square brackets [ ] indicate possible pathological (pathological) physical findings. The following signs may indicate tetany:
- Chvostek’s sign – after tapping the facial nerve trunk (1-2 cm in front of the earlobe/jaw joint), there is a subsequent contraction (twitching) of the facial muscles.
- Trousseau sign – paw position that occurs when the upper arm is compressed (for example, after pumping a blood pressure cuff above systolic blood pressure).
- Erb’s sign – increased galvanic (electrical) excitability of motor nerves.
- Fibularis sign – tapping the superficial fibular nerve (fibular nerve) behind the head of the fibula results in brief foot pronation (foot elevation and inward rotation of the foot)
- Schulze tongue phenomenon – by tapping the tongue comes to the dent / bulge formation.