Muscle Cramps and Spasms: Examination

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]
    • 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?)
  • 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.