STUDY - Technical - New Dacian's Medicine
Muscle
spasms (spasticity) (Classical / Allopathic Medicine)
Muscle spasms,
also known as muscle cramps or muscle hypertonicity, are
strong, painful contractions. They can occur in virtually any
muscle but are most common in the calf and foot. Muscle spasms
typically occur from simple muscle fatigue, commonly after
exercise and during pregnancy. However, they may also develop
as a result of an electrolyte imbalance, a neuromuscular
disorder, or the use of certain drugs. They're typically
precipitated by movement, and can usually be relieved by slow
stretching.
Spasticity is a
state of excessive muscle tone manifested by increased
resistance to stretching and heightened reflexes. It's
commonly detected by evaluating a muscle's response to passive
movement; a spastic muscle offers more resistance when the
passive movement is performed quickly. Caused by an
upper-motor-neuron lesion, spasticity usually occurs in the
arm and leg muscles. Long-term spasticity results in muscle
fibrosis and contractures.
ALERT:
If the patient complains of frequent or unrelieved spasms in many muscles, accompanied by paresthesia in his hands and feet:
- quickly attempt to elicit Chvostek's and Trousseau's signs
- evaluate the respiratory function, watching for the development of laryngospasm
- initiate emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
If the patient complains of frequent or unrelieved spasms in many muscles, accompanied by paresthesia in his hands and feet:
- quickly attempt to elicit Chvostek's and Trousseau's signs
- evaluate the respiratory function, watching for the development of laryngospasm
- initiate emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient about the onset, duration, and progression of muscle spasms, noting whether specific events precipitate onset.
Ask the patient if he has experienced other muscular changes or related symptoms.
Ask the patient when the spasms began and how long they typically last.
Ask the patient if the spasms cause pain. If so, have him describe the pain. Does anything alleviate or aggravate the pain?
Ask the patient about other signs and symptoms, such as weakness, sensory loss, and paresthesia.
Ask the patient if he performed a recent strenuous exercise or suffered a recent injury.
Review the patient's medical history, especially noting degenerative or vascular disease.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. (Drugs that commonly produce spasms include diuretics, corticosteroids, and estrogens.) Also, ask the patient about alcohol intake.
Ask the patient about the onset, duration, and progression of muscle spasms, noting whether specific events precipitate onset.
Ask the patient if he has experienced other muscular changes or related symptoms.
Ask the patient when the spasms began and how long they typically last.
Ask the patient if the spasms cause pain. If so, have him describe the pain. Does anything alleviate or aggravate the pain?
Ask the patient about other signs and symptoms, such as weakness, sensory loss, and paresthesia.
Ask the patient if he performed a recent strenuous exercise or suffered a recent injury.
Review the patient's medical history, especially noting degenerative or vascular disease.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. (Drugs that commonly produce spasms include diuretics, corticosteroids, and estrogens.) Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Evaluate muscle strength and tone. Then, check all major muscle groups, noting whether movement precipitates spasms.
Test the presence and quality of all peripheral pulses, and examine the limbs for color and temperature changes. Test capillary refill time and inspect for edema, especially in the involved area.
Test reflexes and evaluate motor and sensory function in all extremities. Also, check for muscle wasting and contractures.
Take the patient's vital signs and perform a complete neurologic examination.
Evaluate muscle strength and tone. Then, check all major muscle groups, noting whether movement precipitates spasms.
Test the presence and quality of all peripheral pulses, and examine the limbs for color and temperature changes. Test capillary refill time and inspect for edema, especially in the involved area.
Test reflexes and evaluate motor and sensory function in all extremities. Also, check for muscle wasting and contractures.
Take the patient's vital signs and perform a complete neurologic examination.
SPECIAL
CONSIDERATIONS:
During your examination, keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. If necessary, provide ventilatory support, and monitor the patient closely.
During your examination, keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. If necessary, provide ventilatory support, and monitor the patient closely.
PEDIATRIC
POINTERS:
Muscle spasms rarely occur in children. However, their presence may indicate hypoparathyroidism, osteomalacia, rickets or, rarely, congenital torticollis.
In children, muscle spasticity may be a sign of cerebral palsy.
Muscle spasms rarely occur in children. However, their presence may indicate hypoparathyroidism, osteomalacia, rickets or, rarely, congenital torticollis.
In children, muscle spasticity may be a sign of cerebral palsy.
PATIENT
COUNSELING:
Teach the patient to help alleviate muscle spasms by slowly stretching the affected muscle in the direction opposite the contraction.
Teach the patient to help alleviate muscle spasms by slowly stretching the affected muscle in the direction opposite the contraction.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.