Author:

Editor(s):

Updated:

ULY CLINIC

12 Septemba 2025, 01:37:59

Muscle spasms

Muscle spasms are strong, painful, involuntary contractions of muscles. They can occur in any muscle but are most common in the calf and foot. While often resulting from muscle fatigue, exercise, or pregnancy, spasms may also occur due to electrolyte imbalances, neuromuscular disorders, or certain drugs. They are frequently precipitated by quick or jerking movements and are usually relieved by slow stretching.

Emergency interventions

Frequent or widespread spasms with paresthesia: Evaluate for hypocalcemia using Chvostek’s and Trousseau’s signs.
Respiratory assessment: Monitor for laryngospasm; provide supplemental oxygen, intubation, and mechanical ventilation if necessary.
Laboratory and supportive care: Draw blood for calcium, electrolytes, and ABG analysis. Start IV calcium supplementation.
Cardiac monitoring: Observe for arrhythmias and be prepared for resuscitation.

History and physical examination

History

Determine onset, duration, and precipitating activities.
Assess pain intensity, aggravating/relieving factors, and associated symptoms such as weakness or sensory changes.
Review drug and dietary history, recent vomiting or diarrhea, and hydration status.

Physical Examination

Evaluate muscle strength and tone.
Inspect all major muscle groups for spasm occurrence.
Check peripheral pulses, limb color, temperature, capillary refill (<3 s), and edema.
Assess hydration signs (dry mucous membranes, skin turgor).
Test reflexes and sensory function in all extremities.

Medical Causes

Condition	Features	Associated Findings
Amyotrophic lateral sclerosis (ALS)	Muscle spasms with progressive weakness/atrophy	Fasciculations, hyperactive DTRs, dysphagia, drooling, respiratory compromise
Arterial occlusive disease	Spasms and intermittent claudication in legs	Pain, pallor/cyanosis, decreased pulses, hair loss, edema, ulcers
Cholera	Spasms with severe dehydration	Watery diarrhea, vomiting, thirst, weakness, hypotension, tachycardia
Dehydration	Limb and abdominal cramps	Slight fever, dry mucous membranes, tachycardia, orthostatic hypotension, seizures
Hypocalcemia	Tetany — cramps and carpopedal/facial spasms	Paresthesia of lips/fingers/toes, hyperactive DTRs, fatigue, palpitations, arrhythmias
Muscle trauma	Localized mild-severe spasms	Pain, swelling, redness, warmth at injury site
Respiratory alkalosis	Acute spasms with twitching	Carpopedal spasm, circumoral paresthesia, vertigo, syncope, anxiety, possible arrhythmias
Spinal injury/disease	Muscle spasms in affected regions	Cervical or thoracic injury, pain, localized spasticity

Other causes

Drugs: Diuretics, corticosteroids, estrogens can precipitate spasms.

Special Considerations

Alleviation: Slowly stretch the affected muscle opposite to the contraction.
Analgesia: Mild pain medications may be administered if necessary.
Diagnostics: Serum calcium, sodium, CO₂, thyroid function tests, blood flow studies, or arteriography may be indicated.

Patient counseling

Educate on pain relief strategies and proper muscle stretching techniques.
Explain immobilization and wrapping of injured muscles.
Train in assistive device use as needed.

Pediatric pointers

Muscle spasms are rare in children.
May indicate hypoparathyroidism, osteomalacia, rickets, or congenital torticollis.

References

Katzberg HD, Khan AH, So YT. Assessment and symptomatic treatment for muscle cramps (an evidence-based review): Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2010;74:691–696.
Miller KC, Knight KL. Electrical stimulation cramp threshold frequency correlates well with the occurrence of skeletal muscle cramps. Muscle Nerve. 2009;39:364–368.