Nocturnal leg cramps are sudden, involuntary, and violent contractions of the leg muscles during sleep, often caused by factors such as cold legs, calcium deficiency, and fatigue. They are more common in the elderly and pregnant women, and are characterized by intense and painful leg muscle contractions that can wake the patient from sleep.
symptom
Typical manifestations
Nocturnal leg cramps typically present as sudden, intense, involuntary contractions of the leg muscles, often accompanied by intense pain. These contractions can cause the leg muscles to become stiff and can last from a few seconds to several minutes. This can wake the patient up from sleep with pain, tightness, or stiffness in the leg muscles. Following the cramp, the muscles may take some time to relax, during which time the patient may experience fatigue or soreness.
complication
This symptom generally has no obvious complications.
reason
Overview
There are many causes of nocturnal leg cramps, including non-disease factors such as muscle fatigue, poor posture, cold stimulation, drug side effects, pregnancy, as well as disease factors such as hypocalcemia, diabetic peripheral neuropathy, and lower limb vascular disease.
Cause of symptoms
1. Non-disease factors
(1) Muscle fatigue: Excessive exercise at night, especially anaerobic exercise, can cause muscles to contract continuously for a short period of time and produce metabolic waste. If muscles are not stretched and relaxed in time, excessive accumulation of acidic metabolic products can easily stimulate leg muscles and cause leg cramps.
(2) Bad posture: If your legs are pressed down while sleeping, or the quilt is wrapped too tightly around them, it may cause circulatory disorders in the legs, leading to local ischemia and causing leg cramps.
(3) Cold stimulation: If the legs are not covered with a blanket when sleeping, or if the air conditioner or fan blows directly on the legs, it may stimulate the leg muscles to contract strongly or the blood vessels to spasm suddenly, causing leg cramps.
(4) Side effects of medication: Certain medications, such as diuretics and statins, may cause electrolyte imbalance or muscle problems, leading to leg cramps.
(5) Pregnancy: During pregnancy, due to increased parathyroid secretion and decreased calcitonin secretion, a large amount of calcium will be lost. The growth and development of the fetus, especially bone growth, requires a large amount of calcium, and all this calcium comes from the mother. Therefore, pregnant women are prone to calcium deficiency, which will increase muscle nerve excitability and lead to leg cramps.
2. Disease factors
(1) Hypocalcemia: Hypocalcemia can lead to increased neuromuscular excitability, causing muscle spasms and leg cramps.
(2) Diabetic peripheral neuropathy: If diabetic peripheral neuropathy affects the lower limbs, resulting in a decrease in neurotrophic factors in the muscle tissue, the patient may experience leg cramps.
(3) Lower limb vascular disease: When the lower limb arteriosclerosis causes insufficient blood supply, limb ischemia will induce limb vascular spasm and cause leg cramps.
(4) Other diseases: hyponatremia, hyperparathyroidism, lumbar disc herniation, lumbar spinal stenosis, etc. may also cause nocturnal leg cramps.
Common diseases
Hypocalcemia, diabetic peripheral neuropathy, lower limb arteriosclerosis, hyponatremia, hyperparathyroidism, lumbar disc herniation, lumbar spinal stenosis
Seeking medical treatment
Outpatient indications
1. Persistent leg cramps at night that cannot be relieved on their own.
2. Accompanied by leg muscle pain or other symptoms.
3. Other severe, persistent or progressive symptoms and signs occur.
All of the above require prompt medical consultation.
Treatment department
Patients can go to departments such as neurology, orthopedics, endocrinology, and vascular surgery for treatment depending on their specific circumstances.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. A comprehensive physical examination of the legs may be performed, and it is recommended that you wear pants that are easy to put on and take off.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
5. Family members can be arranged to accompany the patient to seek medical treatment.
6. Prepare a list of questions you want to ask in advance.
7. Blood tests may be performed, and it is best to visit the doctor in the morning on an empty stomach.
What questions might a doctor ask a patient?
1. What discomforts do you currently have?
2. How long have you been experiencing this condition?
3. Are your symptoms persistent or intermittent? Is there a pattern?
4. Have your symptoms gotten worse or better since you became ill? What’s the reason?
5. Have you ever had similar symptoms before?
6. Have you ever received treatment before? How was it treated? What was the effect?
7. Are you taking any medications?
What questions can patients ask their doctor?
1. Is my condition serious? Can it be cured?
2. Why does this happen to me?
3. What treatment do I need? Do I need to be hospitalized? How long will it take to recover?
4. What are the risks of these treatments?
5. If medication is used for treatment, what are the usage, dosage and precautions of the medication?
6. What tests do I need? Are they covered by medical insurance?
7. I have other diseases. Will this affect my treatment?
8. How should I take care of myself after returning home?
9. Do I need follow-up examinations? How often?
examine
Scheduled inspection
Doctors usually first perform a physical examination on the patient to gain a preliminary understanding of the disease; they may then recommend tests such as blood tests, electrolyte tests, hormone level tests, lower limb X-rays, head CT or MRI, lower limb vascular ultrasound, electroencephalogram (EEG), electromyogram (EMG), and nerve conduction velocity tests to clarify the diagnosis and cause of the disease.
Physical examination
1. General examination
The doctor will observe whether the patient’s legs have any color changes or whether the skin temperature increases or decreases to determine whether there is a possibility of blood clots.
2. Muscle strength test
The doctor will ask the patient to flex and extend the limbs and apply resistance from the opposite direction to test the patient’s ability to overcome the resistance in order to assess the strength of the leg muscles and whether there is increased muscle tension.
3. Tendon reflex test
With the patient supine, the doctor will flex the hip and knee, dorsiflex the foot to a right angle, and tap the Achilles tendon with a percussion hammer to observe the foot’s response. Normally, the foot flexes toward the plantar surface (tends to point the toes), but diabetic peripheral neuropathy can cause decreased or absent tendon reflexes.
Laboratory tests
1. Blood routine test
A blood test can determine whether the white blood cell, neutrophil, and lymphocyte counts are normal, thereby determining whether there is infection. In addition, a blood test can also provide information about hematocrit, red blood cells, and hemoglobin, which may be related to dehydration or electrolyte imbalance.
2. Electrolyte test
Examination of electrolytes including sodium, potassium, calcium, and magnesium can rule out electrolyte imbalance factors.
3. Hormone level test
Including vitamin D3 and parathyroid hormone measurements, which can help diagnose leg cramps caused by hypoparathyroidism or vitamin D3 deficiency .
Imaging examinations
1. Lower limb X-ray
Leg muscle cramps and pain symptoms caused by fractures can be ruled out.
2. Head CT or MRI (magnetic resonance imaging)
If you suspect leg cramps are caused by a brain disease, such as a stroke or space-occupying lesion in the brain, you may need a CT or MRI of the head.
3. Lower limb vascular ultrasound
The possibility of lower limb thrombosis causing local ischemia leading to leg cramps can be ruled out.
Other tests
1. Electroencephalogram
If you suspect your leg cramps are due to a neurological condition such as epilepsy, you may need an EEG.
2. Electromyography (EMG)
Used to evaluate the functional status of nerves and muscles, it can help doctors diagnose problems such as nerve damage and muscle damage.
3. Nerve conduction velocity test (NCV)
Used in conjunction with electromyography, it can more accurately assess the functional status of the nervous system and is very helpful in diagnosing the type of neuropathy.
diagnosis
Diagnostic principles
The diagnosis of nocturnal leg cramps depends on a comprehensive assessment of the patient’s medical history, symptoms, lifestyle habits, and environmental factors, combined with necessary laboratory tests and imaging examinations to identify the underlying cause of the cramps.
Differential diagnosis
1. Hypocalcemia
It usually manifests as muscle spasms in the face, legs, or back, and may be accompanied by numbness or tingling in the lips, tongue, hands, and feet, as well as dry skin, brittle nails, and coarse hair. A blood test can determine the level of calcium ions in the serum, which helps to identify it.
2. Diabetic peripheral neuropathy
In addition to leg cramps, symmetrical numbness and pain in the lower extremities may also occur, and sometimes abnormal symptoms such as blanching of the skin may occur. Blood sugar tests will show poor blood sugar control, and nerve conduction velocity tests and electromyography can help diagnose neuropathy.
3. Lower limb arteriosclerosis
In addition to leg cramps, other symptoms may include intermittent claudication, lower limb weakness, and pain. Examinations such as arterial ultrasound, CT angiography, or magnetic resonance angiography can be used to assess the stenosis or occlusion of the lower limb arteries.
4. Hyperparathyroidism
In addition to leg cramps, you may experience symptoms of hypercalcemia, such as thirst, increased urination, and kidney stones. A blood test will show elevated calcium levels, and a parathyroid hormone test can also aid in the diagnosis.
5. Lumbar disc herniation
In addition to leg cramps, symptoms such as lower back pain, numbness and pain in the lower limbs are often present, and may indicate sciatic nerve compression. Lumbar spine CT, MRI, or X-rays can confirm the diagnosis.
treat
Expected treatment
The primary goal of treatment is to relieve cramps, reduce pain, and improve the patient’s quality of life. The primary goal is to identify the cause and treat the underlying condition. Medication, surgery, and physical therapy can all improve symptoms.
Treatment of the cause
1. Muscle fatigue
Patients should get enough rest and can have moderate massage, and the symptoms will usually gradually improve.
2. Cold stimulation
Patients should keep warm and apply hot compresses or massage their legs to relieve symptoms.
3. Side effects of medication
In this case, you can consult a doctor and stop or change the medication under the doctor’s guidance.
4. Hypocalcemia
Supplement calcium under the guidance of a doctor. Commonly used drugs include calcium gluconate, calcium carbonate, etc., and treat the cause of hypocalcemia.
5. Diabetic peripheral neuropathy
Under the guidance of a doctor, use metformin, acarbose, insulin and other drugs to control blood sugar, and use nerve nourishing drugs such as coenzyme A, adenosine triphosphate, cytidine diphosphate choline, vitamin B1 and other drugs for treatment .
6. Lumbar disc herniation
Patients can use non-steroidal anti-inflammatory drugs such as diclofenac sodium and ibuprofen, or muscle relaxants such as eperisone and tizanidine to relieve pain as prescribed by the doctor. They can also take nerve nourishing drugs such as methylcobalamin. If necessary, traction, extracorporeal shock wave, electrotherapy, phototherapy or surgical treatment can be performed.
Drug treatment
See treatment of cause for details.
Related drugs
Calcium gluconate, calcium carbonate, metformin, acarbose, insulin, coenzyme A, adenosine triphosphate, citicoline, vitamin B1 , diclofenac sodium, ibuprofen, eperisone, tizanidine, methylcobalamin
Surgical treatment
See treatment of cause for details.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and physical condition, and may vary from person to person.
Estimated treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.