Muscle cramp

“ In its most common form, that of cramp in the limbs, this disorder comes on suddenly, often during sleep, the patient being aroused by an agonizing feeling of pain in the calf of the leg or back of the thigh, accompanied in many instances with a sensation of sickness or faintness from the intensity of the suffering. During the paroxysm the muscular fibres affected can often be felt gathered up into a hard knot. ”

“ Which accounts for the continuance of the contraction, and distinguishes this disease from other convulsions, which are relaxed and exerted alternately. Hence whatever may be the cause of the primary pain, which occasions the cramp of the calf of the leg, the secondary one is relievable by standing up, and thus by the weight of the body on the toes forcibly extending the contracted muscles. For the cause, which induces these muscles of the calf of the leg to fall into more violent contraction than other spasmodic muscles, proceeds from the weakness of their antagonist muscles ”

“ Cramps are sharp, exceedingly painful muscular spasms occurring in the muscles of the calf of the leg, the toes, etc. The42 expectant mother in the later months of pregnancy awkwardly turns in bed, is suddenly awakened and without a moment's warning, is seized with a most excruciating pain in her leg or toe. The most effectual treatment for these cramps is quickly to apply a very cold object to the cramping muscle. Extremes of either heat or cold usually relieve as well as the vigorous grasping or kneading of the muscle. A hot foot bath on going to bed will often prevent an attack. ”

“ The muscles of the legs and feet are the most commonly affected with cramp, especially after great exertion. The best treatment is immediately to stand upright, and to well rub the part with the hand. The application of strong stimulants, as spirits of ammonia, or of anodines, as opiate liniments, has been recommended. When cramp occurs in the stomach, a teaspoonful of sal volatile in water, or a dram glassful of good brandy, should be swallowed immediately. ”

“ CRAMP
—is a most extraordinary spasmodic muscular contraction of some particular limb, where the stiffness and rigidity of the part exceeds belief. To those who have never been accustomed to such cases, they are serious and alarming; for the strength of two men is inadequate to the task of rendering the affected limb pliable and active. The cause is sometimes not to be ascertained; but it has frequently arisen from a horse, in a high state of perspiration, having been placed in a current of cold air, or a damp stable, and in a few minutes found not able to move. ”

“ In acute muscular rheumatism, there is at first a dull pain in the muscles, which gradually increases. When the affected muscles are not used the pain is slight, and certain positions may be assumed without inducing it constantly; but in movements which involve contraction of the muscles the pain is very violent. In some cases, the disease is movable, changing from one muscle to another, but usually it remains fixed in the muscle first attacked. The appetite and digestion are not often impaired, and there is no fever. ”

“ To find a parallel to the severity of this kind of pains we must turn to the case of organic tumors, which, from their position, structure, and mode of growth, necessarily exercise continuous and severe pressure on the branches or the trunk of a nerve; or to the class of pains which attend severe cramp, or tonic contraction of muscles. Now, it can scarcely be doubted that in the latter instance there is an abnormally rapid and violent destruction of tissue going on; at the very least there is an extraordinarily violent and irregular manifestation of motor force. ”

“ Sometimes the effort is one that would scarcely be thought likely to rupture a muscle, as in the case recorded by Pagenstecher, where a professional athlete, while sitting at table, ruptured his biceps in a sudden effort to catch a falling glass. It would appear that the rupture is brought about not so much by the contraction of the muscle concerned, as by the contraction of the antagonistic muscles taking place before that of the muscle which undergoes rupture is completed. The violent muscular contractions of epilepsy, tetanus, or delirium rarely cause rupture. ”

“ The site of rupture in individual muscles is remarkably constant, and is usually at the junction of the muscular and tendinous portions. When rupture takes place through the belly of a muscle, the ends retract, the amount of retraction depending on the length of the muscle, and the extent of its attachment to adjacent aponeurosis or bone. The biceps in the arm, and the sartorius in the thigh, furnish examples of muscles in which the separation between the ends may be considerable. ”

“ If the injury be really to the nerves which control the muscles, as is generally the case, the matter is more difficult. The muscle swells, but this is primarily due to the overstrain of the nerves in the sudden effort they make to bear a crushing load on the muscle. The pain is from pressure in the swelling, and also from inflammatory action. ”

“ The tendinous reflexes were normal, but irritation of the soles produced a peculiar cramp of the leg-flexors and bending of the knees. There is a species of muscular increase which resembles pseudo-hypertrophic paralysis. ”

“ The paralysis is usually symmetrical on both sides. Although the extensors are affected most, the flexors nearly always participate, and a careful investigation will show that they are weakened. If the paralysis continues, there is a wasting and degeneration of the muscle, but this is seen in paralysis from any cause. The muscular affection may cause deformities in the hands, shoulders, &c. Anæsthesia of portions of the skin is generally present in a greater or less degree. ”

“ They are often cast to the ground with great violence, and not infrequently are thrown to a distance of several feet. This is caused by the violent muscular contraction produced by the electric shock, and it may occasion, like any [671] violent push or fall, severe injuries from contact with the various objects against which they may be forced. Although much rarer, it is also possible that the violence of these muscular contractions may be such as of themselves to cause injury, as rupture of a muscle or tendon. ”

“ Thus RD is present in infantile paralysis, acute neuritis, &c., but absent in progressive muscular atrophy where the wasting of nerve and muscle takes place extremely slowly. The reaction of degeneration in the nerve is shown by disappearance of reaction to either kind of current, preceded for some days by hyperexcitability to either current. Where the muscle wasting is due to a lesion in the muscle alone, as in ischaemic myositis (usually due to injury from tight bandaging or badly applied splints) , no reaction of degeneration is found; the only change is a loss of power in the contraction. ”

“ Sometimes a muscle disappears entirely; usually the connective-tissue elements, including the interstitial cellular and adipose tissue, undergo proliferation, so as to mask the wasting of the muscles to some extent.
The morbid process in the nervous system is also a simple degenerative process. The nerve-fibres and cells atrophy first, and the connective-tissue proliferation which marks the sclerotic change of the diseased area is a secondary process. There is still considerable dispute among authorities as to which segment of the motor-conduits the degeneration begins in. ”

“ In miners, who work for long periods lying on the side, the muscle may be paralysed by direct pressure on the terminal filaments of the nerve, and the nerve may also be involved as a result of disease in the sub-deltoid bursa.
The deltoid is wasted, and the acromion unduly prominent. In recent cases paralysis of the muscle is easily detected. In cases of long standing it is not so simple, because other muscles, the spinati, the clavicular fibres of the pectoral and the serratus, take its place and elevate the arm; there is always loss of sensation on the lateral aspect of the shoulder. ”

“ It is interesting to notice that certain muscles are always exempt from paralysis. With the exception of a single case of paralysis of one temporal muscle, cited by Seguin,22 the muscles of the head, eyeballs, ears, larynx, and pharynx are always exempt, as are also the diaphragm and intercostals. The arrest of the spinal lesion below the medulla explains the immunity of muscles supplied by the vagus and spinal accessory nerves. But since the cervical plexus is often involved, the constant escape of the diaphragm, innervated by the phrenic nerve which comes from this plexus, is remarkable. ”

“ It has been stated, that the excessive use of the muscles, as much as their inactivity, tends to weaken them. Nothing is more painful, than the keeping a muscle constantly on the stretch, without any relaxation [Pg 133] or change. This can be realized, by holding out an arm, perpendicularly to the body, for ten or fifteen minutes, if any one can so long bear the pain. Of course, confinement to one position, for a great length of time, tends to weaken the muscles thus strained. ”

“ The cramp in the calf of the leg is another kind of convulsion, which generally commences in sleep, occasioned by the continual increase of irritability from internal stimuli, or of sensibility, during that state of our existence. The cramp is a violent exertion to relieve pain, generally either of the skin from cold, or of the bowels, as in some diarrhœas, or from the muscles having been previously overstretched, as in walking up or down steep hills. ”

“ Attacks last usually but a few days, but may be prolonged for weeks. The pain may be dull, as if the muscle had been bruised, but is often very sharp and cramplike. There is, commonly, slight, if any, fever, and no general disturbance of the health. ”

“ In fractures by indirect violence the soft parts do not suffer by the violence causing the fracture, but they may be injured by displacement of the fragments.
In fractures by muscular action the bone is broken by “traction” or “tearing.” The sudden and violent contraction of a muscle may tear off an epiphysis, such as the head of the fibula, the anterior superior iliac spine, or the coronoid process of the ulna; or a bony process may be separated, as, for example, the tuberosity of the calcaneus, the coracoid process of the scapula, or the larger tubercle (great tuberosity) of the humerus. ”

“ In the process of repair, one or both ends of the muscle or tendon may become fixed by adhesions to adjacent structures, and if the distal portion of a muscle is deprived of its nerve supply it may undergo degeneration and so have its function impaired.
Rupture of a muscle or tendon is usually the result of a sudden, and often involuntary, movement. As examples may be cited the rupture of the quadriceps extensor in attempting to regain the balance when falling backwards; of the gastrocnemius, plantaris, or tendo-calcaneus in jumping or dancing ”

“ That true rheumatic processes may extend from serous or fibrous structures to contiguous muscular masses has, in the absence of demonstration, been assumed by many writers of authority, but that acute or subacute rheumatism, with its recognized characters, ever manifests itself primarily or exclusively as an inflammation of muscle-substance is an assumption wholly without clinical or pathological support. ”

“ The muscle-engine, in like manner, deteriorates if it is allowed to stand idle. Sometimes this occurs in disease. In paralysis the limb cannot move, and the inactive muscles waste, become thin and flaccid, and undergo curious molecular changes, converting the muscular matter into fatty-like particles. ”

“ This would seem to prove that the spasms in question are not reflex, but either central and spinal, or else muscular—an inference which is strengthened by their being tonic and not clonic. As stated, the spasms, or cramps, frequently affect the limbs, but comparatively seldom involve the muscles of the chest or abdomen, and those of the face hardly ever. They are almost the only causes of pain in the disease, which in not a few instances runs its whole course, even to a fatal termination, without their occurrence. ”

“ It debilitates strength and destroys vigor. Extreme muscle weakness and abnormal fatigue weigh down its victims, sapping their ability to stand, to walk, to pick up a glass and drink from it, and-in critical cases-even to breathe.
Myasthenia gravis can strike anyone at any time. While its exact cause is unknown, scientists have found evidence that a chemical needed to stimulate muscle movement is somehow blocked, leaving muscles unable to contract. ”

“ Although either the positive or the negative pole, applied to the healthy muscle, may produce spasmodic contraction, yet the negative pole contracts much more powerfully than the positive—a fact which shows an electrically plus condition in the nerves and muscles involved. Yet we know that cramps are more apt to attend a low condition of general vitality in the system than the opposite. ”

“ The occurrence of ulceration of cartilage and of articular caries is attended with the clinical signs of fixation of the joint from involuntary muscular contraction, wasting of muscles, and starting pains. These _starting pains_ are the result of sudden involuntary movements of the joint. They occur most frequently as the patient is dropping off to sleep; the muscles becoming relaxed, the sensitive ulcerated surfaces jar on one another, which causes sudden reflex contraction of the muscles, and the resulting movement being attended with severe pain, wakens the patient with a start. ”

“ Wasting of muscles is a constant accompaniment of tuberculous joint disease. It is to be attributed partly to want of use, but chiefly to reflex interference with the trophic innervation of the muscles. It is specially well seen in the extensor and adductor muscles of the thigh in disease of the knee, and in the deltoid in disease of the shoulder. The muscles become soft and flaccid, they exhibit tremors on attempted movement, and their excitability to the faradic current is diminished. The muscular tissue may be largely replaced by fat. ”