n.

筋痙攣、筋けいれん、痙攣、けいれん、こむら返り、腓返り、痙直、(複数形で用いて)腹痛

同: クランプ、有病性れん縮
関: abdominal pain、convulse、convulsion、convulsive、jerk、muscle cramp、muscle spasm、muscle twitching、muscular cramp、myospasm、seizure、spasm、spastic、spasticity

WordNet

secure with a cramp; "cramp the wood"
affect with or as if with a cramp
suffer from sudden painful contraction of a muscle
a strip of metal with ends bent at right angles; used to hold masonry together (同)cramp iron
a clamp for holding pieces of wood together while they are glued
move with abrupt, seemingly uncontrolled motions; "The patients legs were jerkings" (同)twitch
(mechanics) the rate of change of acceleration
an abrupt spasmodic movement (同)jerking, jolt, saccade
raising a weight from shoulder height to above the head by straightening the arms
a dull stupid fatuous person (同)dork
throw or toss with a quick motion; "flick a piece of paper across the table"; "jerk his head" (同)flick
shake uncontrollably; "earthquakes convulsed the countryside"
be overcome with laughter
move or stir about violently; "The feverish patient thrashed around in his bed" (同)thresh, thresh about, thrash, thrash about, slash, toss, jactitate
cause to contract; "The spasm convulses her facial muscles"
contract involuntarily, as in a spasm; "The muscles in her face convulsed"
make someone convulse with laughter; "The comedian convulsed the crowd"
put something somewhere so that the space is completely filled; "cram books into the suitcase"
study intensively, as before an exam; "I had to bone up on my Latin verbs before the final exam" (同)grind away, drum, bone up, swot, get_up, mug up, swot up, bone
prepare (students) hastily for an impending exam
constricted in size; "cramped quarters"; "trying to bring children up in cramped high-rise apartments"

PrepTutorEJDIC

〈U〉〈C〉(筋肉の)けいれん,こむらがえり / 《複数形で》急激な腹痛 / …‘に'けいれんを起こさせる
(また『cramp iron』)かすがい / 締め具,締め金 / …'を'かすがい(締め具)で締めつける / …'を'拘束する
(急に)『ぐいっと引っぱる』(『押す』,『ねじる』,『投げる』)『こと』 / (筋肉の)反射運動;けいれん / 《米俗》うぶな人;まぬけ / (重量挙げの)ジャーク / 《運動を表す副詞[句]を伴って》…‘を'『急に引っぱる』(『押す』,『ねじる』,『投げる』) / …‘を'ぶっきらぼうに(投げ出すように)言う《+『out』+『名,』+『名』+『out』》 / 『急に』(『ぐいっと』)『動く』
〈特に牛肉〉‘を'細切りにして干し肉にする
〈地震などが〉…'を'激しく震動させる,動揺させる / 《受動態で》〈怒り・笑いなどが〉〈人〉'を'身もだえさせる
(…に)…'を'ぎっしり詰める《+『名』+『in』(『into』)+『名』》;(…で)〈物〉'を'いっぱいにする《+『名』+『with』+『名』》 / 〈人〉‘に'(…の)詰め込み勉強をさせる《+『名』+『with』+『名』》;〈学科〉'を'詰め込む / (…の)詰め込み勉強をする《+『for』+『名』》
狭苦しい / (文字が)読みにくい

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/08/15 10:04:32」(JST)

wiki en

[Wiki en表示]

For the heraldic device, see Cramp (heraldry). For the band, see The Cramps.

Cramps are neural sensations caused by muscle contraction or overshortening. Common causes of skeletal muscle cramps may include muscle fatigue, low sodium, low potassium, and/or low magnesium.^{[citation needed]} Smooth muscle cramps may be due to menstruation or gastroenteritis.

Differential diagnosis[edit source | edit]

Causes of cramping include^[1] hyperflexion, hypoxia, exposure to large changes in temperature, dehydration, or low blood salt. Muscle cramps may also be a symptom or complication of pregnancy, kidney disease, thyroid disease, hypokalemia, hypomagnesemia or hypocalcemia (as conditions), restless-leg syndrome, varicose veins,^[2] and multiple sclerosis.^[3]

Electrolyte disturbance may cause cramping and muscle tetany, particularly hypokalaemia and hypocalcaemia. This disturbance arises as the body loses large amounts of interstitial fluid through sweat. This interstitial fluid comprises mostly water and salt (sodium chloride). The loss of osmotically active particles outside of muscle cells leads to a disturbance of the osmotic balance and therefore shrinking of muscle cells, as these contain more osmotically active particles. This causes the calcium pump between the muscle lumen and sarcoplasmic reticulum to short circuit; the calcium ions remain bound to the troponin, continuing muscle contraction.

As early as 1965, researchers observed that leg cramps and restless-leg syndrome result from excess insulin, sometimes called hyperinsulinemia.^[4] Hypoglycemia and reactive hypoglycemia are associated with excess insulin (or insufficient glucagon), and avoidance of low blood glucose concentration may help to avoid cramps.

Smooth muscle cramps[edit source | edit]

Smooth muscle contractions may be symptomatic of endometriosis or other health problems. Menstrual cramps may also occur before and during a female menstrual cycle.

Skeletal muscle cramps[edit source | edit]

Skeletal muscles can be voluntarily controlled. Skeletal muscles that cramp the most often are the calves, thighs, and arches of the foot. Sometimes known as a Charley horse or corkie, this kind of cramp is associated with strenuous activity and can be intensely painful—though skeletal cramps can occur while relaxing. Around 40% of people who experience skeletal cramps are likely to endure extreme muscle pain, and may be unable to use the affected limb. It may take up to seven days for the muscle to return to a pain-free state. See also Exercise Associated Muscle Cramps.

Nocturnal leg cramps[edit source | edit]

Nocturnal leg cramps are involuntary muscle contractions that occur in the calves, soles of the feet, or other muscles in the body during the night or (less commonly) while resting. The duration of nocturnal leg cramps is variable with cramps lasting anywhere from a few seconds to several minutes. Muscle soreness may remain after the cramp itself ends. These cramps are more common in older people.^[5] They happen quite frequently in teenagers and in some people while exercising at night. The precise cause of these cramps is unclear. Potential contributing factors include dehydration, low levels of certain minerals (magnesium, potassium, calcium, and sodium), and reduced blood flow through muscles attendant in prolonged sitting or lying down. Nocturnal leg cramps (almost exclusively calf cramps) are considered 'normal' during the late stages of pregnancy.^{[citation needed]} They can, however, vary in intensity from mild to extremely painful.

Lactic acid can build up around the muscles which can trigger cramps; however, these happen during anaerobic respiration which happens when a person is exercising or engaging in an activity where the heart beat speeds up. Medical conditions associated with leg cramps are cardiovascular disease, cirrhosis, pregnancy, and lumbar canal stenosis.

Various medications may cause nocturnal leg cramps:^[6]

Diuretics, especially potassium sparing
Long acting adrenergic beta-agonists (LABAs)
Hydroxymethylglutaryl-coenzyme A reductase inhibitors (HMG-CoA inhibitors or statins)

Besides being painful, a nocturnal leg cramp can cause much distress and anxiety.^[7]

Gentle stretching and massage, putting some pressure on the affected leg by walking or standing, or taking a warm bath or shower may help to end the cramp.^[8] If the cramp is in the calf muscle, pulling the big toe gently backwards will stretch the muscle and, in some cases, cause almost immediate relief.

Iatrogenic causes[edit source | edit]

Statins sometimes cause myalgia and cramps among other possible side effects. Raloxifene (Evista) is a medication associated with a high incidence of leg cramps. Additional factors, which increase the probability for these side effects, are physical exercise, age, female gender, history of cramps, and hypothyroidism. Up to 80% of athletes using statins suffer significant adverse muscular effects, including cramps;^[9] the rate appears to be approximately 10–25% in a typical statin-using population.^[10]^[11] In some cases, adverse effects disappear after switching to a different statin; however, they should not be ignored if they persist, as they can, in rare cases, develop into more serious problems. Coenzyme Q10 supplementation can be helpful to avoid some statin-related adverse effects, but currently there is not enough evidence to prove the effectiveness in avoiding myopathy or myalgia.^[12]

Pathophysiology[edit source | edit]

Main article: Muscle contraction

Skeletal muscles work as antagonistic pairs. Contracting one skeletal muscle requires the relaxation of the opposing muscle in the pair. Cramps can occur when muscles are unable to relax properly due to myosin fibers not fully detaching from actin filaments. In skeletal muscle, ATP must attach to the myosin heads for them to disassociate from the actin and allow relaxation — the absence of ATP in sufficient quantities means that the myosin heads remains attached to actin. An attempt to force a muscle cramped in this way to extend (by contracting the opposing muscle) can tear muscle tissue and worsen the pain. The muscle must be allowed to recover (resynthesize ATP), before the myosin fibres can detach and allow the muscle to relax.

Treatment[edit source | edit]

Stretching and drinking plenty of fluids, such as water, may be helpful in treating simple muscle cramps.^[13] With exertional heat cramps due to electrolyte abnormalities (primarily sodium loss and not calcium, magnesium, and potassium) appropriate fluids and sufficient salt improves symptoms.^[14]

Medication[edit source | edit]

Quinine is likely to be effective. However, due to side effects its use should only be considered if other treatments have failed and in light of these concerns.^[15] Vitamin B complex, naftidrofuryl, lidocaine, and calcium channel blockers may be effective for muscle cramps.^[15] Research has also shown that pickle juice can be an effective remedy based on its high sodium and electrolyte content.^[16]

Prevention[edit source | edit]

Adequate conditioning, stretching, mental preparation, and adequate fluid/electrolyte balance are likely helpful in preventing muscle cramps.^[13]

References[edit source | edit]

^ Muscle Cramps Symptoms, Causes, Treatment – Do all muscle cramps fit into the above categories on MedicineNet. Medicinenet.com. Retrieved on 2011-02-13.
^ Bergin J. The Vein Book, Hardcover text, Editor Bergin J , 2007.
^ Muscle Cramps at WebMD
^ Roberts, HJ (1965). "Spontaneous Leg Cramps and "restless Legs" Due to Diabetogenic Hyperinsulinism: Observations on 131 Patients". Journal of the American Geriatrics Society 13: 602–38. PMID 14300967.
^ Night leg cramps - Mayo Clinic
^ Garrison, Scott R.; Colin R. Dormuth, Richard L. Morrow, Greg A. Carney, Karim M. Khan (2011-12-12). "Nocturnal Leg Cramps and Prescription Use That Precedes Them: A Sequence Symmetry Analysis". Arch Intern Med: archinternmed.2011.1029. doi:10.1001/archinternmed.2011.1029. Retrieved 2011-12-13.
^ Weiner, Israel H. "Nocturnal Leg Muscle Cramps". JAMA. Retrieved 26 October 2011.
^ Ray, C. Claiborne (2009-06-09). "Q & A – A Charley Horse in Bed". New York Times. Retrieved 2009-06-09.
^ Sinzinger H, O'Grady J (2004). "Professional athletes suffering from familial hypercholesterolaemia rarely tolerate statin treatment because of muscular problems". Br J Clin Pharmacol 57 (4): 525–8. doi:10.1111/j.1365-2125.2003.02044.x. PMC 1884475. PMID 15025753.
^ Bruckert E, Hayem G, Dejager S, Yau C, Bégaud B (2005). "Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients—the PRIMO study". Cardiovasc Drugs Ther 19 (6): 403–14. doi:10.1007/s10557-005-5686-z. PMID 16453090.
^ Dirks, A. J.; Jones, KM (2006). "Statin-induced apoptosis and skeletal myopathy". Am. J. Physiol., Cell Physiol. 291 (6): C1208–12. doi:10.1152/ajpcell.00226.2006. PMID 16885396.
^ Lamperti C, Naini AB, Lucchini V, et al. (2005). "Muscle coenzyme Q10 level in statin-related myopathy". Arch. Neurol. 62 (11): 1709–12. doi:10.1001/archneur.62.11.1709. PMID 16286544.
^ ^a ^b PMID 8784961
^ doi:10.1016/S1440-2440(03)80005-1
^ ^a ^b Katzberg HD, Khan AH, So YT (2010). "Assessment: Symptomatic treatment for muscle cramps (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology 74 (8): 691–6. doi:10.1212/WNL.0b013e3181d0ccca. PMID 20177124.
^ Reynolds, Gretchen. "Phys Ed: Can Pickle Juice Stop Muscle Cramps?". Retrieved 9/11/2012.

External links[edit source | edit]

What are Cramps?
Cramps at Patient UK
Muscle Cramps (Of Skeletal Muscles)

UpToDate Contents

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Reilly BD, Cramp RL, Wilson JM, Campbell HA, Franklin CE.SourceSchool of Biological Sciences, The University of Queensland, Brisbane, QLD 4072, Australia.
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Related Pictures

★リンクテーブル★

リンク元	「100Cases 79」「不随意運動」「痙攣」「convulsion」「痙直」
拡張検索	「crampy pain」「writer's cramp」「abdominal cramp」「muscle cramp」

「100Cases 79」

Cramp
ICD-10	R25.2
ICD-9	729.82
DiseasesDB	3151
MedlinePlus	003193
MeSH	D009120

　　[★]

☆case79　混乱

79歳　女性

主訴：混乱

現病歴：5年前より高血圧と診断され薬物で加療中であった。混乱がひどくなってきたと訴え娘と来院。娘の話では3週間前より混乱の症状が始まっており、以前は認知機能に問題は無かった。患者は食欲の減退、頭痛、筋痙攣(muscle cramp)も訴えていた。高血圧の治療は診断時よりアテノロールを服用していたが四肢の冷感をうったえて2ヶ月前に中止、ベンドロフルメチアジド1日2.5mgに切り替え特に問題なかった。

生活歴：単身であり、近くに娘が住んでいる。

嗜好歴：飲酒、喫煙共に無し。

服用薬：服用薬無し。近所の薬品屋で購入したビタミン剤は飲んでいる。

身体所見 examination

　皮膚のツルゴール正常。脈拍 80/分、整。血圧 146/90 mmHg。頚静脈圧：正常。異常心音認めず。末梢の浮腫無し。呼吸器系、消化器系異常なし。abbreviated mental test scoreは6/10。時間と場所の見当識無し。局所神経症状無し。眼底に銀線動脈とarteriovenous nippingを認める。乳頭浮腫は認めない。

検査所見 investigations

　低ナトリウム血症、軽度の低カリウム血症、クレアチニン軽度低下、尿浸透圧低下。

問診(S)

　混乱(程度は次第に重度に)

　食欲減退

　頭痛

　筋痙攣

　高血圧

　アテノロール服用(5年前より2ヶ月前まで。服用により四肢が出る)中止後、ベンドロフルメチアジド服用

身体所見(O)

　高血圧(146/90mmg)　→　Japanの基準だとI度高血圧(YN.C-162)

　abbreviated mental test score: 6/10　→　認知症/譫妄疑い

　眼底にsilver-wiringとarteriovenous nippingを認め乳頭浮腫を認めない (YN.C-165)

　(陰性所見)

　ツルゴールは正常　→　脱水を否定

　高血圧以外の循環器疾患は否定的？、呼吸器、消化器系は正常らしい

　場所にと時間に関する見当識がないのでJCSだと2

　局所神経症状なし　→　中枢神経系の疾患は考えづらい？

検査(O)

　低ナトリウム血症、軽度の低カリウム血症、クレアチニン軽度低下、尿浸透圧低下。

----------------

■チアジド系利尿薬

　・副作用は？

　　低カリウム血症、耐糖能低下、高尿酸血症、高カリウム血症、アルカローシス、GFR↓。(YN.C-62)

　・禁忌は？

　　無尿、腎不全、糖尿病、高脂血症。(YN.C-62)

　・特徴(医学用語辞典より)

　　・降圧利尿薬として本態性高血圧症に対する第一選択薬の1つとして用いられる。

　　・有効率が高いこと、至適用量の個人差が少ないこと、効果の発現が緩徐で過度の降圧を来さないことなどの利点を有している。

　・ベンドロフルメチアジド　bendroflumethiazide

　　チアジド系利尿薬の一種

■アテノロール(YN.C-64)

　・β1選択性β遮断薬。

　・心臓のβ1受容体に選択的に作用し、本態性高血圧症、狭心症、頻脈性不整脈に対して有用性が認められている。

■学習事項

　・混乱(confusion)をきたす疾患を鑑別してみよう

■abbreviated mental test score (en wikipediaより)

　・1972年にHodkinsonが老人の認知症の可能性について、迅速に評価できる手法として紹介。

　・認知症以外にも、混乱や認知機能障害の評価にも使われている。

　・10の項目があって、答えられると1点。6点以下でdelirium(譫妄)やdementia(認知症)が疑われる。

　・年齢、今何時、住所を覚えてもらい最後に聞く、今何年、病院名/家の住所、二人の人の認知、誕生日、世界大戦が始まった年、現在の王？の名前、20から1までカウントダウン

■診断

　利尿薬による低ナトリウム血症

　　利尿剤による低ナトリウム血症は治療開始後2,3週間以内に起こりやすい。

　　NSAIDも服用している老年女性に多い(NSAIDは水の排泄を抑制)

　　　メカニズム？：NSAIDはプロスタグランジンの生成を阻害　→　レニン分泌↓　→　輸出細動脈は拡張したまま　→　GFR低下　→　水の排泄がうまくいかないのだろうか。

■血漿浸透圧を計算してみよう

　2 x ([Na+] + [K+]) + [urea] + [glucose] [単位:mOsmol/kg]

■低ナトリウム血症(YN.D-138)

「不随意運動」

　　[★]

英: involuntary movement IVM
関: 不随意筋

不随意運動と大脳基底核との関連

		大脳基底核の障害との関連	特徴	好発部位	代表疾患
振戦	tremor	黒質	律動的な振動運動	指、手	Parkinson病本態性振戦
舞踏病様運動	choreiform movement	尾状核	不規則で、目的のない、非対称性運動 [show details] <youtube>http://www.youtube.com/watch?v=JzAPh2v-SCQ</youtube>	顔面、四肢	Huntington舞踏病
バリズム	ballism/ballismus	視床下核	舞踏様病の一種。運動はより急速、粗大、持続性。四肢の抹消よりも体幹に誓い部分に強く起こり、上下肢を投げ出すよう激しい運動 [show details] <youtube>http://www.youtube.com/watch?v=Cn3WSt6omzY</youtube>	四肢	視床下核 Juys体の出血・梗塞
アテトーゼ	athetosis	赤核、被殻、淡蒼球	舞踏病よりゆっくりで、持続性のある運動。舞踏病に比べ一定の運動。虫が這うような運動。 [show details] <youtube>http://www.youtube.com/watch?v=I63SobW58J0</youtube>	手・指	脳性麻痺 CO中毒レンズ核障害
ミオクローヌス	myoclonus	赤核	1つまたは多くの筋の短時間の不随意な収縮。関節や四肢の強い運動を伴わないのが原則 [show details] <youtube v=faiVIKmmi5k></youtube>	全身・局所	Creutzfeldt-Jakob病 Ramsay Hunt症候群てんかんリピドーシスミトコンドリア脳筋症
痙攣	cramp/convulsion		筋肉が不随意に，激しく攣縮する状態
ジストニー	dystonia		異常姿勢。筋緊張の亢進で異常な姿勢となり、体幹の捻転、胸郭の傾斜、頚の捻転、肘の過伸展、手首の過屈曲、指の過伸展などを呈する。 [show details] <youtube v=1MQtaMENDV0></youtube>	体幹・近位筋	捻転ジストニー
チック	tic		顔、頚部、肩などに起こる、比較的急激で、繰り返して起こる運動 [show details] <youtube>http://www.youtube.com/watch?v=xIAbmfxIm6I</youtube>	顔面	てんかん緊張

「痙攣」

　　[★]

痙攣

英: (脳脊髄性)convulsion、seizure、(痛性)cramp、(痙縮)spasm、convulsive
同: 痙攣発作
関: 筋痙攣、痙縮、痙直、痙攣、痙攣性、スパスム、スパズム、てんかん、癲癇、てんかん発作、腹痛、発作、攣縮、けいれん性、れん縮、こむら返り、腓返り、筋けいれん

分類

部位

全身性
局所性

原因

全身性

頭部外傷、てんかん、脳出血、脳腫瘍、中毒、代謝異常(低血糖、低カルシウム血症・低マグネシウム血症(被刺激性亢進)、低ナトリウム血症、高ナトリウム血症)

アミノ酸代謝異常で痙攣を呈さないもの

チロシン血症、アルカプトン尿症、ヒスチジン血症

乳幼児期の精神発達遅延＋痙攣

YN.J-39

代謝異常　　　：フェニルケトン尿症、糖原病
神経皮膚症候群：結節性硬化症、スタージ・ウェバー症候群
てんかん　　　：レノックス・ガストー症候群、ウェスト症候群

参考

1. 小児科診療・2009年・6号　（103）1083　けいれん

国試

103G006

「convulsion」

　　[★]

n.

痙攣、けいれん

関: clonic seizure、convulse、convulsive、convulsive seizure、cramp、focal seizure、generalized seizure、Jacksonian seizure、jerk、motor seizure、seizure、sensory seizure、somatosensory seizure、spasm、spasticity、tonic seizure、tonic-clonic seizure

「痙直」

　　[★]

英: spasticity、cramp、spastic
関: 筋痙攣、痙縮、痙縮性、痙性、痙攣、痙攣性、拘縮、腹痛、けいれん性、こむら返り、腓返り、けいれん、筋けいれん
関: 痙縮

「crampy pain」

　　[★]

差し込むような痛み、疝痛

A 29-year-old woman with a history of pelvic inflammatory disease presents to the emergency department with severe left lower quadrant crampy pain and spotting, and amenorrhea for the past two cycles.