Cramping or spasms Discussion

Cramping or spasms of the upper extremity represent sudden painful involuntary muscle contractions, distinguished from other types of sudden pain by the fact that there is an uncontrollable fixed posture of the arm, hand or fingers. Most often, upper extremity cramps are due to problems apparent from the patient's history, such as brain injury or recent acute musculoskeletal trauma. In the absence of such a story, true cramping is most often due to upper extremity use in the presence of a problem with the function of the nerve or artery which supplies the affected muscles. Much less commonly, upper extremity cramping is a sign of an undiagnosed endocrine or metabolic disease, in which case all extremities are usually affected to some degree. I do not believe that it is helpful to label any patient with the diagnosis of writer's cramp, for its existence is currently debatable - there is no proven cause, no clear guidelines for diagnosis, and no widely accepted treatment. Cramping may be impossible to distinguish from voluntary posturing or malingering, and should be managed with additional caution in a compensation related situation. Because cramping is generally secondary to another problem, treatment begins (and usually ends) with management of the primary problem. If the reason for cramping cannot be determined or if the cramping is felt to be due to malingering, no treatment is indicated.

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