Risk Factors for the Occurrence of Muscle Cramps in Patients with Varicose Veins下肢静脈瘤におけるこむら返りの発生因子
Abstract
Muscle cramps in patients with varicose veins occur more frequently in comparison with those from the general population. In this study, 421 patients with primary variocse veins were analyzed by using a questionnaire and muscle pump plethysmography in order to investigate the risk factors for the occurrence of muscle cramps in patients with varicose veins. In this analysis, 421 patients whose muscle cramps occured within 1 year prior to examination and 114 patients without muscle cramps were compared. The incidence of muscle cramps was significantly higher in patients with saphenous vein incompetence than in patients with non-saphenous varicosities. Furthermore, the patients with skin changes such as lipodermatosclerosis, pigmentation, eczema or ulcer showed a significantly higher incidence of muscle cramps than the patients without skin changes. The half-refilling time after five active dorsiflexions of the feet in photoplethysmography was significantly shorter in patients with muscle cramps than patients without muscle cramps. These findings indicate that muscle cramps occur more frequently in patients with severer venous insufficiency. In patients aged 50 or more, the prolonged standing occupation was also a risk factor for the occurrence of muscle cramps. After treatments for varicose veins, 84 of 158 patients, 53%, reported complete relief or marked decrease in the frequency of muscle cramps. However, the relief of muscle cramps was not related to age, sex, obesity, type of varicose veins, occupation, characteristics of muscle cramps or the degree of venous reflux before treatments.
... Several authors 2~5) have sug-28 216 gested that impaired peripheral circulation plays an important role in cramp production. Our previous study 6,7) demonstrated that muscle cramps were commonly associated with varicose veins and were more prevalent in patients with varicose veins than in the general population. However, to date there has been little information available concerning the role of peripheral circulatory insufficiency in the development of muscle cramps. ...
One thousand three hundred and fifty four subjects from the general population retuned questionnaires giving details about muscle cramps. The overall prevalence of muscle cramps in the survey population was 59.7%. The prevalence of cramps occurring within 1 year prior to examination was 49.4%. Persons aged 50 or more years showed a significantly higher incidence of muscle cramps than persons aged 30-49 years or persons aged 10-29 years (p<0.001). Furthermore, the incidence of muscle cramps in persons aged 10-29 years was significantly higher than that in persons aged 30-49 years (p<0.05). Persons aged 10-29 years old showed a significantly higher incidence of muscle cramps during the day (p<0.05), and their muscle cramps were more often induced by daytime exercise than that in other age groups. Persons with leg varicose veins showed a significantly higher incidence of muscle cramps than those without varicose veins (p<0.001). However, there was no significant difference in the incidence of muscle cramps between persons with and without risk factors for arteriosclerosis. From these results it might be concluded that one reason muscle cramps were quite common in older people was the increased incidence of leg varicose veins. However, risk factors for arteriosclerosis were not a cause of developing muscle cramps.
Objective
To investigate the clinical significance of corona phlebectatica.
Design
Clinical and plethysmographic evaluation of corona phlebectatica associated with primary varicose veins.
Setting
Department of Surgery, Aichi Prefectural College of Nursing, Nagoya, Japan.
Main outcome measures
In 411 limbs with greater saphenous incompetence, including 101 with skin changes and 310 without skin changes, clinical analysis and plethysmographic evaluation using the photoplethysmographic technique were carried out.
Results
In 204 of 411 limbs, corona phlebectatica was observed, including 75 coloured red and 129 coloured blue. Blue coronas were observed significantly more often then red coronas in limbs with skin changes. The half refilling time in limbs with skin changes was significantly shorter than that in limbs without skin changes. In limbs without skin changes, limbs with blue coronas showed a significantly shortened half refilling time than those with red coronas.
Conclusions
Blue coronas are a strong indicator of the presence of prolonged venous hypertension in varicose veins.
Muscle cramp is a common, painful, physiological disturbance of skeletal muscle. Many athletes are regularly frustrated by exercise-induced muscle cramp yet the pathogenesis remains speculative with little scientific research on the subject. This has resulted in a perpetuation of myths as to the cause and treatment of it. There is a need for scientifically based protocols for the management of athletes who suffer exercise-related muscle cramp. This article reviews the literature and neurophysiology of muscle cramp occurring during exercise.
Disturbances at various levels of the central and peripheral nervous system and skeletal muscle are likely to be involved in the mechanism of cramp and may explain the diverse range of conditions in which cramp occurs.
The activity of the motor neuron is subject to a multitude of influences including peripheral receptor sensory input, spinal reflexes, inhibitory interneurons in the spinal cord, synaptic and neurotransmitter modulation and descending CNS input.
The muscle spindle and golgi tendon organ proprioceptors are fundamental to the control of muscle length and tone and the maintenance of posture. Disturbance in the activity of these receptors may occur through faulty posture, shortened muscle length, intense exercise and exercise to fatigue, resulting in increased motor neuron activity and motor unit recruitment.
The relaxation phase of muscle contraction is prolonged in a fatigued muscle, raising the likelihood of fused summation of action potentials if motor neuron activity delivers a sustained high firing frequency.
Treatment of cramp is directed at reducing muscle spindle and motor neuron activity by reflex inhibition and afferent stimulation. There are no proven strategies for the prevention of exercise-induced muscle cramp but regular muscle stretching using post-isometric relaxation techniques, correction of muscle balance and posture, adequate conditioning for the activity, mental preparation for competition and avoiding provocative drugs may be beneficial. Other strategies such as incorporating plyometrics or eccentric muscle strengthening into training programmes, maintaining adequate carbohydrate reserves during competition or treating myofascial trigger points are speculative and require investigation.
Painful involuntary skeletal muscle contractions, or cramps, are common patient complaints and may be classified as examples of true cramp, tetany, contracture, or dystonia. The pathophysiologic and clinical features of each of these diagnoses are described. The approach to the patient with cramps should emphasize the history, physical examination, and, if the diagnosis is unclear, minimal routine laboratory data. Although many therapies have been proposed for ordinary cramps, the best evidence supports stretching exercises and quinine. Areas for future study of this common symptom are proposed.
Dynamic and static stretch responses in muscle spindles were investigated in fatigued muscle to determine if acute adaptations do occur in receptor discharge as has been shown after contractions of short duration. Fatigue to 60-50% maximum tetanic tension was induced in the isolated gastrocnemius muscle in 16 cats by sustained, 7 X threshold electrical stimulation (100 Hz) of the cut L7 ventral root and S1 ventral root. Group Ia and II afferent fiber responses to slow ramp stretches (5 mm X s-1) and vibration (100 Hz) applied to the Achilles tendon were monitored before and immediately after muscle tetany to fatigue. Changes in firing characteristics were similar when results from faster (25-30 mm X s-1) ramp stretches were contrasted. During muscle fatigue, decreases in response latency to displacement and increases in resting discharge, mean frequency during stretch, and frequency of firing to vibration were predominant in both afferent fiber types. Static responses were generally lower, indicating a decrease in position sensitivity. Resting muscle force and passive peak muscle stiffness were consistently higher following contraction. The sum effects of these proprioceptive afferent and mechanical muscle responses would be to increase muscle stiffness and thus resist yield in muscle length to perturbations at lower muscle forces. The magnitude of these adaptations in proprioceptive discharge appears dependent on intrafusal muscle fiber activation.
Alterations in Golgi tendon organs' (Ib afferent receptors) stretch sensitivity were assessed in fatigued gastrocnemius muscle of cats. Muscle fatigue to 60-50% peak tension was induced in 13 cats by electrical stimulation of L7 and S1 ventral roots. Forty-three group Ib afferent fibers were recorded in L7 or S1 dorsal root filaments before and during fatigue. Fiber activity was assessed by applying to the Achilles tendon a 5-mm ramp stretch at 5 or 25-30 mm X s-1. Group Ib afferent responses to both velocities of stretch were either completely abolished or depressed over several seconds compared to pre-fatigue firing frequencies. When responding, longer latencies (measured at 5 mm X s-1 only) to firing onset occurred during fatigue. Increasing the rate of stretch (250 mm X s-1) to produce a 5-mm stretch approximately equivalent to twitch tension time revealed a depression more selective to static stretch sensitivity. Post-excitation depression of the Ib receptor potential appears to be one possible mechanism. These acute adaptations in Ib afferent discharge to muscle stretch were opposite in direction to those recently reported in fatigued muscle for group Ia and group II muscle spindle afferents. Functional implications of these results are discussed.
Leg cramps are a common problem, especially in the elderly. The differential diagnosis is extensive and includes the following conditions: true cramps, such as those related to heat, hemodialysis and electrolyte disturbances, as well as idiopathic cramps (the most common type); contractures occurring in conditions such as metabolic myopathies and thyroid disease; tetany, which is usually related to electrolyte disturbances, and dystonias, such as occupational cramps and those related to antipsychotic medications. Other leg problems that are not cramps, such as restless legs syndrome and periodic leg movements, also must be distinguished. The etiology of idiopathic leg cramps is not clear. Treatments for leg cramps include stretching exercises, quinine sulfate and vitamin E, but no treatment is conclusively effective. Nonetheless, in many patients relief of symptoms is achieved with one or more of these treatments.
Two hundred and eighteen subjects, out of 250 individuals taken from a general practice register, returned completed questionnaires
giving details about rest cramps, and a further 15 were contacted by telephone. The overall prevalence of rest cramps in the
survey population was 37%. The symptom was more prevalent in older subjects. Rest cramps were most commonly experienced in
the muscles of the leg, in 83% of the 86 cramp sufferers. Symptoms were usually present at night (73%). On average cramp episodes
lasted for 9min (95%CI 6.7–11.2). Most cramps sufferers experienced symptoms infrequently, but 40% had cramp episodes more
than three times per week and 6% complained of at least one episode per day or night. Twenty-one per cent of cramp sufferers
described their symptoms as very distressing. A minority, 32% of the 86 cramp sufferers, had reported the symptoms to a general
practitioner although the 86 subjects self-rated their health more negatively than the individuals without muscle cramps.
There was a significant, positive association between rest cramps and symptoms of angina or intermittent claudication although
these two factors only accounted for 12% of the variance, suggesting that peripheral vascular disease may play a relevant
but limited role in the aetiology of rest cramps.