In This Section
- What can I do about cramps and PMS?
- How do I know if my menstrual cycle is normal?
- How do I use tampons, pads, period underwear, and menstrual cups?
- What is premenstrual dysphoric disorder (PMDD)?
Many people get emotional and have cramps before and during their periods. This is sometimes called PMS. Cramps and PMS are normal and can be treated.
X in a circle
- What causes cramps?
- What helps with cramps?
- What’s PMS?
- What I can do to relieve PMS?
- 8 Ways to Get Rid of Period Cramps That Actually Work
- A Harvard Medical School doctor answers a question about hand cramps
- Rheumatoid Arthritis: Are Hand Cramps a Symptom?
- Overview – Trigger finger
- What causes trigger finger?
- Remedies for hand cramps
- Clinical Significance
- Trigger Finger: When Your Finger “Gets Stuck”
- Learn more:
Problems with your period?
Find a Health Center A right arrow in a circle
What causes cramps?
Menstrual cramps can be really uncomfortable and painful, but they do happen for a reason. During your period, your uterus contracts — meaning it squeezes or cramps up. This makes the lining come off the walls of your uterus and leave your body. When your uterus cramps up, it’s helping the period blood flow out of your vagina.
Most people get cramps during their periods at some point in their lives. They usually feel like throbbing pains in your lower belly. They can start a couple of days before your period comes, and sometimes continue throughout your period. Cramps are usually worse during the first few days of your period, when your flow is the heaviest.
You can get cramps as soon as you get your first period. Your periods may get more or less painful throughout your life. For many people, cramps become less painful as they grow older.
Menstrual cramps can be painful and irritating, but they’re super common and there are lots of ways to treat them.
What helps with cramps?
Here are a some things that can help ease cramps:
Over-the-counter pain medicine like ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol). Always follow the instructions on the bottle. Talk with your doctor before taking pain medication if you have an allergy to aspirin or severe asthma.
Putting a heating pad on your belly or lower back.
Taking a hot bath.
Having an orgasm (by yourself or with a partner).
Hormonal birth control (like the pill, patch, ring, implant, and hormonal IUD).
Acupuncture and acupressure.
Transcutaneous electric nerve stimulation (TENS) — therapy that uses mild electric currents to stimulate your nerves to relieve pain.
Certain vitamins and herbs like vitamin B1, fish oil, fenugreek, ginger, valerian, zataria, and zinc sulfate.
Cramps are a pretty normal part of getting your period, but sometimes people have period cramps that are so painful it’s hard to do everyday things (like go to school or work). If your period pain is really bad, and over-the-counter medicine doesn’t help, talk with your doctor. They can help with other ways to manage the pain, or they may want to check to see if there’s something more serious going on.
Cramps that are really bad may be a sign of:
Pelvic Inflammatory Disease — an infection in your reproductive organs.
Endometriosis — a condition where the lining of your uterus grows outside of your uterus.
Adenomyosis — when the tissue that lines your uterus grows into the muscle wall of your uterus.
Uterine fibroids — non-cancerous tumors that grow inside your uterus, in the walls of your uterus, or on the outside of your uterus.
Cramps caused by these conditions may start when you’re older. And they might get worse as time passes. They can also last longer than other cramps or last longer than the last day of your period.
If you have super bad cramps that you can’t treat, or other period symptoms that are hard to deal with, call your doctor or local Planned Parenthood health center.
PMS stands for premenstrual syndrome — the emotional and physical symptoms that some people feel right before and during their periods. PMS is caused by the hormonal changes that your body goes through during your menstrual cycle.
Some people get PMS every time they have their periods. Others only get PMS every once in a while. You may have all or just some of the common PMS symptoms. And some people don’t get PMS at all.
There are two main kinds of PMS symptoms: the ones that affect you physically and the ones that affect you emotionally.
Physical symptoms of PMS include:
Craving certain foods or being more hungry than usual
Tender, swollen, or sore breasts
Feeling bloated (puffy or full in your stomach)
Gaining a little weight
Swelling in your hands or feet
Aches and pains in your joints or muscles
Feeling more tired than usual or needing more naps
Skin problems, like pimples
Cramps or pain in your belly
Emotional symptoms of PMS include:
Feeling sad, depressed, tense, or anxious
Feeling more irritable or angry than normal
Not feeling very social or wanting to be around people
Having trouble concentrating
Trouble falling asleep or staying asleep
Changes in your desire to have sex
It’s common to have some of these symptoms and not others. For example, you might have bloating and sore breasts, but not mood swings or skin problems. It may also change from month to month: you could be tired and cranky one month but not the next, or have cramps one month but not the next. It’s different for every person.
In order for a doctor to officially diagnose you with PMS, you need to have PMS symptoms for at least 3 months in a row. They must start in the 5 days before your period and interfere with some of your normal activities, like school, work, or exercise. If you think you may have PMS, keep a record of your period and symptoms each day for at least 2-3 months. You can use a calendar or our app to track your PMS symptoms.
Other conditions, like depression and anxiety, perimenopause, and thyroid disease can act like PMS, so visiting a doctor is the only way to know for sure what’s going on.
Some people have really severe PMS that’s called Premenstrual Dysphoric Disorder (PMDD). PMDD symptoms can be really scary and may include feeling out of control, depressed, having panic attacks, or even feeling suicidal. If you think you’re experiencing symptoms of PMDD, see a doctor as soon as possible.
What I can do to relieve PMS?
Many of the things that help ease cramps can also help with PMS. Here are some different ways to relieve PMS symptoms:
Take over-the-counter pain medicine like ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol). Always follow the instructions on the bottle. Talk with your doctor before taking pain medication if you have an allergy to aspirin or severe asthma.
Do aerobic exercise, like walking, running, riding a bike, swimming, or any activity that gets your heart rate up. Regular exercise (at least 30 minutes most days of the week) is ideal.
Do breathing exercises, meditation, or yoga.
Get plenty of rest. Sleeping regularly every night can help with stress, mood changes, and feeling tired or fatigued.
Eat healthy foods like fruits, veggies (especially the leafy green ones), whole grains, and yogurt.
Limit fat, salt, sugar, caffeine, and alcohol.
Make sure you get enough vitamins in your diet, or take vitamin supplements. If you don’t get enough calcium, take a supplement of 1200 mg of calcium daily. Magnesium and Vitamin E might also help.
Use hormonal birth control (like the pill, patch, ring, implant, and hormonal IUD). Your doctor can help you find a birth control method that can help with PMS.
Was this page helpful?
Help us improve – how could this information be more helpful?
How did this information help you?
You’re the best! Thanks for your feedback. Thanks for your feedback.
Cramps are the absolute worst, no doubt, but because so many of us get them, it’s easy to assume they’re just something that comes with the territory. But really, there’s no reason you should be doubled over in pain every month for the next few decades. Who has time for that!? So next time you’re cursing your uterus, here’s how you can get some much-needed relief.
1. Grab some oils.
According to a study in the Caspian Journal of Internal Medicine, fish oil can be extremely useful in treating menstrual cramps. Simply take the fish oil pills as you would Ibuprofen. Similarly, research has found that lavender and sesame oil will also relive pain. To use these, rub them into your stomach like you would for a massage.
Get some fish oil here:
Nature’s Bounty Fish Oil Nature’s Bounty amazon.com $17.29 $11.49 (34% off)
Get lavender oil here:
Lavender Essential Oil Healing Solutions amazon.com $18.99 $7.99 (58% off)
2. Pop a pain med before your cramps start.
No surprise here, but taking a pain reliever can, um, relieve pain. Ibuprofen lowers your levels of prostaglandins, which are the hormone-like substances that trigger uterine cramping and cause pain and inflammation. And you don’t need to wait until you’re miserable to take a pain reliever — if your cycle is pretty regular and you know when your period’s coming, you may be able to stave off cramps before they even start. “Take pain relievers at the very beginning of your period, before cramps become intense,” says Marc Winter, MD, a board-certified OB/GYN at Saddleback Memorial Medical Center in Laguna Hills, CA. Just make sure you follow the dosage recommendations on the box, and give your parents a heads-up that you’re taking it.
3. Apply heat.
If your cramps are making it impossible to get comfy, try snuggling up with a heating pad or hot water bottle against your belly, or soaking in a hot bath. “Heat will increase blood flow to the area, and it relaxes the contracting muscles that are causing the pain,” Dr. Winter says.
Check out this heating pad, perfect for alleviating cramp pain:
Huggable Llama Cooling + Heating Pad urbanoutfitters.com $29.00
4. Do some light exercise.
This may sound like the worst idea ever, especially when you barely have the motivation to get off the couch to change your tampon. But don’t worry, you don’t have to run a 5K or anything —a short walk or a few minutes of yoga is enough to get your circulation going and loosen up your muscles. “Stretching and aerobic exercise help with the production of endorphins, which are your body’s feel-good hormones,” Dr. Winter says. Endorphins actually change the way your brain processes pain, so if you can power through those first few I-don’t-wanna-do-this minutes, a sweat sesh can help you feel a lot better.
5. Strike a pose.
If you feel like a giant hand is squeezing your insides, yoga is a great way to stretch and soothe your muscles. (And if you’re not feeling terribly zen right now, it can also help you shake a bad mood). Leigh Ryan, a yoga teacher in New Jersey, suggests these cramp-relieving poses:
- HALF CAMEL POSE: Kneel upright on the floor (so your butt isn’t resting on your heels) and reach back with your right hand to touch your right ankle, keeping your hips pressed forward. Repeat on your left side. Ryan says this can stretch the muscles around your hips and help release some negative energy.
- SEATED FORWARD FOLD: Sit with your legs straight out in front of you and bend forward as far as you comfortably can. “Deep folds massage the organs in your abdominal cavity,” Ryan says — kind of like a backrub for your achy uterus.
- CHILD’S POSE: Start on your hands and knees, with your knees about hip-width apart and your big toes touching each other. Keeping your hands on the floor and arms outstretched, rock your butt back towards your heels and lower your torso to the floor. “Try this if your cramps are causing lower back pain,” Ryan says.
6. Load up on cramp-fighting foods.
“I’m craving spinach,” said no one ever in the history of periods. But while you might be tempted to polish off a bag of chocolate-covered potato chips, eating junk can make you feel worse in the long run. Instead, try these nutrition tips to ease your cramps:
Load up on omega-3 fatty acids, vitamin E, and magnesium — these nutrients are thought to reduce inflammation and help relieve cramps, according to the University of Maryland Medical Center.
Sip ginger tea. One study done by the Shahid Beheshti University of Medical Sciences found ginger to be as effective as ibuprofen for relieving menstrual cramps. (It’s also good for tummy troubles, so if you tend to spend a lot of QT in the bathroom when you have your period, it can help with that too.)
Avoid anything too spicy or greasy. “That can irritate your intestinal tract and add to the cramping,” Dr. Winter says.
7. Stay hydrated.
Okay, so chugging water isn’t going to make your cramps magically disappear. But if you usually get bloated when you’re PMS-ing, water can help with that — so at least you have one less thing making you feel craptastic. And go easy on the Starbucks. Caffeine can make the pain worse because it constricts blood vessels and raises tension levels.
8. When all else fails, call the doc.
If nothing seems to be helping, talk to your gyno — she can check for any underlying causes, like endometriosis, that might be making your cramps extra-painful. She may also recommend birth control pills, which can thin the uterine lining and make cramps less intense. Cramps may be common, but they shouldn’t interfere with your life — so if you’ve tried everything and you’re still in pain every month, definitely let your doc know.
8 Ways to Get Rid of Period Cramps That Actually Work
If your period sidelines you with painful cramps every month, you’ve got plenty of company. About 50% of women of reproductive age deal with period pain, medically known as dysmenorrhea. Doctors believe the cramps are caused by chemicals called prostaglandins—which trigger contractions in the uterus that help the body shed the uterine lining every month.
Fluctuating hormones, along with high levels of inflammatory compounds, may also contribute to menstrual cramps. And for some women with severe period pain, conditions like endometriosis, adenomyosis (when the inner lining of the uterus breaks through the muscular uterine wall), or uterine fibroids may play a role. “This is something that many women live with, and for some women it’s quite severe,” says Brett Worly, MD, ob-gyn at The Ohio State University Wexner Medical Center.
RELATED: What Your Period Reveals About Your Health
If the pain is so bad it makes a major dent in your daily life, talk to your health care provider, Dr. Worly suggests, to rule out a serious underlying cause. If you get an all-clear and need easy cramp relief strategies that really work, give these expert-backed remedies a try. Some may help you feel better temporarily, while others may reduce the level of pain you feel for the long-term.
Eat a low-fat, high-fiber diet
Women who eat more fiber tend to report less menstrual pain than those who eat less, according to a 2005 study in the European Journal of Clinical Nutrition. The connection may have to do with the fact that fiber intake can decrease blood estrogen levels in women, the study authors say, and estrogen seems to be a driving factor behind period-related pain.
In that sense, foods that may help with period cramps include whole grains, fruits, and vegetables (especially leafy greens). Adding more of these foods to your diet can also help improve digestion in the long run, which may help minimize stomach pain and cramping at any time of the month.
RELATED: Why Your Period Screws Up Your Poop Habits—and How to Deal
Fatty foods, on the other hand, have been shown to increase estrogen levels in women. The 2005 study did not find a significant association between high-fat diets and increased period pain, but the authors say the connection should be studied further. In an earlier study, women who followed a low-fat vegetarian diet (and increased their fiber intake) reported reduced pain duration and intensity.
Take OTC pain meds—even before your period starts
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve) act by blocking prostaglandin production, and several studies have shown that they can be very effective in treating menstrual pain. All of the NSAIDs studied seem to work better than acetaminophen (Tylenol), according to a 2015 Cochrane Review of previous research—but it’s not clear which one of the two is the best medicine for severe menstrual cramps.
“Taking Motrin or Tylenol, or a combination of the two, every four to six hours can be helpful,” says Dr. Worly. “Sometimes it can also be helpful to start taking those medicines before your period starts—so if you know it’s going to start on a Friday, start taking those medicines on Thursday.”
Dial back your stress level
Stress may affect the severity and duration of period pain, according to a 2010 Journal of Women’s Health study. When participants experienced high levels of stress in a given month, they were more likely to report more (and worse) menstrual symptoms during their next cycle, compared to months when they had less stress. For women who had two consecutive high-stress months, there seemed to be a cumulative effect: The number of women reporting 8 or more symptoms nearly doubled between the first and second cycle, from 27% to 50%.
RELATED: How to Add Self Care to Your Workout Routine
Study co-author Audra Gollenberg, PhD, now an associate professor of public health at Shenandoah University, recommends making time on the regular for self-care and stress-busting activities, from meditation to outings with friends. “Stress has been shown to affect reproductive hormones, so it makes sense that it could affect your period, too,” she says. “Stress reduction is very individual, but anything that helps you handle stressful situations may help reduce discomfort at this time of the month.”
Keep a heating pad handy
“For some women, using a heating pad or taking a hot bath or shower can provide some relief from period pain,” says Dr. Worly. There’s some science behind this age-old remedy: In 2005, researchers from University College London showed how heat placed on the skin can block pain signals, as well as deactivate painful sensations at a molecular level for up to an hour.
Topical heat can also relax tense uterine muscles, which may help reduce the contractions that cause cramping. In a 2001 study in Obstetrics and Gynecology, women who wore a heated abdominal patch during their period reported significant reductions in pain, compared to those who wore a placebo, unheated patch.
RELATED: We Asked 9 Wellness Influencers to Confess Their Unhealthiest Habit
Don’t skip the gym
Working out may be the last thing you feel like doing when your period starts, but there’s good reason to push through. “High-intensity exercise when you have really bad cramps isn’t necessarily going to make you feel better right away,” says Dr. Worly. “But in the long run, studies show that women who exercise regularly and stay fit tend to have less pelvic pain overall.”
In some cases, getting your heart rate up and your body moving really could have some immediate benefits. “Exercise can release endorphins, which is the body’s natural pain medicine,” says Dr. Worly. If you’re not feeling up something as intense as kickboxing class, try yoga and deep breathing.
Go on hormonal birth control
Taking birth-control pills or using another form of hormonal contraception prevents ovulation, which can make a big difference for women who have endometriosis and suffer from severe cramps every month as a result. (Endometriosis is a condition in which uterine tissue grows outside of the uterus.)
RELATED: 7 Health Benefits of Birth Control Nobody Talks About
But even women with normal periods may notice that their cramps go away or aren’t quite so bad when they start taking hormonal birth control. “Contraception can help regulate hormone levels and decrease extreme fluctuations, which can be helpful,” says Dr. Worly.
The market for supplements that claim to help period pain is full of vitamins, minerals, and herbal remedies—but most have very little or no evidence that they make a difference. One exception: magnesium. At least three small clinical trials have compared the effects of magnesium supplements to a placebo for women with menstrual pain. Overall, women who took magnesium reported less pain, and their need for extra medication was lower.
In 2017, a review in the journal Magnesium Research stated that magnesium deficiency may play a role in a number of gynecological conditions, including premenstrual syndrome (PMS) and dysmenorrhea. Researchers believe that magnesium may inhibit painful contractions by relaxing muscle cells in the uterus.
RELATED: 5 Period Side Effects That Aren’t Cramps
More research is needed in order to recommend an effective dosage, researchers say, and popping too much of the supplement can cause a dangerous heart arrhythmia. Talk to your doctor before you start taking any new supplement, or aim to get more magnesium from food sources like whole grains, beans, nuts, seeds, and dark, leafy greens.
As if you need one more reason to give up cigarettes: Several studies have found a —as well as inhaling secondhand smoke—and an increased risk of menstrual pain. One 2015 report published in Tobacco Control found that the earlier women started smoking, the more likely they were to have chronic period pain as adults.
While kicking the habit may not help you feel better instantly, it can help improve your health overall, says Dr. Worly. It can also make exercise, another period-pain remedy, a little easier.
A Harvard Medical School doctor answers a question about hand cramps
Q: I have strong hand cramps that curl my fingers into a claw shape. I can only straighten them by using my other hand. What can I do to keep this from happening?
A: What you describe sounds like carpal spasm. Spasms, or cramps, are involuntary muscle contractions. The most common causes of spasms are overused muscles (in the hands that might be due to writing or typing) and dehydration. Other causes of muscle cramping include low levels of calcium and magnesium.
Another possibility is that you have carpal tunnel syndrome, which occurs when the nerves in the wrist are compressed. Typical symptoms of carpal tunnel syndrome include pain in the wrist and tingling and numbness in the fingers, but hand spasms may also occur. Spasms in other areas of your body, such as the upper arm, neck or face, suggest an underlying neurological problem.
What is CTS?
CTS, or carpal tunnel syndrome, may be the cause behind your frequent hand cramps and finger cramps.
Carpal tunnel syndrome is a combination of numbness, tingling, pain, and weakness in the hand caused by compression of the median nerve in the carpal tunnel.
Symptoms include numbness, pain, and stiffness in the hand, fingers, and thumb.
A third possibility is writer’s cramp, also called musician’s cramp. It is a spasmodic contraction of the muscles of the hand and forearm. The fingers may suddenly freeze up, dramatically affecting the ability to write or play an instrument. Some golfers experience contractions of the hand while putting, a phenomenon that’s been nicknamed “the yips.”
Talk to your doctor if the cramps occur often. If he or she can’t find a specific cause, focus on drinking enough water and stretching your fingers periodically.
— Dr. William Kormos, editor-in-chief of Harvard Men’s Health Watch and a primary care physician at Massachusetts General Hospital
For more on the causes and treatment of hand pain, buy Hands: Strategies for strong, pain-free hands, a Special Health Report from Harvard Medical School.
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
Rheumatoid Arthritis: Are Hand Cramps a Symptom?
Hand Cramps and RA
“Muscle cramps in the hands is a very frequent symptom described by patients with RA,” Dr. Weselman says. “Inflammation of the joints and tendons in adjacent muscles can affect muscle function, making RA patients more prone to muscle cramps.” And the joint stiffness that people with RA experience can mimic a muscle cramp, so it can sometimes be difficult to differentiate between the two, she says.
Although muscle spasms may be uncomfortable, they rarely cause any serious complications. You may notice that cramping gets worse under certain condtions, such as in colder temperatures, during periods of increased joint inflammation, at times when you’re not using your hands as often (and your muscles are weakened as a result), or following repetitive activities such as typing or texting — which stress the hand muscles, she explains.
Moves for Hand Cramp Relief
What should you do when a muscle cramp strikes? Try these DIY fixes:
- Gentle stretching To help the cramp subside, try this simple stretch. Using the opposite hand, push back all four fingers and thumb on the cramping hand, very lightly, and massage the tight muscle.
- Heat A heat wrap can also help tame tight muscles, but don’t worry if you don’t have one at the ready — simply run your hands under warm water instead. Or improvise by making your own warm compress: Fill a tube sock with uncooked rice, tye a knot at the top, and warm it in the microwave for about a minute, Weselman suggests.
It’s also possible that certain medications may indirectly help ease muscle cramping by treating inflammation, she explains.
Stop Cramps Before They Start
Better yet, aim to prevent muscle cramps in the first place. “Keeping hand muscles strong will help prevent muscle fatigue, so exercises can decrease cramps long term,” Weselman explains. Try repetitive finger tapping (tapping your thumb to each finger), or squeezing silly putty or a stress ball.
If muscle cramps or hand pain persists, occurs often, or interferes with everyday activities, talk with your doctor, who can look for signs of underlying causes such as poor circulation, dehydration, poor nutrition, kidney disease, or electrolyte imbalances due to medication. In some cases, muscle atrophy could be related to injury, muscle abnormality, or a neurological condition.
Additional reporting by Jessica Firger.
What causes trigger finger?
Tendons are tough cords that join bone to muscle. They move the bone when the muscle contracts. In the hand, tendons run along the front and back of the bones in the fingers and are attached to the muscles in the forearm.
The tendons on the palm side of the hand (flexor tendons) are held in place by strong bands of tissue, known as ligaments, which are shaped in arches over the tendon. The tendons are covered by a protective sheath which produces a small amount of fluid to keep the tendons lubricated. This allows them to move freely and smoothly within the sheath when the fingers are bent and straightened.
Trigger finger occurs if there’s a problem with the tendon or sheath, such as inflammation and swelling. The tendon can no longer slide easily through the sheath and can bunch up to form a small lump (nodule). This makes bending the affected finger or thumb difficult. If the tendon gets caught in the sheath, the finger can click painfully as it’s straightened.
The exact reason why these problems occur is not known, but several factors may increase the likelihood of trigger finger developing. For example, it’s more common in women, people over 40 years old, and those with certain medical conditions.
Another hand-related condition called Dupuytren’s contracture can also increase your risk of developing trigger finger. In Dupuytren’s contracture, the connective tissue in the palm of the hand thickens, causing 1 or more fingers to bend into the palm of the hand.
Long-term conditions, such as diabetes and rheumatoid arthritis, are also sometimes associated with trigger finger.
Remedies for hand cramps
Published: March, 2013
Q. I have been experiencing strong muscle cramps that curl my fingers into a claw shape, which I can straighten only by using the other hand. How can I prevent this?
A. The symptoms you describe sound like carpal spasm. Spasms, or cramps, are involuntary contractions in the hands or feet. The most common sources of spasms include overused muscles and dehydration. Prolonged writing or typing can lead to hand cramping from overuse of the muscles. Other reasons for cramping are low levels of calcium and magnesium. Numerous things can affect your calcium level, but the usual culprit is vitamin D deficiency.
To continue reading this article, you must login.
Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School.
- Research health conditions
- Check your symptoms
- Prepare for a doctor’s visit or test
- Find the best treatments and procedures for you
- Explore options for better nutrition and exercise
Learn more about the many benefits and features of joining Harvard Health Online “
As mentioned previously, cramps can be due to a variety of causes. Some cramps remain benign and mysterious; others are of a more definite nature and respond to specific therapy.
Ordinary muscle cramps are characterized by a painfully hard, palpable contraction of explosive onset, at times preceded or followed by brief twitches, which usually involves one muscle at a time. They may be precipitated by volitional movement of trivial extent or more forceful contraction in a muscle already shortened (as may occur during or after exercise). The cramps can be terminated by passive stretching of the muscle or activation of its antagonist. In severe cramps, the muscle may remain sore and tender for days.
While leg cramps are fairly common in the elderly, and hardly unusual in otherwise healthy, athletic individuals, they appear more frequently in certain clinical settings (see Table 53.1). The mechanism of such a relatively familiar malady has remained obscure, although a popular theory suggests that the intramuscular nerve branches are for some reason rendered hyperexcitable.
Clinically similar but on a different pathophysiologic basis are the cramps, or more correctly, contractures of muscle associated with various metabolic myopathies. In several inherited disorders of glycogen metabolism, such as myophosphorylase (McArdle’s) or phosphofructokinase (Tauri’s) deficiency, patients classically experience myalgias and painful, hard muscle cramps only during vigorous exercise. Occasionally, an episode of cramps will be followed by myoglobinuria, which, if excessive, could induce acute renal insufficiency. Conversely, patients deficient in carnitine palmityl transferase, an enzyme critical for fatty acid oxidation, get cramps only during prolonged exercise, especially if in the fasted state, on a low-carbohydrate diet, or in cold weather. The proposed physiologic thread that ties these conditions together is acute depletion of ATP during exercise, disrupting calcium reuptake into the sarcoplasmic reticulum and preventing muscle relaxation.
Tetany is a cramplike syndrome consisting of painless spasms, most notable for their carpopedal distribution but potentially involving other muscles. The hand typically assumes a posture of tonic adduction of thumb and fingers, flexion of metacarpophalangeal joints, with extension of interphalangeal joints. The toe becomes plantar flexed and the ankle inverted. The spasms, commonly precipitated by hyperventilation, are preceded by tingling paresthesias of the mouth, fingers, and toes, a discriminative feature from dystonia. Tetany is seen in states that cause alkalosis or reduction in ionized calcium and magnesium, which appear to render the peripheral nerves hyperirritable.
A more focal disorder of peripheral nerve function is hemifacial spasm. Here, potentially any facial movement (e.g., blinking) may provoke either fine twitching or prolonged gross spasms of facial muscles. It is believed that most cases are attributable to compression of the facial nerve in the posterior fossa.
Tetanus, in contrast, is due to the suppression of spinal inhibitory neurons by an exotoxin of the bacterium Clostridium tetani. Clinically, involuntary spasms triggered by movement, sensory or emotional stimuli are superimposed on a state of virtually continuous stiffness. The symptoms may begin in the vicinity of a wound and remain localized or, more often, become generalized. Even in the localized form, one may note mild trismus due to the susceptibility of the masseter innervation. Persistent muscular rigidity and painful cramps can also occur with strychnine poisoning, black widow spider bites, and the rare “stiff man” syndrome.
Patients with prominent spasticity due to spinal cord lesions frequently complain of stiffness, muscle cramps, and spasms. Presumably, damage to the descending motor pathways disrupts the normal suprasegmental inhibitory influences on the spinal motor neurons, allowing afferent sensory impulses to evoke unbridled reflex activity. As a result, flexor spasms of the thigh, knee, and foot can be set off by cutaneous or visceral (e.g., distended bladder) stimuli. Being reflexogenic in nature, they are at times accompanied by such autonomic responses as sweating, piloerection, or incontinence.
Other involuntary muscle hyperactivity states, including several rare familial syndromes, have been described and are reviewed elsewhere (Layzer, 1971, 1979; Sumi et al, 1984).
Trigger Finger: When Your Finger “Gets Stuck”
This topic came to our attention thanks to a discussion on the Arthritis Forum of our sister site, Spine-health.com.
Someone described how a finger “got stuck” in a bent position and was looking for possible causes. It wasn’t long before another user suggested the likely cause: trigger finger.
Trigger finger, a common name for a medical condition known as stenosing tenosynovitis, occurs when the fingers’ tendon sheaths become inflammed. Learn more: Trigger Finger (Stenosing Tenosynovitis)
Trigger finger is caused when the sheath that encases the tendon in a finger or thumb becomes inflamed. This causes the tendon to catch on the sheath, locking the finger in place. Once the finger is manually straightened, it may snap straight out as the tendon moves again suddenly.
See How Arthritis Causes Joint Pain
Despite its name, trigger finger most often affects the ring finger or thumb—and can also affect multiple fingers at once.
Other symptoms of trigger finger include:
- Painful snapping sensation when bending or straightening your finger
- A tender bump where the base of your finger meets the palm
- Symptoms that are worse in the morning
Trigger finger can occur in both children and adults, but some factors raise your risk:
- Being female
- Being older than 45
- Having rheumatoid arthritis, gout, or diabetes
- Doing work or activities that involve repeated gripping movement
To treat trigger finger, the goal is to bring down the inflammation causing the tendon to catch. This can be done by immobilizing the finger using a splint or tape and/or by icing the finger.
See Nonsurgical Treatment for Trigger Finger
If symptoms persist, your doctor may suggest a cortisone injection to relieve inflammation or possibly even surgery.
See Trigger Finger Release: Percutaneous and Open Surgery
Do you have a question about arthritis? Find support and information from others with arthritis on the Arthritis Forum.
Is My Hand Pain Caused by Arthritis or Carpal Tunnel Syndrome?
Foot and Ankle Pain Due to Rheumatoid Arthritis (RA)