Cramp

Cramp, a painful spasmodic contraction of muscles, most frequently occurring in the limbs, but also apt to affect certain internal organs. This disorder belongs to the class of diseases known as local spasms, of which other varieties exist in such affections as spasmodic asthma and colic. The cause of these painful seizures resides in the nervous system, and operates either directly from the great nerve centres, or, as is generally the case, indirectly by reflex action, as, for example, when attacks are brought on by some derangement of the digestive organs.

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. The attack in general lasts but a few seconds, and then suddenly departs, the spasmodic contraction of the muscles ceasing entirely, or, on the other hand, relief may come more gradually during a period of minutes or even hours. A liability to cramp is often associated with a rheumatic or gouty tendency, but occasional attacks are common enough apart from this, and are often induced by some peculiar posture which a limb has assumed during sleep. Exposure of the limbs to cold will also bring on cramp, and to this is probably to be ascribed its frequent occurrence in swimmers. Cramp of the extremities is also well known as one of the most distressing accompaniments of cholera. It is likewise of frequent occurrence in the process of parturition, just before delivery.

This painful disorder can be greatly relieved and often entirely removed by firmly grasping or briskly rubbing the affected part with the hand, or by anything which makes an impression on the nerves, such as warm applications. Even a sudden and vigorous movement of the limb will often succeed in terminating the attack.

What is termed cramp of the stomach, or gastralgia, usually occurs as a symptom in connexion with some form of gastric disorder, such as aggravated dyspepsia, or actual organic disease of the mucous membrane of the stomach.

The disease known as Writer’s Cramp, or Scrivener’s Palsy, is a spasm which affects certain muscles when engaged in the performance of acts, the result of education and long usage, and which does not occur when the same muscles are employed in acts of a different kind. This disorder owes its name to the relative frequency with which it is met in persons who write much, although it is by no means confined to them, but is liable to occur in individuals of almost any handicraft. It was termed by Dr Duchenne Functional Spasm.

The symptoms are in the first instance a gradually increasing difficulty experienced in conducting the movements required for executing the work in hand. Taking, for example, the case of writers, there is a feeling that the pen cannot be moved with the same freedom as before, and the handwriting is more or less altered in consequence. At an early stage of the disease the difficulty may be to a large extent overcome by persevering efforts, but ultimately, when the attempt is persisted in, the muscles of the fingers, and occasionally also those of the forearm, are seized with spasm or cramp, so that the act of writing is rendered impossible. Sometimes the fingers, instead of being cramped, move in a disorderly manner and the pen cannot be grasped, while in other rare instances a kind of paralysis affects the muscles of the fingers, and they are powerless to make the movements necessary for holding the pen. It is to be noted that it is only in the act of writing that these phenomena present themselves, and that for all other movements the fingers and arms possess their natural power. The same symptoms are observed and the same remarks apply mutatis mutandis in the case of musicians, artists, compositors, seamstresses, tailors and many mechanics in whom this affection may occur. Indeed, although actually a rare disease, no muscle or group of muscles in the body which is specially called into action in any particular occupation is exempt from liability to this functional spasm.

The exact pathology of writer’s cramp has not been worked out, but it is now generally accepted that the disease is not a local one of muscles or nerves, but that it is an affection of the central nervous system. The complaint never occurs under thirty years of age, and is more frequent in males than females. Occasionally there is an inherited tendency to the disease, but more usually there is a history of alcoholism in the parents, or some neuropathic heredity. In its treatment the first requisite is absolute cessation from the employment which caused it. Usually, however, complete rest of the arm is undesirable, and recovery takes place more speedily if other actions of a different kind are regularly practised. If a return to the same work is a necessity, then Sir W. R. Gowers insists on some modification of method in performing the act, as writing from the shoulder instead of the wrist.