Symptoms And Signs /Obsolete , Evergreen And New


DIFFERENTIAL DIAGNOSIS OF SYMPTOMS OF "CRAMPS" AND "CLAUDICATION"

O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai,
Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.




The other day I saw a newspaper item where one of the vascular surgeons was promoting his speciality by writing that anybody who complaints of cramps should have a check up done to see whether his peripheral vessels are normal. I am writing this article specially to stress that such articles are misguiding for the public and the doctors.

Cramps are involuntary painful contractions usually occurring in the skeletal muscles of the calves or the lower limbs but can occur anywhere. The most important point about this contraction is that it may be precipitated by a slight movement but basically occurs at the time of resting or sleeping. So often the contracted muscles are felt very hard and painful and by massaging and putting pressure can relax within few minutes.


Cramps are very common in normal population. Although, in the text books dozens of causes for cramps (like hypothyroidism) have been described, in private practice, the most common cause of cramps is "idiopathic". Unfortunately, there is no good treatment and doctors prescribe plenty of Vit. E, though often I prefer to prescribe small doses of quinine, aspirin and tranquillisers at bedtime. I do not mind if such patients go for homoeopathic or ayurvedic treatment, because the results of allopathic treatment are poor.

Regarding the complaint of claudication, this symptom occurs only "on" walking, running or climbing and subsides within 5 to 10 minutes of rest. This pain will be felt in the area of distribution of the artery which is narrowed. Though patients having claudication are much rarer than those complaining of cramps (for every one case of claudication I see dozens of cases of cramps in my practice), it is in this field that our allopathic medicine has advanced markedly.


The most common cause of arterial claudication is smoking and diabetes with or without hypertension. Often it causes narrowing of the lower abdominal aorta and the symptoms occur in both the legs. The pulsations in the lower limbs may be felt markedly diminished but may appear normal. However, the doppler examination can pick up the narrowing of the aorta very accurately. If stoppage of smoking and continuing to walk does not improve the complaints within few months, then angioplasty could be done to clean the aorta and no operation is required. Such symptom of claudication may involve any other arteries with many other aetiologies.


However, the fact remains that in allopathic medicine advances are occurring in the fields of rare conditions and rare symptoms, while in the field of common complaints there have been often no advances for many many years as is the case of cramps.


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