Clinical inquiries. What is the diagnostic approach to a patient with leg cramps?

■ Evidence summary More than two thirds of people aged >50 years have experienced leg cramps. Though leg cramps are common, little is known about their actual causation. A small, retrospective chart review, limited to male patients, identified an association of vascular and neurologic diseases among patients taking quinine, presumably for leg cramps. Although commonly idiopathic, leg cramps are sometimes associated with various disorders including endocrine, metabolic, occupational, structural, neuromuscular, vascular, and congenital disorders, as well as toxinand drug-related causes (TABLE). All reviews suggest that the best diagnostic approach to leg cramps is a thorough history, and careful physical and neurological examination. The health care provider should clarify the onset and duration of leg cramps, any precipitating activity, and factors that provide relief. A detailed history should focus on precipitating factors for iron deficiency anemia (gastro-intestinal bleeding, frequent blood donations, menorrhagia), a history of renal disease (especially end-stage renal failure) and medication use (antidepressants and diuretics). Hayam K. Shaker, MD Hendersonville Family Practice Residency Program, MAHEC, Hendersonville, NC