Trousseau's sign

Trousseau's sign

Trousseau’s sign is a sign of tetany.(1,2) It is most often due to hypocalcemia but can occur with a normal calcium level and in other conditions.(3-7) Ischemia of the peripheral nerve trunks increases nerve excitability and causes spontaneous discharges that produce carpopedal spasm.

Compression of the arm by manual pressure, a tourniquet, or a sphygmomanometer cuff is followed first by distal paresthesias that progress centripetally, then twitching of the fingers, and finally by cramping and contraction of the muscles of the fingers and hand with the thumb strongly adducted and the fingers stiffened, slightly flexed at the MCP joints, and forming a cone clustered about the thumb (obstetrician’s or accoucheur's hand, main d’ accoucheur). (Figure) There may be a latent period of ½- 4 min.

Similar pressure around the leg or thigh will cause pedal spasm. A modification is to keep a moderately inflated sphygmomanometer cuff on one arm for about 10 min., then remove it and have the patient hyperventilate; typical tetanic spasm occurs earlier in the previously ischemic arm.

Trousseau's sign is more specific than Chvostek's sign for latent tetany. As many as 4% of healthy controls may have a positive Trousseau's sign; its sensitivity is unknown, but it can be absent in patients with definite hypocalcemia.

Hochsinger's sign may be a variation of Trousseau’s sign.(2) Pressure on inner aspect of biceps muscle causes spasm and contraction of the hand.

This patient taking a thiazide diuretic for ankle edema complained of hand and wrist spasms when typing, writing or holding the phone. Hyperventilation caused generalized paresthesias. After the application of a BP cuff above systolic pressure and making a fist several times the cramping sensation began and was shortly followed by classic main d’ accoucheur—a positive Trousseau’s sign.

An NEJM video https://www.youtube.com/watch?v=kvmwsTU0InQ shows both Chvostek's and Trousseau's signs due to postoperative acquired hypoparathyroidism.(8)

References

1. Campbell WW. Clinical signs in neurology: a compendium. Philadelphia: Wolters Kluwer Health, 2016.

2. Campbell WW. Barohn RJ. DeJong's the neurologic examination, 8th ed. Philadelphia: Wolters Kluwer, 2020.

3. Rehman HU, Wunder S. Trousseau sign in hypocalcemia. CMAJ 2011;183:E498.

4. Kale V, Handy JM. Normocalcaemic tetany. Clin Med (Lond). 2012;12:298.

5. Cardim Filho A, Vieira JG. Tetany secondary to hypokalemia. Rev Paul Med. 1989;107:250-2.

6. Lameris AL, Monnens LA, Bindels RJ, Hoenderop JG. Drug-induced alterations in Mg2+ homoeostasis. Clin Sci (Lond). 2012;123:1-14. 531.

7. Kaufmann H, Elijovich F, Yahr MD. An unusual cause of tetany: surreptitious use of furosemide. Mt Sinai J Med. 1984;51:625-8.

8. Jesus JE, Landry A. Images in clinical medicine. Chvostek's and Trousseau's signs. N Engl J Med. 2012;367:e15.