Thread by @theneurolander

Signs of tetany!!!

“Trousseau sign of malignancy, Trousseau sign of latent tetany, Trousseau–Lallemand bodie”

French internist Armand Trousseau (1801–1867)

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Definition

Tetanus
- it is different disease w/ different pathology

Tetanic contractions (physiologic tetanus)
- broad range of muscle contraction types

Tetany
- a type of tetanic contraction

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Clinical manifestations of tetany

“spasm and tonic contractions of the skeletal muscles, principally the distal muscles of the extremities”

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Pathophysiology

- more easily obtained if the patient first hyperventilates for a few minutes (latent tetany)

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Chvostek’s sign

“tapping over the facial nerve causes a twitch”

Hyperexcitability of the motor nerves

2 points of stimulation
-Chvostek: just below zygomatic process of temporal bone, in front of ear
-Schultz: midway between the zygomatic arch and the angle of the mouth

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Conditions associated w/ Chvostek sign

- tetany
- CST lesion (hyperreflexia)
- children w/ epilepsy
- neonatal period disappearing w/ aging

Limitation
- crude indicator of neuro-muscular irritability and an unreliable indicator of hypocalcemia

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Chvostek’s sign

via: NEJM

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Chvostek’s sign

via: Ivan Paredes

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Trousseau’s sign

“compression of the arm by manual pressure cause contraction of the muscles of the hand”

Ischemia increases nerve excitability & spontaneous discharges
Obstetrician’s/accoucheur’s hand, main d’accoucheur
Similar pressure around thigh will cause pedal spasm

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Phases

First, paresthesia progress centripetally
Second, finger twitching
Third, contraction

- there may be a latent period of 1/2 to 4 minutes
- 20 mmHg over their systolic blood pressure for 3 minutes

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Limitations

- sometimes positive in hysterical subjects
- workers whose hands are held in a semi-tetanic position for some hours daily

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Trousseau’s sign

via: NEJM

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Trousseau’s sign

via: Doams BD

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Clinical significance

a. Sensitivity for latent tetany
- Trousseau (94%) vs Chvostek (29%)

b. Healthy individuals
- 4% of healthy individuals have Trousseau

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Hyperventilation test

Elicitation: hyperventilate at rate of 55-60/min for 3 min. Sitting upright, with hands placed loosely on knees
Response: if no tetanic manifestation develops, tetany is ruled out
Disadvantages: disturbing symptoms after hyperventilation

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Hyperventilation test

via: Sanjoy Ray

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Trousseau-von Bonsdorff test
(tourniquet&hyperventillation)

a. sitting up, hands placed on knees
b. tourniquet for 4 min
c. if no cramp appear, tourniquet is removed
d. hyperventilate at the rate of 40 breaths/min
d. test is stopped at 75sec/sooner if carpel cramp appears

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Pool-Schlesinger sign

Pool/arm phenomenon
- abduct&elevate patient's arm w/ his forearm extended
- brachial plexus tension

Schlesinger/leg phenomenon
- flex patient's extended leg at the hip
- sciatic nerve tension

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Peroneal (Lust phenomenon)

Elicit: tap over the common peroneal nerve (lateral neck of the fibula with the patient's knee
relaxed and slightly flexed)
Response: dorsiflexion and abduction of the foot

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Escherich's sign

Elicit: percussion of the inner surface of the lips/tongue
Response: contractions of the lips, masseters, and tongue

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Hochsinger’s sign

Elicit: pressure on inner aspect of biceps muscle
Response: spasm and contraction of the hand (variant of Trousseau sign)

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Kashida thermic

Elicit: application of either hot or cold irritants
Response: hyperesthesias and spasms

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Schultze’s sign

Elicit: mechanical stimulation of protruded tongue
Response: transient depression or dampling at the site of stimulation (similar to myotonia)

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Erb’s sign

- increased irritability of motor nerves, detected by electromyography

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