From the Research
Trousseau sign is a clinical indicator of hypocalcemia, not hypercalcemia. This sign is characterized by carpal spasm, which occurs when a blood pressure cuff is inflated on the upper arm to a pressure exceeding systolic blood pressure for about 3 minutes. The most recent and highest quality study, 1, published in 2025, highlights the importance of recognizing Trousseau's sign as a manifestation of severe hypocalcemia. According to this study, hypocalcemia can lead to various complications, including Trousseau's sign, and emphasizes the need for careful management and follow-up.
Clinical Significance of Trousseau Sign
The Trousseau sign is elicited by inflating a blood pressure cuff, causing carpal spasm due to increased neuromuscular excitability in the presence of hypocalcemia. This occurs because hypocalcemia makes nerves more sensitive to mechanical stimulation, and the resulting ischemia and local acidosis from the cuff further increase nerve excitability, triggering the characteristic hand spasm. Other manifestations of hypocalcemia may include:
- Perioral numbness
- Muscle cramps
- Tetany
- Seizures
- QT prolongation on ECG
Causes of Hypocalcemia
Common causes of hypocalcemia include:
- Hypoparathyroidism
- Vitamin D deficiency
- Chronic kidney disease
- Pancreatitis As noted in 2, pseudohypoparathyroidism can also lead to hypocalcemia, emphasizing the importance of investigating the etiology of hypocalcemia in patients presenting with Trousseau's sign.
Management of Hypocalcemia
The management of hypocalcemia involves correcting the underlying cause and may include intravenous calcium infusion for acute cases, as well as oral calcium and vitamin D supplementation for chronic management, as discussed in 3. In cases of hypoparathyroidism, recombinant human parathyroid hormone (rhPTH) therapy may be considered, as it has been shown to effectively correct serum calcium levels and reduce the need for calcium and vitamin D supplements, according to 3.