Signs of Latent Tetany

1. 2. 3. 4. 5. 6. 7. 8. 1. Chvostek's sign Trousseau's sign Hyperventilation test Trousseau-von Bonsdorff Test Pool-Schlesinger sign Peroneal sign Erb's sign Escherich's sign

Chvostek's sign (Frantiek Chvostek -1835-1884, Austria) Elicitation: Elicited by tapping the facial nerve either just anterior to the earlobe and below the zygomatic arch (Chvostek I phenomenon), or Between the zygomatic arch and the corner of the mouth (Chvostek II phenomenon). Response: A positive response varies from twitching of the lip at the corner of the mouth to spasm of all facial muscles, depending on the severity of hypocalcemia. Advantages: It precedes other signs of hypocalcemia and persists until the onset of tetany. Convenient bed side examination. Limitations: Crude indicator of neuro-muscular irritability and an unreliable indicator of hypocalcemia. High incidence of false +ve (25%) & false ve (29%) responses. Cant be elicited during tetany because of strong muscle contractions. May also be +ve in rickets, diphtheria, measles, scarlet fever, whooping cough, and myxedema. May be +ve in healthy infants, so cant be used for neonatal tetany. 2. Trousseau's sign (Armand Trousseau, 1801-1867, France) Elicitation: Apply a blood pressure cuff to the patient's arm; then inflate the cuff to a pressure between the patient's diastolic and systolic readings, and maintain it for 4 minutes. Response: Carpal spasm (main daccoucheur or obstetrician hand) paresthesia of the fingers, muscular fasciculations or twitches of the fingers, and A sensation of muscular cramping or stiffness. Advantages: Both sensitive and specific for hypocalcemic tetany. Rarely +ve in normal subjects. Limitations: sometimes positive in hysterical subjects or, in workers whose hands are held in a semi-tetanic position for some hours daily-e.g., seamstresses, cobblers, and glove or leather stitchers. Rarely its +ve only in dominant arm.

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Hyperventillation test Elicitation: Hyperventilate at the rate of 55-60/min for 3 min. sitting upright, with the hands placed loosely on the knees. Response: If no tetanic manifestation develops, tetany is ruled out. Advantage: High specificity (9/72 normal dev. carpel cramps after 3 min.) Disadvantage: Disturbing generalized signs and symptoms after hyperventilation for two or more minutes. Usually it is also found positive only when the tourniquet test is already positive, therefore no further information is gained. (7/64 hypocalcaemic gave +ve test when Tourniquet test was ve). Failure in cases which restrict proper movement of diaphragm (asthma, emphysema, recurrent laryngeal nerve injury, abdominal tumors, pregnancy) Serious physical or mental disability. Children under 10 years of age. Trousseau-von Bonsdorff Test (combined Tourniquet + Hyperventillation test) Elicitation: sitting upright, with the hands placed loosely on the knees Tourniquet applied for 4 min. If no definite carpel cramp appear, tourniquet is removed and subject is asked to hyperventilate at the rate of 40 breaths/min. Test is stopped at 75 sec or sooner if carpel cramp appears. Response: The hand previously under the tourniquet becomes spastic before 75 seconds, with few or no generalized symptoms of tetany. Rarely the opposite hand can become cramped also, but not so intensively. Advantage: It shows that tetany is often a summation of factors which increase the sensitivity of the nervous system. (alkalosis + hperexcitability) Reduces the period of hyperventilation, eliminates the possibility of an unpleasant generalized tetany. It also reduces the frequency of hyperventillation. More sensitive than either the tourniquet test or the hyperventilation test alone. Disadvantage: Failure in cases which restrict proper movement of diaphragm (asthma, emphysema, recurrent laryngeal nerve injury, abdominal tumors, pregnancy) Serious physical or mental disability. Children under 10 years of age.

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Pool-Schlesinger sign Elicitation: Forcefully abduct and elevate the patient's arm with his forearm extended. (Pools phenomenon/arm phenomenon) Forcefully flex the patient's extended leg at the hip. (Schlesinger's sign/leg phenomenon) Response:

 Muscle spasm of the forearm, hand, and fingers or of the leg and foot. Spasm results from tension on the brachial plexus or the sciatic nerve. 6. Peroneal sign Elicitation: 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. 7. Erbs sign: Increased irritability of motor nerves, detected by electromyography. 8. Escherich's sign: Contraction of the lips, tongue, and masseters on percussion of the inner surface of the lips or the tongue.