1/17/22, 9:26 PM Trousseau Sign - StatPearls - NCBI Bookshelf

Trousseau Sign
Patel M, Hu EW.

Definition/Introduction
Trousseau’s sign for latent tetany is most commonly positive in the setting of hypocalcemia.[1] The sign is
observable as a carpopedal spasm induced by ischemia secondary to the inflation of a sphygmomanometer
cuff, commonly on an individual’s arm, to 20 mmHg over their systolic blood pressure for 3 minutes.[1] The
carpopedal spasm is visualized as flexion of the wrist, thumb, and metacarpophalangeal joints with
hyperextension of the fingers.[1]

Issues of Concern
The normal level of calcium in the blood is between 8.5 to 10.5 mg/dL.[2] The sensitivity and specificity of
Trousseau’s sign for individuals with hypocalcemia are reported to be 94 percent and 99 percent, respectively.
[2][3] Despite this, one to four percent of healthy individuals may have a positive Trousseau’s sign.[3]
Trousseau’s sign may also be elicited in the setting of hypomagnesemia and metabolic alkalosis, such as in the
context of hyperventilation or excessive acid loss through the gastrointestinal system.[4] In both of these
cases, however, hypocalcemia tends also to be present.   

Hypocalcemia can present in numerous conditions, most commonly in the setting of vitamin D deficiency or
hypoparathyroidism.[5] Medications, commonly bisphosphonates such as zoledronic acid used in the
treatment of osteoporosis, and cisplatin, a chemotherapeutic, among others, are also common culprits.[6]
Individuals with life-threatening conditions such as sepsis, hemorrhagic shock, rhabdomyolysis, and tumor
lysis syndrome may also develop hypocalcemia. In sepsis, a condition that occurs secondary to one’s own
immune response to microbial infection, hypocalcemia is hypothesized to occur secondary to a problem along
the parathyroid-vitamin D axis.[7] Examples include acquired parathyroid gland insufficiency, calcitriol
resistance, or vitamin D insufficiency secondary to a nutritional deficit or a lack of conversion to its active
form secondary to a deficiency in renal 1-alpha-hydroxylase.[7] In the case of hemorrhagic shock,
hypocalcemia stems from calcium chelation by the anticoagulant storage solution (sodium citrate) in packed
red blood cells.[8] In both rhabdomyolysis and tumor lysis syndrome, the hypocalcemia is secondary to
phosphate overload in the setting of cell destruction.[9][10] These individuals can potentially develop torsades
de pointes, ventricular tachycardia, or complete heart block due to prolongation of their QT interval secondary
to the plateau phase of the cardiac action potential being prolonged.[11][12]

Clinical Significance
Through the utilization of a thorough history and physical exam, healthcare practitioners may be able to
discover if a patient has hypocalcemia early in their presentation to a healthcare facility after finding
Trousseau’s sign during blood pressure measurement, allowing for rapid intervention.

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Nursing, Allied Health, and Interprofessional Team Interventions

Vital signs are often obtained at the beginning of a patient encounter, frequently by a nurse, certified nursing
assistant, or medical assistant. Therefore, Trouseeau's sign may commonly be noted by the allied health
professional taking the vital signs, rather than by the clinician. Recognition of the sign and communication to
the clinician may be the only opportunity for the patient to have this issue addressed.

Review Questions
Access free multiple choice questions on this topic.
Comment on this article.

Figure
trousseau sign. Image courtesy S Bhimji MD

Figure
Trousseau Sign. Contributed by Katherine Humphreys

References
1. Young P, Bravo MA, González MG, Finn BC, Quezel MA, Bruetman JE. [Armand Trousseau (1801-
1867), his history and the signs of hypocalcemia]. Rev Med Chil. 2014 Oct;142(10):1341-7. [PubMed:
25601121]
2. van Bussel BC, Koopmans RP. Trousseau's sign at the emergency department. BMJ Case Rep. 2016 Aug
01;2016 [PMC free article: PMC4986008] [PubMed: 27481262]
3. Jesus JE, Landry A. Images in clinical medicine. Chvostek's and Trousseau's signs. N Engl J Med. 2012
Sep 13;367(11):e15. [PubMed: 22970971]
4. Williams A, Liddle D, Abraham V. Tetany: A diagnostic dilemma. J Anaesthesiol Clin Pharmacol. 2011
Jul;27(3):393-4. [PMC free article: PMC3161471] [PubMed: 21897517]

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1/17/22, 9:26 PM Trousseau Sign - StatPearls - NCBI Bookshelf

5. Schafer AL, Shoback DM. Hypocalcemia: Diagnosis and Treatment. In: Feingold KR, Anawalt B, Boyce
A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G,
Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R,
Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP,
editors. Endotext [Internet]. MDText.com, Inc.; South Dartmouth (MA): Jan 3, 2016. [PubMed:
25905251]
6. Liamis G, Milionis HJ, Elisaf M. A review of drug-induced hypocalcemia. J Bone Miner Metab.
2009;27(6):635-42. [PubMed: 19730969]
7. Zaloga GP, Chernow B. The multifactorial basis for hypocalcemia during sepsis. Studies of the
parathyroid hormone-vitamin D axis. Ann Intern Med. 1987 Jul;107(1):36-41. [PubMed: 3592447]
8. Li K, Xu Y. Citrate metabolism in blood transfusions and its relationship due to metabolic alkalosis and
respiratory acidosis. Int J Clin Exp Med. 2015;8(4):6578-84. [PMC free article: PMC4483798] [PubMed:
26131288]
9. Davis AM. Hypocalcemia in rhabdomyolysis. JAMA. 1987 Feb 06;257(5):626. [PubMed: 3795440]
10. Williams SM, Killeen AA. Tumor Lysis Syndrome. Arch Pathol Lab Med. 2019 Mar;143(3):386-393.
[PubMed: 30499695]
11. Chhabra ST, Mehta S, Chhabra S, Singla M, Aslam N, Mohan B, Wander GS. Hypocalcemia Presenting
as Life Threatening Torsades de Pointes with Prolongation of QTc Interval. Indian J Clin Biochem. 2018
Apr;33(2):235-238. [PMC free article: PMC5891463] [PubMed: 29651218]
12. Nijjer S, Ghosh AK, Dubrey SW. Hypocalcaemia, long QT interval and atrial arrhythmias. BMJ Case
Rep. 2010;2010:bcr0820092216. [PMC free article: PMC3029862] [PubMed: 22242081]

Publication Details

Author Information

Authors

Milan Patel1; Eugene W. Hu2.

Affiliations
1
Northwell Northshore University Hospital/Long Island Jewish Medical Center
2
Desert Regional Medical Center

Publication History

Last Update: July 19, 2021.

Copyright
Copyright © 2022, StatPearls Publishing LLC.

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This book is distributed under the terms of the Creative Commons Attribution 4.0 International License
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Publisher

StatPearls Publishing, Treasure Island (FL)

NLM Citation

Patel M, Hu EW. Trousseau Sign. [Updated 2021 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2022 Jan-.

https://www.ncbi.nlm.nih.gov/books/NBK557832/ 4/4