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Carpopedal spasm is the violent, painful contraction of the muscles in the hands and feet. (See Recognizing carpopedal spasm, page 126.) It's an important sign of tetany, a potentially life-threatening condition characterized by increased neuromuscular excitation and sustained muscle contraction and is commonly associated with hypocalcemia.
Carpopedal spasm requires prompt evaluation and intervention. If the primary event isn't treated promptly, the patient can also develop laryngospasm, seizures, cardiac arrhythmias, and cardiac and respiratory arrest.
If the patient isn't in distress, obtain a detailed history. Ask about the onset and duration of the spasms and ask for a description of pain they produce. Also ask about related signs and symptoms of hypocalcemia, such as numbness and tingling of the fingertips and feet, other muscle cramps or spasms, and nausea, vomiting, and abdominal pain. Check for previous neck surgery, calcium or magnesium deficiency, tetanus exposure, and hypoparathyroidism.
During the history, form a general impression of the patient's mental status and behavior. If possible, ask family members or friends if they've noticed changes in the patient's behavior. Mental confusion or even personality changes may occur with hypocalcemia.
Inspect the patient's skin and fingernails, noting dryness or scaling and ridged, brittle nails.
Carpopedal spasm is an early sign of hypocalcemia. It's usually accompanied by paresthesia of the fingers, toes, and perioral area; muscle weakness, twitching, and cramping; hyperreflexia; chorea; fatigue; and palpitations. Positive Chvostek's and Trousseau's signs can be elicited. Laryngospasm, stridor, and seizures may appear in severe hypocalcemia.
Chronic hypocalcemia may be accompanied by mental status changes; cramps; dry, scaly skin; brittle nails; and thin, patchy hair and eyebrows.
Tetanus develops when Clostridium tetani enters a wound in a nonimmunized individual. The patient develops muscle spasms and painful seizures. Difficulty swallowing and a low-grade fever are also present. If the patient isn't treated or treatment is delayed, the mortality rate is very high.
Multiple blood transfusions and parathyroidectomy may cause hypocalcemia, resulting in carpopedal spasm. Surgical procedures that impair calcium absorption, such as ileostomy formation and gastric resection with gastrojejunostomy, may also cause hypocalcemia.
Carpopedal spasm can cause severe pain and anxiety, leading to hyperventilation. If this occurs, help the patient slow his breathing through your relaxing touch, reassuring attitude, and clear directions about what he should do. Provide a quiet, dark environment to reduce his anxiety.
Prepare the patient for laboratory tests, such as complete blood count and serum calcium, phosphorus, and parathyroid hormone studies.
Idiopathic hypoparathyroidism is a common cause of hypocalcemia in children. Carefully monitor children with this condition because carpopedal spasm may herald the onset of epileptiform seizures or generalized tetany followed by prolonged tonic spasms.
Always ask elderly patients about their immunization record. Suspect tetanus in anyone who comes to your facility with carpopedal spasm, difficulty swallowing, and seizures. Such patients may have incomplete immunizations or may not have had a recent booster shot. Always ask about any recent wound, no matter how inconsequential it may seem.
Read excerpts from these other book chapters related to Seizures:
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1 
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