What is carpopedal spasm? Carpopedal spasm is a significant noticeable contraction of the foot and hand muscle which is significantly painful. Carpopedal spasm is a life threatening condition as it is one of the important signs of tetanus. Carpopedal spasm may also present in hypocalcemic patient. Carpopedal spasm is caused by sustained muscle contraction due to increase in the neuromuscular excitation. Carpopedal spasm requires prompt and careful intervention and evaluation as the untreated condition may develop into seizures, laryngospasm, cardiac arrhythmias, respiratory arrest and cardiac arrest.
Detail history is obtained from the patient. The patient is asked about the degree of pain related to the carpopedal spasm, duration of the spasm and the onset of carpopedal spasm. The patient is also asked about the signs and symptoms of hypocalcemia such as nausea and vomiting, abdominal pain, muscle cramp, and tingling and numbness of the feet and the fingertips. Patient’s previous neck surgery or any history of hypoparathyroidism is also checked. Any evidence of calcium and magnesium deficiency should also be elicited from the patient. It is also important to ask the patient about nay previous exposure to tetanus and the vaccination against tetanus status of the patient. Patient’s mental status and behaviour are also observed. Family members and relatives should notice any recent changes in the behaviour. The fingernails and skins are inspected . Look for any brittle, ridged nails or any scaling or dryness of the skin.
Carpopedal spasm is associated with tetanus and hypocalcaemia. Tetanus occurs when Clostridium tetani enter the patient’s wound especially the non immunize patient. Sooner or later the patient may present with difficulty in swallowing (dysphagia) and low grade fever. The patient will also develop a painful seizures and muscle spasm. The mortality rate is high in patients who delays the treatment or remains not treated.
Hypocalemia is a condition due to a low plasma level of the calcium. Hypocalcaemia is initially presented with carpopedal spasm. Other signs and symptoms of hypocalcemia are chorea, palpitation, twitching, weakness and cramping of the muscle, fatigue, perioral , toe and finger paraesthesia and hyperefflexia. Hypocalcaemia may present with positive Trousseau’s sign and positive Chvostek ‘s sign. Positive Trousseau’s sign is presented with carpopedal spasm due to occlusion of the blood in the leg or forearm by increasing the pressure in this region with blood pressure cuff that wrapped and surround the forearm and leg. Positive Chvostek ‘s sign is presented with twitching of the facial muscle after tapping over the facial nerve. In severe cases of hypocalcemia , patients may present with laryngospasm and stridor. The evidence of chronic hypocalcaemia may include brittle nail, dry, scaly skin, patchy thin eyebrow and hair, cramps and changed in mental status.
Carpopedal spasm may also be associated with medical procedures and treatments. Parathyroidectomy or multiple transfusion of the blood may leads to hypocalcemia which presented with carpopedal spasm as its early sign. Hypocalcemia may also occur in procedures which impair the absorption of calcium such as gastric resection with gastrojejunostomy or the formation of an ileostomy.
Patient presented with carpopedal spasm may require to undergo a series of lab test which include full blood count, urea and electrolyte studies, serum calcium and phosphorus as well as parathyroid hormone studies. A patient who is hyperventilating may require arterial blood gas analysis to confirm the finding.
Hypocalcemia in children is mostly associated with idiopathic hypoparathyroidism. Children who develop carpopedal spasm may require a careful monitoring as the prolonged tonic spasm may lead to the onset of generalized tetany or epileptiform seizures.
Elderly patients who develop carpopedal spasm should be inspected for the other signs and symptoms of tetanus. The patient should be asked regarding any signs and symptom such as seizures or difficulty swallowing. The patient’s immunization status also should be checked. The patient tends to develop tetanus due to incomplete immunization or due to lack of recent booster shot. Any history of trauma or wound also should be noted.
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