Definition and clinical significance

Carpopedal spasm refers to the painful, involuntary contraction of the muscles of the hands and feet, often representing an early and significant indicator of tetany. Tetany is a state of increased neuromuscular excitability, typically resulting from hypocalcemia or alkalosis, and should not be confused with tetanus, which is an infectious neuromuscular disorder. Carpopedal spasm necessitates immediate assessment and management, as it may precede life-threatening complications such as laryngospasm, seizures, and cardiorespiratory arrest.

Emergency management

Upon identifying carpopedal spasm, assess the patient for signs of respiratory compromise (e.g., laryngospasm, stridor, cyanosis) and cardiovascular instability (e.g., arrhythmias suggestive of hypocalcemia). Promptly obtain serum electrolyte levels, particularly calcium and bicarbonate, and perform a 12-lead electrocardiogram. Initiate continuous cardiac monitoring and administer intravenous calcium gluconate or calcium chloride as clinically indicated. In cases where seizures persist despite calcium supplementation, consider administration of sedative agents such as phenobarbital or chloral hydrate. Provide advanced airway and circulatory support if necessary.

History and physical examination

In stable patients, a comprehensive history should explore the onset, duration, frequency, and associated pain of the spasms. Elicit symptoms of hypocalcemia, including paresthesia (especially perioral and distal extremities), muscle cramps, nausea, vomiting, and abdominal discomfort. Review any history of recent neck or thyroid surgery, potential magnesium deficiency, known hypoparathyroidism, or exposure to Clostridium tetani in non-immunized individuals.

Physical examination tips

Carpopedal spasm in the hands typically presents as adduction of the thumb across the palm, flexion of the metacarpophalangeal joints, extension of the interphalangeal joints, and flexion of the wrist and elbow. Similar posturing may be noted in the feet. Inspect for dry, scaly skin, brittle nails, and alopecia, which may suggest chronic hypocalcemia. Evaluate mental status, as cognitive changes may accompany prolonged calcium deficiency.

Medical etiologies

Table: Medical etiologies of carpopedal spasm

Special considerations

Carpopedal spasm can induce anxiety and hyperventilation, potentially exacerbating alkalosis. Use calming techniques to help the patient control breathing, such as coached pursed-lip breathing. Maintain a quiet, low-stimulation environment.

Prepare the patient for laboratory testing including CBC, serum calcium, phosphorus, magnesium, and parathyroid hormone (PTH) levels. Imaging or additional diagnostic studies may be warranted based on clinical suspicion.

Patient counseling

Educate the patient on the importance of maintaining adequate calcium levels and adherence to any prescribed calcium or vitamin D supplements. Discuss the necessity of tetanus immunization and maintaining up-to-date immunization records.

Pediatric considerations

In children, idiopathic hypoparathyroidism is a frequent cause of hypocalcemia. Carpopedal spasm may precede more severe manifestations such as generalized tonic-clonic seizures or tetany.

Geriatric considerations

Older adults may present atypically. Tetanus should be considered in elderly patients with spasms, especially if immunization history is incomplete. Carefully investigate recent wounds, regardless of severity.

References

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