A 42-year-old woman is evaluated in the hospital on post-operative day 2 following a total thyroidectomy for papillary thyroid carcinoma. She reports new-onset tingling around her mouth and in her fingertips. Her temperature is 37.1°C (98.8°F), blood pressure is 118/76 mmHg, pulse is 82/min, and respirations are 14/min. The physician suspects a specific electrolyte abnormality related to her recent surgery. Which of the following physical examination maneuvers is most appropriate to demonstrate the expected physical finding for this condition?
- Inflation of a blood pressure cuff above systolic pressure for 3 minutesAnswer
- BPercussion over the median nerve at the volar aspect of the wrist
- CAssessment of deep tendon reflexes to demonstrate a diminished response
- DPassive flexion of the neck while the patient is in a supine position
- EHaving the patient hold both arms outstretched with the wrists extended
Answer
Inflation of a blood pressure cuff above systolic pressure for 3 minutes
The patient's recent total thyroidectomy puts her at high risk for inadvertent parathyroid gland damage or removal, which leads to acute hypocalcemia. Perioral tingling and acral paresthesias are classic early symptoms of the resulting neuromuscular irritability. This can be confirmed on physical examination by eliciting Trousseau sign. This maneuver involves inflating a sphygmomanometer cuff above the patient's systolic blood pressure for 3 minutes, which restricts blood flow and exacerbates the irritability, resulting in a visible carpopedal spasm (flexion of the wrist and metacarpophalangeal joints, extension of the interphalangeal joints, and adduction of the thumb).
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Key Concept
Physical Examination Findings in Post-thyroidectomy Hypocalcemia