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Chvostek and Trousseau signs: how to check them
Chvostek's and Trousseau's signs are bedside checks for low calcium (hypocalcemia). Chvostek's sign is a twitch of the face when you tap the facial nerve in front of the ear; Trousseau's sign is a hand spasm when a blood pressure cuff is inflated above systolic pressure for 2 to 3 minutes.
How to check each sign
| Sign | How to check | Positive result |
|---|---|---|
| Chvostek's | Tap the facial nerve just in front of the ear, below the cheekbone | Twitching of the lip, nose or side of the face |
| Trousseau's | Inflate a blood pressure cuff on the upper arm to about 20 mm Hg above the systolic pressure and keep it there for 2 to 3 minutes | Carpal spasm: the wrist and knuckles flex, the finger joints straighten and the thumb pulls in |
Which one is more reliable
- Trousseau's sign is more specific for hypocalcemia.
- Chvostek's sign can be positive in some healthy people and negative in people with low calcium, so read it with the calcium level and other signs.
- Both can also appear with low magnesium.
Who is at risk for low calcium
- After thyroid or parathyroid surgery (the parathyroid glands can be injured or removed).
- Hypoparathyroidism and vitamin D deficiency.
- Acute pancreatitis.
- Chronic kidney disease.
- Massive blood transfusion (the citrate in stored blood binds calcium).
What the nurse does
- Report a positive sign along with numbness or tingling around the mouth or in the fingers.
- Check the calcium (and magnesium) level and the cardiac rhythm (low calcium can prolong the QT interval).
- Start seizure precautions and keep emergency airway equipment nearby.
- Give calcium as ordered; IV calcium goes through a pump with the client on a monitor.
NCLEX tip: After a thyroidectomy, tingling around the mouth or a positive Chvostek or Trousseau sign means possible hypocalcemia. Report it right away and keep IV calcium gluconate available.
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Frequently asked questions
What does a positive Chvostek sign mean?
Facial twitching when the facial nerve is tapped, which suggests low calcium (and sometimes low magnesium).
How long do you inflate the cuff for Trousseau's sign?
About 20 mm Hg above systolic pressure for 2 to 3 minutes, watching for a carpal spasm.
Are Chvostek and Trousseau signs seen in hypercalcemia?
No. They are signs of low calcium. High calcium causes weakness, constipation and confusion instead.
What is the difference between Chvostek's sign and Trousseau's sign?
Both check for low calcium. Chvostek's sign is facial twitching when you tap the facial nerve in front of the ear. Trousseau's sign is a hand spasm when a blood pressure cuff is inflated above systolic pressure for 2 to 3 minutes; it is the more specific sign.
Where do you tap for Chvostek's sign?
Just in front of the ear, below the cheekbone, over the facial nerve. A positive sign is twitching of the lip, nose or side of the face.
How to assess Trousseau's sign?
Inflate a blood pressure cuff on the upper arm to about 20 mm Hg above the systolic pressure and hold it for 2 to 3 minutes. A positive sign is a carpal spasm: the wrist and knuckles flex, the finger joints straighten and the thumb pulls in.
Keep studying
Sources
- Chvostek Sign, StatPearls, NCBI Bookshelf
- Trousseau Sign, StatPearls, NCBI Bookshelf
- Hypocalcemia, StatPearls, NCBI Bookshelf
For study only, not medical advice. Ranges and protocols vary by facility; follow your program, your facility's policies and the provider's orders.