Wrist and Thumb signs

[Queen of Pain]

I know that the Walker-Murdoch wrist & Steinberg thumb signs are commonly used to diagnose Marfan's - Do any other HMS/EDS people (non-Marfans) on this board also have these abilities?

I am able to do both of these with ease (I'm HMS) and just wonder if these signs are proof of more 'overlapping symptoms' among the syndromes?

I'm starting this thread here, instead of in the 'Diagnosis' area, so I can get input from the EDS peeps - thanks!

[nonyanomemory]

I wonder if this article would be helpful reading - have never used this link before so am hoping it is reputable! It talks specifically of the signs you talk of in the context of overlapping inheritable collagen disorders. clickable link

i can wrap my thumb and forefinger round my wrists with my forefinger reaching beyond my first knuckle, as they are mega skinny (my wrists i mean) and stay so regardless of weight gain or loss. The other one about the nails and thumb I don't really get if you know what I mean so I wouldn't know! From the pictures on the web of it I can but I can also do this other odd thing with my thumb which involves bringing it forward if you imagine your hand palm down and bend it over my hand facing bent with thumb facing little fingers - do not try this at home peeps I can do it and it doesn't hurt but my thumbs really do go in and out at will. They hurt from everyday things like picking up mugs to drink - you know the simplest of tasks. In a rambly mood tonight but in essence I can do them - does that help!

nonya

[kdangelo]

Yep...I can do both easily. I'm JHS+ and am currently being tested for EDS IV.

Thanks for the article link nonyanomemory!

Karen-

[antimatter]

I have to say me too about the Murdoch and Steinberg arachnodactyly signs. I had seen that article Nonya linked to at some point and of course had to try some of the tricks . I can do the hand reaching around the back to touch the bellybutton (I don't know if this is bad for unstable shoulders).

I think the marfanoid habitus was possible indicator for HMS, but have no idea about the arachnodactyly part.

...antimatter

[Shadowlady]

Ello QoP,

I've been diagnosed with 'mild BJHS' and am currently waiting to see a rheumy for an updated diagnosis taking all my symptoms into account.

I have positive Walker-Murdoch wrist signs and Steinburg thumb signs on both hands, which means I have arachnodactyly - Oooh spider fingers! Ha ha ha! I have small feet for my height though (size 6, 5'7") and my back is really long in comparison to my legs. I haven't bothered working out the ratios as I'm so sure that they won't be anywhere near marfanoid.

So, my self-diagnosis (how I hate self-diagnosing - gimme a Doc who can just tell me! Purlease!), using my 'bible' - Hypermobility Syndrome - Recognition and Management for Physiotherapists by Rosemary Keer and Rodney Grahame, is that I have HMS with some marfanoid features (well, just the one, arachnodactyly), but quite definitely do not have Marfan Syndrome.

This pleases me, because it means my fingers are officially long and spideryly graceful, but I don't have the additional problems of Marfans to deal with! Sorry, I just really like the words 'arachnodactyly' and 'spiderlyly' which I know is a made up word, but I still like it!

Best wishes,
S

[cocol]

I have been diagnosed with HMS with Marfanoid Habitus (or EDS with Marfanoid Habitus rheumy didn't make up his mind), anyway people here do know I'm not tall, but my arm span/ height ratio is high, I have arachnodactyly, my legs are long compared to my trunk, I have a high palate and I can do both Steinberg and Walker-Murdoch diagnostic tests... I am also waiting to see the geneticist/cardiologist for a better diagnosis (sigh)

[cnc03]

I can also do this other odd thing with my thumb which involves bringing it forward if you imagine your hand palm down and bend it over my hand facing bent with thumb facing little fingers - do not try this at home peeps I can do it and it doesn't hurt but my thumbs really do go in and out at will.

That sounds very much how I would describe my thumb trick, except my thumb doesn't come out of place.

I can do the Walker-Murdoch wrist and the Steinburg thumb test easily.
As far as I'm aware I've got HMS.... Waiting to see a rheumo to make that totally official.

[Linny]

My dd who is 14 has been diagnosed with severe Ehlers Danlos hypermobility type and also incomplete Marfanoid Habitus by Prof Grahame based on examination and measurements. She has a small scoliosis, spider like fingers and can do all the Steinberg and Walker-Murdoch tests.
We were told that with connective tissue disorder they can sometimes overlap but I do wonder if we should not have more tests ( genetic ) just to rule out anything more sinister.

Linny

[elfed]

I can do both.
Generally, I have extremely long fingers (I need the biggest size in men's gloves (and I'm a girl ), long narrow feet and toes (my bf is always making fun of my "monkey toes" *lol*) and long, slender arms and legs.
I'm not diagnosed with Marfan's though and I don't have any other symptoms of Marfan's.

[Queen of Pain]

Thanks you all for your replies! They are extremely helpful to me!

Wow, Nonya - I don't think I can do your trick - (If I understand it correctly) - I don't think my thumbs are hypermobile (?) even though my Rheumy said that they are...

The weird thing about all of this is that my fingers do not look long and I don't think a doctor would say that I have arachnodactyly (?) - I can do the wrist and thumb signs, but does that automatically mean that I have arachnodactyly? My palm is longer than the span of my fingers. Can someone without arachnodactyly do these signs?

Also - one more question - when you all are doing the thumb sign, are you letting your thumb fall naturally or are you extending it a bit? My thumb does not naturally fall outside of my palm when I make a fist - I have to sort of make an effort to extend it (I can easliy do this, but I wonder if this makes a difference between a positive and neg. thumb sign ability).

One thing I'm sure of: I need to get myself a copy of Professor Grahame's book(s)!

[Sandy L]

Queen of Pain:
Just for comparison, the furthest I can get my thumb over is about to the middle of the knuckle of the little finger, and that is starting to hurt. I can move it passively (pushing with the other hand) to the point that the tip almos, but not quite, gets to the ulnar margin of the hand. My thumb and finger tip will touch, but not overlap, when reaching around the wrist. I would assume that is what the average ("normal") person can do. (Such assumptions have proven wrong in the past, however.)

[Sue New]

Hi Everyone,

I have just tried to see how far I can get my thumb to go past my little finger across the palm of my hand and it reaches over an inch past the outside edge of my little finger (that is without an extra help from my other hand - with help this distance extends to almost 3 inches ). I can also bend my thumb backwards (and inwards) to rest on the outside of my hand - at right angles to the lower part of the finger normally next to the thumb (I hope that makes sense). I should point out that I am not recommending that anyone tries to do this - my thumbs are totally mucked up and dislocate at the slightest touch. I have Classical EDS and can easily do the Steinberg test on page 19 of the "Hypermobility Syndrome - Recognition and Management for Phsyios" book as well as the pictures in Figure 2.6 and 2.7 on page 21 of the book. In fact my GP quoted my rheumy as saying I could "easily tie my thumbs up at will" as if it was something that was an asset rather than a curse .

I always remeber that when I used to be able to do Lawn Bowls, people used to comment on the span of my hands - I have quite small hands and needed one of the smallest sized bowls but my hand span was longer than a lot of the other bowlers with much bigger hands. I now realise this was because my thumbs easily dislocate

I am paying the price now and have to wear a wrist splint with thumb spica to try to keep my right thumb from giving out on me too many times a day. I think in the long run I will need to have the joint stabilised but I will try to hold off on this for as long as I can.

PLEASE DON'T TRY THIS AT HOME FOLKS (I learnt the hard way as I used to do all the cliched party tricks when I was younger and my body is certainly paying the price now ).

Take care all,

Sue.

[Queen of Pain]

I can get my entire thumbnail all the way outside of my palm (palm closed and with palm opened) without any help - but it doesn't naturally fall that way (in other words, when I make a fist normally my thumb doesn't fall that way - I have to extend it a little bit but NOT by using my other hand or with any help from any other fingers).

Sue New - when you make a "normal" fist (relaxed), does your thumb hang outside of your palm or do you make some sort of effort (not with the other hand or by using any other fingers - just by extending it a bit at will)?
(3 inches is a LOT, by the way! - and I totally know what you mean when you say the tricks hurt - my fingers feel like they are stiff and starting to slip out of joint just by typing!)

Does that make sense

I'm trying to discern whether or not a positive wrist sign means that the thumb naturally falls outside of the palm or whether a person extends it a little (not by using another hand or fingers) - I hope you are able to understand what it is I'm trying to ask

(and thanks for the 'normal' perspective, Sandy It does help!)

[tigerbunny]

How interesting. My left thumb easily goes an inch past, but my right is less. I'm left handed.

I feel like such a dope, though. I google and google but cannot find a decent description of Steinberg. Is that the one of the thumb to the forearm? (um, looked that up, that's the Beighton sign) I used to do that with ease, and now it doesn't. I can't tell if that's a good thing or a bad thing. I do have arachnodactyly (as did mom and dad's mom) and can easily wrap fingers around my wrists (is that the Murdoch one?).

I have the scoliosis. I was ruled out of Marfan's though, with the echocardiogram (I also don't really have such a huge span/height ratio). It was funny though. My parents read about it in the paper, about all these folks with their hearts going funny and they had no idea they were at risk. They handed me the paper and said, 'well, what are you going to do about it?'. So, I went to my (wonderful) doc, and said, 'my parents want to know what I'm going to do about this'

Overlap of symptoms, pshhhh. Bad enough nobody knows our disease, doesn't help the weird ones share signs.

[Sue New]

Hi There,

I am off to work in a minute so I will have to keep this brief.

Here is a link that shows a picture of the Steinberg sign (and other tests) for Marfans:

http://www.emedicine.com/ped/topic1372. ... n~pictures

Take care,

Sue.

P.S. Perhaps I was a little bit ott when I said nearer 3 inches - it is probably more like 2 inches (still a long way though), and like others, my dominant hand (right) is more flexible than my other hand .