Walker Murdoch Sign

The Walker Murdoch sign is a clinical test used to assess for potential Marfan syndrome by evaluating the length of the fingers relative to wrist circumference. The test is performed by having the patient grip their opposite wrist with their hand.

A positive test occurs when the thumb and fifth finger of the gripping hand overlap with each other, indicating abnormally long, slender fingers (arachnodactyly) characteristic of Marfan syndrome.

Clinical Significance of Walker Murdoch Sign

The Walker Murdoch Sign becomes particularly valuable when used in conjunction with other clinical assessments. When both the Walker-Murdoch sign and the Steinberg sign are positive, and the patient demonstrates joint hypermobility (as measured by the Beighton Score), there is a 90% probability that the patient has Marfan syndrome.

See Also: Beighton Score for Ligamentous Laxity

Why This Matters

Marfan syndrome is a connective tissue disorder that can affect multiple organ systems, including the cardiovascular, skeletal, and ocular systems. Early identification is crucial because patients may be at risk for serious complications such as aortic dilatation or dissection. Simple screening tests like the Walker-Murdoch sign allow clinicians to identify patients who may benefit from further genetic counseling and specialized cardiac evaluation.

Clinical Application

The beauty of the Walker Murdoch sign lies in its simplicity. It requires no special equipment and can be performed during routine physical examinations. While a positive test doesn’t confirm Marfan syndrome, it serves as an important screening tool that can prompt appropriate referrals for comprehensive evaluation.

Remember that clinical signs should always be interpreted within the broader clinical context, and definitive diagnosis of Marfan syndrome requires comprehensive evaluation using established criteria such as the revised Ghent nosology.

References & More

1. Peripheral facial palsy after set-forward orthognathic surgery: A case report and review of literature – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Walker-Murdoch-wrist-sign-A-and-Steinberg-thumb-sign-B_fig11_321122877
2. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
3. Walker BA, Murdoch JL. The wrist sign. A useful physical finding in the Marfan syndrome. Arch Intern Med. 1970 Aug;126(2):276-7. doi: 10.1001/archinte.126.2.276. PMID: 5433066.