Steinberg (the thumb sign ) 

method of eliciting

Steinberg or the thumb sign is elicited by asking the patient to fold his thumb into the closed fist. If the thumb tip extends from the palm ofthe hand,the test is positive 

discussion 

seen in marfans syndrome, ehler danlos syndrome and in some percentage of normal children (part of ghent criteria 1 and 2)

reference 

Gupta S, Gupta N. Wrist (Walker–Murdoch) and Thumb (Steinberg) Signs. MAMC J Med Sci 2017;3:111-2. 

The Walker–Murdoch sign (the wrist sign )

method eliciting 

elicited by asking the patient to grip his wrist with his opposite hand. If the thumb and fifth finger of the hand overlap with each other, the sign is positive 

discussion 

seen in marfans syndrome 

The wrist sign indicates hypermobility and arachnodactyly, which is suggestive of Marfan syndrome, when accompanied by other signs and symptoms 

reference 

Gupta S, Gupta N. Wrist (Walker–Murdoch) and Thumb (Steinberg) Signs. MAMC J Med Sci 2017;3:111-2. 

dupuytren's contracture 

Dupuytrens contracture (Viking diseaseà believed to disseminated by the Vikings ) is progressive fibroproliferative condition  of the palmar fascia. Pitting and thickening of the palmar skin are the earliest manifestations of Dupuytren’s disease. Classically, a nodule precedes development of a cord. Over time, which may be months or several years, the cord gradually contracts, reeling in the metacarpophalangeal joint and the proximal interphalangeal joint and leading to progressive digital flexion deformity The condition most commonly affects the ring and little fingers, although any digit can be involved. Usually bilateral . more common in men (Dupuytren contracture is typically seen in men of northern European descent aged >40 years)

o   Familial à autosomal dominant inheritance

o   Secondary to

·       Alcoholism (not to chronic liver disease)

·       Trauma

·       Epilepsy

·       antiepileptic medications

·       Manual labour with vibrating tools

·       Diabetes taking OHA and insulin

·       Smoking

·       Hypercholesterolaemia

Frank's sign 

(aka diagnonal ear lobe crease sign )

diagonal earlobe crease that extends backwards from the tragus at an angle of 45 degree across the lobule to the ear edge of the auricle .it considered as a predictor  of coronary artery disease 

image and reference from :

Oxford Medical Case Reports, 2021;9,367–368 https://doi.org/10.1093/omcr/omab089 

saddle shaped nose deformity 

seen in 

• trauma (most common cause)

• surgery 

• infections like leprosy and syphilis 

• cocaine snorters 

• rheumatological conditions like wegners granulomatosis and relapsing polychondritis 

• Neoplastic Conditions, i.e. EBV Associated Nasal Lymphomas-Lymphatomatoid Graulomatosis (B-Cell) -Extranodal NK/T-Cell Lymphoma, Nasal type (T-Cell) *Note: The above conditions are collectively called “Midline Destructive Disease” 

• atrophic rhinosinusitis 

xanthalesma palpebrum

 external markers of dyslipidemia  

arcus cornealis 

external markers of dyslipidemia  

tendon xanthomas 

external markers of dyslipidemia  

barnetts neck sign (scleroderma neck sign )

The neck sign consists of ridging and tightening of the skin of the neck on extension of the head. It is positive in more than 90 % of SSc patients