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Wrist McMurray Sign

Exams and Signs

Historical Overview

  • Burgess first described two anatomical variations of the midcarpal joint.1

Description

  • McMurray’s wrist sign can help diagnose hamate arthrosis (proximal pole), which is usually related to lunotriquetral (LT) ligament tears.2

Pathophysiology

  • A positive McMurray’s wrist sign may also result from a triangular fibrocartilage (TFCC) tear or pisotriquetral (PT) arthritis.

Instructions

  1. Obtain an accurate and complete patient history, including any history of injuries in manual work. Ask the patient to rate on a scale from 1 to 10 how much pain s/he experiences in the affected wrist.
  2. Examine the TFCC for damage and inflammation.
  3. Firmly ulnar deviate the wrist. This movement entraps the TFCC between the triquetrum and the distal ulna.
  4. Check for ulnar-sided tenderness and pain.
  5. Examine the contralateral wrist

Variations

  • Check the patient’s forearm motion.

Related Signs and Tests

  • Reagan’s ballottement test (LT)
  • Distal radial ulnar joint (DRUJ) compression test
  • Extensor carpi ulnaris (ECU) stability test
  • ECU tenderness
  • Flexor carpi ulnaris (FCU) tenderness
  • Hook of hamate tenderness
  • Grip strength
  • Joint exam
  • X-rays
  • Arthroscopy3
  • Magnetic resonance imaging (MRI), without contrast

Additional Information

Definition of Positive Result
  • A positive result occurs when the patient has pain with ulnar deviation of wrist.
Definition of Negative Result
  • A negative result occurs when the patient does not not has pain with ulnar deviation of wrist.
Comments and Pearls
  • Arthroscopic resection of the proximal pole of the hamate is a useful treatment for hamate arthrosis. This treatment has worked for patients with lunotriquetral laxity.2,3
  • With excision of the proximal pole of the hamate, patients with secondary wrist pathology may have less dependable results.
Diagnoses Associated with Exams and Signs
References
  1. Burgess RC. Anatomic variations of the midcarpal joint. J Hand Surg Am1990;15(1):129-31. PMID: 2299152
  2. Harley BJ, Werner FW, Boles SD, et al. Arthroscopic resection of arthrosis of the proximal hamate: a clinical and biomechanical study. J Hand Surg Am2004;29(4):661-7. PMID: 15249091
  3. Pirolo JM, Yao J. Minimally invasive approaches to ulnar-sided wrist disorders. Hand Clin2014;30(1):77-89. PMID: 24286746
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