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Old 10-17-2009
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MusculoSkeletal Confusion regarding "Pope's blessing"

Hey guys,

As we know, pope's blessing is the look we get when our 4th and 5th digits are clawed.

Is pope's blessing due to a median nerve injury or ulnar nerve injury? Why is it that First Aid mentioned pope's blessing as the sign of median nerve injury, but also said that pope's blessing is the same as ulna claw? (FA pg 353, 354)
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Old 10-17-2009
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Both Ulnar nerve and Median Nerve can cause somewhat like a Pope's blessing hand.

In Ulnar nerve injury you have loss of PIP and DIP extension and MP flexion of the 4th and 5th medial fingers so you end up having this hand
Confusion regarding "Pope's blessing"-popes-blessing-claw-hand.jpg

In Distal Median nerve injury and if the patient is asked to make a fist there will be no 1st and 2nd lumbricals to flex the lateral fingers but the ulnar nerver function still there able to flex MP and extend PIP and DIP of the 4th and 5th all the way down to the palm and you'll get this hand
Confusion regarding "Pope's blessing"-popes-blessing-02.jpg

As you can see both of these hands postures can be called a Pope's blessing. Though the name claw is usually preserved to the ulnar nerve lesion as it also cause loss of the interossei of all the digits.

Hope that helps
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Old 10-17-2009
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Ahh I see.

Another question though, in a distal median nerve lesion, according to FA's diagram (pg. 354) and the description, it says that the 2nd and 3rd digits are clawed. If patient is asked to make a fist, wouldn't that be more like a really extremely crooked blessing, rather that a straight 2nd 3rd digit with clawed 4th 5th digit (pope's blessing)?
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Quote:
Originally Posted by lemontea88 View Post
wouldn't that be more like a really extremely crooked blessing, rather that a straight 2nd 3rd digit with clawed 4th 5th digit (pope's blessing)?
Yeah, it would be crooked.
Personally I think they'll never ask how Pope's blessing look like or at least they should give some other information such as sensory loss, thenar/hypotherna wasting ...etc
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Old 10-17-2009
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Nice hands Sabio
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Ahh, thanks for the explanations Sabio. This confusion has been bugging my head for a real long time already.
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Old 10-17-2009
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great finally I understood that
thanks buddies
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Old 10-18-2009
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as for kaplan qbank and the lecture notes and also the dvds ... talk about the Benediction sign (pope's blessing) as median nerve injury only ...

i think if it seen on a question without any other facilitating info's ... I'll have more predilection to Median Nerve rather than Ulnar nerve
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Old 10-20-2009
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Here are some facts-
  • Pope's blessing is also known as Benediction Hand (Preacher's Hand)
  • This is also seen in syringomyelia, and extensor tendon rupture in RA

Ref-Degowin's diagnostic examination
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Old 05-16-2011
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from what I understood "and what I heard from DIT" it's 2nd and 3rd digitals what meant by Pope's blessing and it's associated with median nerve damage.

ulnar nerve damage assiciated with 4th and 5th digits and it's called Claw hand ..

isn't that right ? this is what my friends and I finally decided to memorize !!
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Old 05-16-2011
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He explains it very well: (kaplan 2010)

http://v.youku.com/v_show/id_XMjUxNzQ0NjAw.html
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