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The Benediction authorize is the an outcome of peripheral neuropathy affect musculature in the hand. That is seen once the patience is asked to make a fist and also the ring and little finger flex but the index and middle finger can not flex at the metacarpal-phalangeal joint or interphalangeal joint.

There is some controversy regarding the source of the Benediction authorize for plenty of years, especially if the average nerve or the ulnar nerve is involved<1>. According to Futterman, <1> the desired position that the hand during a blessing or benediction would typically have to be an open position v the finger extended. In fact, he notes that the fourth and 5th digits would have actually been abducted native the second and 3rd digits (similar come the hand sign offered by Vulcans in the Star Trek TV and also movie series). <1> based on this author"s research study of cultural artwork, he asserts that Peter, the first Pope, had an ulnar neuropathy which minimal Peter"s capacity to carry out the then-traditional open hand blessing and also has led to the hand place that has since become the norm for giving blessings.

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In the presence of ulnar neuropathy, the duty of the interossei and also lumbrical muscles to the fourth and fifth digits would be compromised, hence the fourth and 5th digits might not abduct indigenous the midline of the hand (interossei function) nor can those fingers flex in ~ the MCP joints or extend at the IP joints (lumbrical function). Extensor digitorum (innervated through the radial nerve) acts mainly on the metacarpophalangeal (MCP) joint, not the interphalangeal (IP) joints, as such it could not expand the IP joints to compensate for the lose of lumbrical function. <2> together a result, during an effort to expand the 4th and 5th digits (as in the open hand blessing described above) the MCP joints it is in extended yet the IP joints would continue to be flexed.

Futterman <1> notes the Benediction sign is often explained as a average nerve injury due to the fact that this would result in an inability to do flexion in ~ the MCP and IP joints of the 2nd and 3rd digits. However, the notes the this would only make sense if the injured human being was trying to make a fist and since a fist is no a historically-known sign of blessing or greeting, Benediction Sign have to stem native an ulnar neuropathy and also the succeeding inability to completely open the hand.

Clinically relevant Anatomy


The ulnar nerve originates native the terminal branch the the medial cord of the brachial plexus and contains yarn from C8, T1, and, occasionally, C7. The innervates muscle in the anterior compartment of the forearm; Flexor carpi ulnaris and medial fifty percent of Flexor digitorum profundus, and also muscles that the hand; Hypothenar muscle, Medial 2 lumbricals, Adductor pollicis, Palmar and dorsal interossei of the hand, and Palmaris Brevis.

For much more detailed info on the anatomy that the ulnar nerve

Clinical Presentation

Benediction Hand is presented through numbness the the fourth and fifth fingers and also hand muscle weakness. The fourth and fifth fingers show a clawed-like appearance, v hyperextension at the metacarpophalangeal (MCP) joints and flexion the the proximal and distal interphalangeal (IP) joints, and also the fingers and also thumb are hosted slightly abducted. Tenderness or pain may be it was observed at the medial wrist or medial elbow region.

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Differential Diagnosis

Benediction hand suggests peripheral neuropathy, most most likely an ulnar neuropathy and on physical examination, various other clinical presentations associated v ulnar neuropathy could be observable. These include:<4>

Management and also Treatment

The therapy of Benediction Hand entails the management and also treatment the ulnar and median nerve neuropathies by using: <5>

Non-steroidal inflammatory drugs (NSAIDs) to regulate pain and also prevent symptoms to get worse.An arm or wrist brace to avoid nerve compression and also excessive bending.

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