Master Nerve Palsies - Pope's Blessing with Picmonic for Medicine

With Picmonic, facts become pictures. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio stories, and built-in quizzing.

Nerve Palsies - Pope's Blessing

Nerve Pause with the Pope
Picmonic

Also called the “hand of benediction”, the “pope’s blessing” is caused by a proximal lesion to the median nerve.  This can occur through a supracondylar fracture of the humerus, which can cause the thumb, index and middle finger to stay extended, and only the ring and pinky finger to flex when the patient tries to make a fist.  Although the pope’s blessing may look like the ulnar claw, the ulnar claw is due to ulnar nerve damage and is seen when the patient tries to extend all their fingers.  Whereas the “pope’s blessing” is caused by median nerve damage and is seen when trying to make a fist.

6 KEY FACTS
NERVE
Proximal Median Nerve
P-proximal Median Nerve

This nerve is comprised of the nerve roots from C5-T1 from the lateral and medial cords of the brachial plexus.  It originates in the axilla and courses with the brachial artery around the medial side of the arm.  It then runs through the antecubital fossa, branching off into the anterior interosseous branch and continues down to innervate the anterior forearm flexors.  The distal part of the nerve courses through the carpal tunnel to innervate the the first and second lumbricals, opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis. 

CAUSES
Supracondylar Fracture of Humerus
Super-cape with Fracture on Funny-bone

These fractures are more common in children than adults and may cause damage to the anterior interosseous branch of the median nerve.  They can be sustained from falling onto a hyperextended elbow.  The classic sign of supracondylar fracture on radiograph is an anterior fat pad.

FUNCTIONAL DEFICIT
Loss of Flexion of Thumb, Pointer and Middle Finger
Can't Flex Thumb, Pointer and Middle Finger while Flexing

The proximal median nerve innervates the lateral half of flexor digitorum profundus while the distal median nerve innervates the first and second lumbricals, opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis.  With a proximal median nerve injury, the flexor digitorum profundus is unable to flex the pointer and middle finger.

PRESENTATION
Trouble Making a Fist
Trouble Making a Fist

If a patient sustains proximal median nerve damage, they may lose function the lateral half of flexor digitorum profundus, preventing digits 2 and 3 from flexing.  As a result, the patient has trouble making a fist on flexion due to unopposed action of the extensor digitorum resembling the “pope’s blessing” position.

Hand Resembles Popes Blessing on Flexion
Pope Blessing with Hand

If a patient sustains proximal median nerve damage, they may lose function the lateral half of flexor digitorum profundus, preventing digits 2 and 3 from flexing.  As a result, the patient has trouble making a fist on flexion due to unopposed action of the extensor digitorum resembling the “pope’s blessing” position.

COMPLICATIONS
Atrophy of Thenar Eminence
@-trophy of Thumb-near-palm

Because the proximal median nerve innervates the muscles of the thenar eminence, median nerve damage may result in muscle atrophy.  These muscles include opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis.

Unlock all 6 facts & definitions with Picmonic Free!

JOIN FREE

Take the Nerve Palsies - Pope's Blessing Quiz

Picmonic's rapid review multiple-choice quiz allows you to assess your knowledge.

START QUIZ NOW

It's worth every penny

Our Story Mnemonics Increase Mastery and Retention

Memorize facts with phonetic mnemonics

Unforgettable characters with concise but impactful videos (2-4 min each)

Ace Your Medical (MD/DO) Classes & Exams with Picmonic:

Over 870,000 students use Picmonic’s picture mnemonics to improve knowledge, retention, and exam performance.

Choose the #1 Medical (MD/DO) student study app.

Picmonic for Medicine (MD/DO) covers information that is relevant to your entire Medical (MD/DO) education. Whether you’re studying for your classes or getting ready to conquer the USMLE Step 1, USMLE Step 2 CK, COMLEX Level 1, or COMLEX Level 2, we’re here to help.

Works better than traditional Medical (MD/DO) flashcards.

Research shows that students who use Picmonic see a 331% improvement in memory retention and a 50% improvement in test scores.