Claw Hand?

[xanthomondo]

Can someone please help me with this topic?

In FA (I'm using the '09), in the brachial plexus lesions chart it says an medial nerve lesion --> Pope's blessing. This is repeated in the gray chart for upper extremity nerves.

On the next page it says twice that the Pope's blessing is an ulnar claw and is from a distal ulnar nerve lesion.

I tried googling it and came to this page: http://scrubnotes.blogspot.com/2008/02/popes-blessing-vs-claw-hand.html
which tries to sort out FA's error, but then manages to talk about "ulnar claw hand" in the "claw hand" section and perfectly describes the Pope's blessing.

So can someone give me a quick lesson? Are these three different things? Claw hand vs ulnar claw hand vs popes blessing (median nerve)? Where the latter two are just idenitical in presentation?

Thanks

---

Members don't see this ad.

 

[Doctor D]

Popes blessing with a median nerve lesion is when you ask the patient to make a fist and their 2nd and 3rd digits do not flex --> "pope's blessing"

In an ulnar nerve lesion the lumbricals which flex the MCP and extend the DIP are paralyzed and therefore your 2nd and 3rd digits will stand up properly while your 4th and 5th are in the claw position thus making a "pope's blessing".

It can also be called hand of benediction sometimes.

 

[bergwood]

Can someone please help me with this topic?

In FA (I'm using the '09), in the brachial plexus lesions chart it says an medial nerve lesion --> Pope's blessing. This is repeated in the gray chart for upper extremity nerves.

This is fixed in the '10 version. I have both and just checked the difference.

Pope's blessing is failure of extension of digits 4 and 5, caused by loss of innervation to the 4th and 5th lumbricals, due to damage to the ulnar nerve.

 

[Dirt]

Popes blessing with a median nerve lesion is when you ask the patient to make a fist and their 2nd and 3rd digits do not flex --> "pope's blessing"

In an ulnar nerve lesion the lumbricals which flex the MCP and extend the DIP are paralyzed and therefore your 2nd and 3rd digits will stand up properly while your 4th and 5th are in the claw position thus making a "pope's blessing".

It can also be called hand of benediction sometimes.

Bingo. They look the same. With median nerve you get "the claw" when the patient is asked to make a fist. With ulnar you get "the claw" when the patient is asked to open their hand.

 

[xanthomondo]

I see.

Thanks for the clarification

 

[xx216xx]

I'm going to recommend you don't even learn what those mean...they don't actually mean anything clinically and all it's going to do is confuse you. Nobody is going to say to you, "patient presents with Pope's blessing," that has no descriptive value. Don't waste your time learning those ******ed claw descriptions and just know what happens when X nerve is affected and you'll be better off.

 

[Sol Rosenberg]

I'm going to recommend you don't even learn what those mean...they don't actually mean anything clinically and all it's going to do is confuse you. Nobody is going to say to you, "patient presents with Pope's blessing," that has no descriptive value. Don't waste your time learning those ******ed claw descriptions and just know what happens when X nerve is affected and you'll be better off.

👍 I was just going to post the same thing. I haven't had a single question {Kaplan, UW, NBME} that used any of those claw descriptions -- they all just asked the motor and/or sensory effects of lesioning the different nerves.