Pope's Hand

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Ihateverbal

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On page 352 of First Aid 2009

It says Median Nerve "Pope's Blessing" and on page 354, it says ulnar nerve "Pope's Blessing"

Anyone know which it is?
 
I think it's a mistake in FA... here's a good explanation.

The discussion in the comments really helps too:
Yeah, you don't have it completely right.

Comment by Bean is pretty on the money, but here's the thing.

First, clawing has to do with what happens to the hand when the patient is asked to straighten/extend his fingers.

If the ulnar nerve is damaged then you get ulnar claw (2nd/3rd digits straight, 4th/5th digits extended at the MCP and flexed at the PIP and DIP). This is due to loss of the ulnar innervated lumbricals that leave the radial extensors unnopposed.

If the median nerve is damaged, then you get the same deformity - but only with the 2nd & 3rd digits instead. This is median claw.

If the patient is asked to make a fist, and said patient has median nerve damage then you get the hand of benediciton (2nd/3rd digits slightly arched, 4th/5th digits completely flexed). This is due to loss of the FOREARM flexors innervated be the median nerve.

The confusion stems from the fact that the Hand of Benediction/ Pope's Blessing looks very similar to Ulnar Claw... The similarity is only superficial though, the mechanism resulting in the deformity is different.

So Pope's blessing refers to a PROXIMAL median nerve injury and is seen upon MAKING A FIST.

Claw hand, without further descriptive modifiers, refers to a PROXIMAL unlar nerve injury and is seen upon MAKING A FIST.

An ULNAR CLAW is DISTAL ulnar nerve damage demonstrated upon finger EXTENSIOM.

Likewise, a MEDIAN CLAW is DISTAL medial nerve damage demonstrated upon finger EXTENSION.

So there's 4 diffent hands, one for proximal and distal nerve injury of both ulnar and median nerve. 3 have the word claw in there name and 2 of the hands resemble each for dissimilar reasons... hence, why it's so confusing and generally poorly understood.
 
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I think the confusion comes becasue bothe ulnar nerve claw hand and pops blessing are called claw hand ... so I guess in the real one they have to be specific
 
This is the most frustrating thing I have come across studying for Boards.

I have looked literally in DOZENS of sources and have not found two sources that say the same thing. Can someone please tell me what is correct for boards in terms of what an ulnar nerve lesion looks like (distal and proximal) and what a median nerve lesion looks like (distal and proximal) being Ape hand, Ulner claw, Pope's blessing, etc.

FA 2009 has it all messed up as does every other source I've seen. Thank you!
 
This is the most frustrating thing I have come across studying for Boards.

I have looked literally in DOZENS of sources and have not found two sources that say the same thing. Can someone please tell me what is correct for boards in terms of what an ulnar nerve lesion looks like (distal and proximal) and what a median nerve lesion looks like (distal and proximal) being Ape hand, Ulner claw, Pope's blessing, etc.

FA 2009 has it all messed up as does every other source I've seen. Thank you!

I know this isn't what you're looking for, but I've never seen a question that just shows a sketch of a hand. They always reference the interosseous muscles, the hypothenar or thenar eminences, the associated sensory loss or the site of the injury.

So I think knowing what it looks like visually exactly is less important than understanding which joints and sensory distribution are innervated by each nerve, and what injures each.
 
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