Master Pope's Blessing (Hand of Benediction) Deformity

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.

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.

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.

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.

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.

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.