Hand of Benediction

content of this page

1- Introduction

2- Anatomical Overview

3- Causes of Median Nerve Injury

4- Treatment


The “Hand of Benediction” is a clinical sign resulting from median nerve injury, often associated with the inability to flex the first three fingers when attempting to make a fist. This condition highlights the crucial role of the median nerve in hand function. 

  • Appearance: When the patient attempts to make a fist, the index and middle fingers remain extended, while the ring and little fingers flex normally.
  • Mechanism: This occurs because the flexor muscles for the index and middle fingers (FDS and FDP) and the thenar muscles are impaired, while the ulnar nerve-innervated muscles that flex the ring and little fingers remain functional.
© image from moore clinically oriented anatomy

Anatomical Overview

Anatomy Involved

  1. Median Nerve:

    • Origin: Arises from the brachial plexus, with contributions from the lateral and medial cords (C5-T1).
    • Course: Travels down the arm, through the cubital fossa at the elbow, and into the forearm. It passes through the carpal tunnel into the hand.
    • Innervation: Supplies motor innervation to several muscles of the forearm and hand, and sensory innervation to parts of the palm and fingers.
  2. Muscles Affected:

    • Forearm Flexors:
      • Flexor Digitorum Superficialis (FDS): Flexes the middle phalanges of the index and middle fingers.
      • Flexor Digitorum Profundus (FDP) (lateral half): Flexes the distal phalanges of the index and middle fingers.
      • Flexor Pollicis Longus (FPL): Flexes the thumb.
    • Thenar Muscles:
      • Abductor Pollicis Brevis: Abducts the thumb.
      • Flexor Pollicis Brevis: Flexes the thumb.
      • Opponent’s Pollicis: Opposes the thumb.
    • Lumbricals (1st and 2nd): Flex the metacarpophalangeal joints and extend the interphalangeal joints of the index and middle fingers.

Causes of Median Nerve Injury

  • Trauma: Direct injury to the nerve from fractures, lacerations, or penetrating injuries.
  • Compression: Carpal tunnel syndrome, where the median nerve is compressed at the wrist.
  • Systemic Conditions: Diabetes, which can cause peripheral neuropathy affecting the median nerve.
  • Tumors or Masses: Space-occupying lesions pressing on the median nerve.


  • Conservative Management:

    • Splinting: To support the hand and maintain proper positioning.
    • Physical Therapy: To maintain muscle strength and joint flexibility.
    • Medications: NSAIDs for pain and inflammation; corticosteroids in some cases of compression.
  • Surgical Intervention:

    • Decompression Surgery: For cases of carpal tunnel syndrome.
    • Nerve Repair or Grafting: In cases of traumatic injury.
    • Removal of Tumors or Masses: If a mass is compressing the nerve.
Scroll to Top