Two years of school, 2 rotations in the field, a whole lot of reading and studying and this is the first time the difference between "ape" and "benediction" has truly been explained. "Aple" hand is the default resting position of median nerve dmg. "Benediction" occurs when a person attempts flexion of all the digits. Got it now, thank you! So simple yet never simple stated anywhere else.
One of the most well-put-together anatomy videos/explanations I've ever seen. From start to finish everything was incredibly well explained with no room for misinterpretation.
At min 6:13 of the video, you mentioned that flexor digitorum superficialis and profundus is active BUT in fact the FDP ulnar part is supplies by Ulnar nerve so the remaining only FDS that will act
omar sameer for those that may have the same confusion, the injury to the ulnar nerve in this case is distal, therefore muscles that are proximal to the injury such as FDP will still be innervated by the ulnar nerve and will be able to do the corresponding action.
this is great! the only thing is that at 6:14 I think the FDP for digits 4 and 5 is also knocked out by an ulnar nerve lesion, so it's only the FDS that contributes to the unopposed flexion...
So what he showed was a DISTAL ulnar nerve lesion if you look at the point where he put the lesion; at this point, the ulnar nerve has most likely provided its motor innervation to the FDP for digits 4 and 5, which is why they wouldn't be affected (based on where he put his lesion). IF the lesion was more proximal, then you would definitely be correct.
THANK YOU SO MUCH! I am a true visual learner so the pictures combined with the excellent explanation helped ALOT. Thank you! - from a stressed PT student
Great video but I'm confused about one thing: If the FDS is lost in a high median nerve injury, why then are the PIPs of digits IV and V flexed in the depiction of the Sign of Benediction? Shouldn't these digits only be able to flex the DIPs since only the medial half of the FDP would be intact?
At 6:10 you mention that the the extensor digitorum can't resist against the flexor digitorum superficialus and profundus. But the medial aspect of profundus is innervated by the ulnar nerve. So why is there flexion at the dips of digits 4 and 5 in ulnar nerve lesion?
Thank you for the excellent question. When the ulnar nerve is damaged at the wrist (as shown in this video), flexor digitorum profundus function is not impaired since it receives its motor innervation more proximally (i.e., between the elbow and the wrist); thus, there would still be unopposed flexion at the distal interphalangeal joints of digits 4 and 5. If ulnar nerve damage occurs “higher” (i.e., in the cubital tunnel posterior to the medial epicondyle), then flexor digitorum profundus would lose its motor innervation and there would be a corresponding loss of flexion at the distal interphalangeal joints of digits 4 and 5. In fact, this anatomy is responsible for the Ulnar Nerve Paradox, wherein a more distal lesion of the ulnar nerve results in “worse” symptoms -in this case, tighter or more severe “clawing” of the affected digits. In nearly all other cases of peripheral nerve injury the more distal the lesion, the less severe the symptoms. In the interest of time and clarity, a discussion of the Ulnar Nerve Paradox was excluded from the video.
6:13, little bit confused there. You mentioned un opposed FDP 4th and 5th. Isn’t those muscles are also affected when u have Claw hand or Ulnar nerve injury.?
Flexor Digitorum Profundus' s medial part(4. and 5. digits) is innervated by ulnar nerve. And FDP is responsible for DIP flexion. How come DIP's can still be flexed in ulnar nerve damage?
Thanks so much for this, I understand whats happened to me for the last ten years that I hide. Now I at least know what happened after my accident. It was way over my head but I really got the effects and actions very clear! Thanks mate!!!
Isn't clawing of the 4 th and 5 th digits in Ulnar nerve palsy due to action of flexor digitorum superficialis at PIP and DIP. Since they is palsy of flexor digitorum profundus to the 4 th and 5 th digits.
With the sign of benediction, the video notes the only remaining functional flexor is the ulnar one half of flexor digitorum profundus...however, what about the third and fourth lumbricals? The lumbricals also flex the MP joint right? So being the 1st/2nd lumbricals are innervated by the median nerve and the 3rd/4th by the ulnar nerve, wouldnt this also play a significant role in the development of the sign of benediction?
Can anyone explain why there is partial claw hand of ulnar nerve but not median nerve ? Lumbricals are seperately innervated right....also when both nerves are injured there is complete claw hand...
Can anyone explain in the case of ape hand, wouldn't the abductor pollicis longus (from the posterior interosseous radial nerve) still function in abduction and oppose the adductor pollicis?
Doctor My father is 63 years old and he now has clawing of fingers (Claw Hand) could this lead to something serious?? Since my country is in a complete lock down I am not able to take him to the hospital.. please do help
Well your comment is old and you probably already know why or you just completely forgot about this whole thing. The reason is the median nerve innervates the 1st and 2nd lumbeicals which are responsible for flexion at the MCP, these are knocked out as well in a proximal median nerve injury, so no hyperflexion would occur.
Hello! Thank you for this amazing video. I have a question regarding the end of your video: I hear you mention that when the hand is relaxed, the clawed appearance goes away. I thought that it's the opposite, that when the hand is relaxed, the clawed appearance appears. Could you help me understand further please? Many thanks!
Was always wondering when someone would make a clear video describing the differences, explaining the A & P along the way. Where was this in med school? U would put osmosis & UWORLD out of business
![Hand of Benediction vs the Claw Hand [feat. the Ulnar Paradox]](http://i.ytimg.com/vi/BWhB_B3e4gc/mqdefault.jpg)
![The Brachial Plexus- Animated Review [HD]](http://i.ytimg.com/vi/5YJJkK4Kw88/mqdefault.jpg)
Two years of school, 2 rotations in the field, a whole lot of reading and studying and this is the first time the difference between "ape" and "benediction" has truly been explained. "Aple" hand is the default resting position of median nerve dmg. "Benediction" occurs when a person attempts flexion of all the digits. Got it now, thank you! So simple yet never simple stated anywhere else.
ttt&&&&&55fT⅝&555555&5&5
This video worth more than a million dollars, thanks for the video, this is magical!
One of the most well-put-together anatomy videos/explanations I've ever seen. From start to finish everything was incredibly well explained with no room for misinterpretation.
BEST EXPLANATION EVER - heartfelt thanks from a medical student. Please put up more if you would!
InstaBlaster
Adding to the chorus but seriously, thank you, this is SO well done and I finally understand how these injuries work.
Do u suffer from any?
WHAT?!! WHY AM I SEEING THIS TODAY! This video singlehandedly outsmarted professors in my university. Kudos
This explained a confusing 50 min lecture in 8 minutes. Bless.
What a remarkably well-done video that deserves the highest of praise. This should raise the standard for medical education
I have an exam tomorrow and you saved my great amount of time by your simple explanation, thank you
At min 6:13 of the video, you mentioned that flexor digitorum superficialis and profundus is active BUT in fact the FDP ulnar part is supplies by Ulnar nerve so the remaining only FDS that will act
omar sameer for those that may have the same confusion, the injury to the ulnar nerve in this case is distal, therefore muscles that are proximal to the injury such as FDP will still be innervated by the ulnar nerve and will be able to do the corresponding action.
@@immunealtair2737 Thank you. I was so confused by this.
@@immunealtair2737 by reading omar i got same confusion but right next comment you cleared it thanks
This is the best video I have ever seen in my life explaining these complex issues so clearly...
this should be played in all anatomy classes
This is so freaking awesome, the fact that you reviewed the muscles and the joint made it so easy. Now I’ll never forget any of these clinical signs
without reading up on the topic, or watching the video. Do you still remember? =)
Considering my attention span and the amount of information in this video I am truly amazed that I captured pretty much all that was presented.
I love you PhDs, the illustration is much more better than MDs.
this is great! the only thing is that at 6:14 I think the FDP for digits 4 and 5 is also knocked out by an ulnar nerve lesion, so it's only the FDS that contributes to the unopposed flexion...
I noticed that and puzzled over it for a bit. Glad someone else noticed it and commented.
@@rufussweeneymd Yes, this was my thought as well.
FDP is divided above the wrist so it still remains function.
So what he showed was a DISTAL ulnar nerve lesion if you look at the point where he put the lesion; at this point, the ulnar nerve has most likely provided its motor innervation to the FDP for digits 4 and 5, which is why they wouldn't be affected (based on where he put his lesion). IF the lesion was more proximal, then you would definitely be correct.
This explained what several websites failed. Thank you
This is incredible. I was quite overwhelmed by this info in PA school but this is crystal clear.
soooo helpful- i loved how the animations go way beyond solely diagrams. Thank u!
You just saved me from 30 hours of studying. You're an MVP. Thanks!
Awesome video. Amazing job at explaining the concepts and great pictorals. Saved it for future review!
THANK YOU SO MUCH! I am a true visual learner so the pictures combined with the excellent explanation helped ALOT. Thank you! - from a stressed PT student
Colleges should follow this kind of teaching..which make clear concept in mind...
This is really the best video about this topic that I have ever watched…
THANKYOU ❤
BEST EXPLANATION EVER - heartfelt thanks from a medical student. Exactly what I was going to say.
Fantastic description. Thank you
I have experienced tons of struggles till i watched this amazing video, thanks alot!
Hey, this was brilliant! Thanks so much for finding the logic in all of these injuries.
Please make more videos!! This has been life saving!!!
Do u suffer from any?
that was absolutely perfect, so logically explained and i love the animation , one would understood even not a medical student
Wonderful explanation with excellent animations. Thanks a ton!
Thanks for making our lives easy.
Great explanation of the clinical differences between The Hand of Benediction and ulnar claw
OMG !
This video is life saving !
Thank you very much
Thank you so much. I have a test in a few hours and you saved me
Wow @Doctor Eric Laywell, God bless you and your team. Excellent , Excellent video with explanation made super easy.
Thanks very much for explaining the causes of these confusing signs.
Great video but I'm confused about one thing: If the FDS is lost in a high median nerve injury, why then are the PIPs of digits IV and V flexed in the depiction of the Sign of Benediction? Shouldn't these digits only be able to flex the DIPs since only the medial half of the FDP would be intact?
At 6:10 you mention that the the extensor digitorum can't resist against the flexor digitorum superficialus and profundus. But the medial aspect of profundus is innervated by the ulnar nerve. So why is there flexion at the dips of digits 4 and 5 in ulnar nerve lesion?
Thank you for the excellent question. When the ulnar nerve is damaged at the wrist (as shown in this video), flexor digitorum profundus function is not impaired since it receives its motor innervation more proximally (i.e., between the elbow and the wrist); thus, there would still be unopposed flexion at the distal interphalangeal joints of digits 4 and 5. If ulnar nerve damage occurs “higher” (i.e., in the cubital tunnel posterior to the medial epicondyle), then flexor digitorum profundus would lose its motor innervation and there would be a corresponding loss of flexion at the distal interphalangeal joints of digits 4 and 5.
In fact, this anatomy is responsible for the Ulnar Nerve Paradox, wherein a more distal lesion of the ulnar nerve results in “worse” symptoms -in this case, tighter or more severe “clawing” of the affected digits. In nearly all other cases of peripheral nerve injury the more distal the lesion, the less severe the symptoms. In the interest of time and clarity, a discussion of the Ulnar Nerve Paradox was excluded from the video.
@@FSUMedMedia please are there more videos?
6:13, little bit confused there. You mentioned un opposed FDP 4th and 5th. Isn’t those muscles are also affected when u have Claw hand or Ulnar nerve injury.?
I just passed my metacarpal PHD after watching this thorough video. Very informative.
Precisec....concise...clean clear......thanks so much
this is quality medical education. This is a standard
have to agree with all prior comments - BEST EXPLANATION EVER - thank you
Thank you so much for explaining this concept! It was so confusing for me, but you cleared it up with your thorough explanation with great visuals!
Thanks
@Doctor Eric Laywell ...just excellent👍👍👍👍
This was the greatest review ever.
We're waiting for another physican guide videos like this one thanks
I haven't seen a video more interesting and understanding than this.. Wow.. Thank you
Correction at 6.10...in claw hand..flexor pull is only bt FDS..not by FDP...4th,5th tendon of FDP supplied by ulnar nerve itself.....thnks...
Great videos. Very high quality and get down to the essence of what is important in an approachable way. Please make more animated videos.
This is one hell of a video! Absolutely the best!
thank you very much. Greetings from Jamaica
Perfectly presented- thank you!
Fabulous video and presentation. Superb quality.
Flexor Digitorum Profundus' s medial part(4. and 5. digits) is innervated by ulnar nerve. And FDP is responsible for DIP flexion. How come DIP's can still be flexed in ulnar nerve damage?
Quadriga phenomena
Clear explanation and helpful animation. This is an incredible vid!
thank you! never been explained better
Very useful video for explaining a previously complicated concept
Excellent
Thank you so much for this video! Best explanation on the topic
Thanks so much for this, I understand whats happened to me for the last ten years that I hide. Now I at least know what happened after my accident. It was way over my head but I really got the effects and actions very clear! Thanks mate!!!
Pls do upload more videos found very useful and this was the best best explain I have seen in this topic..... upload videos on anatomy of PNS and CNS
Thank you so much for explaining this concept!
😮 OMG , i have been searching for this years.thank you very much. Sir.
amazing! but what about the last hand position?
Since abductor pollicis longus abducts the thumb, and is innervated by the radial nerve, why would a median nerve palsy cause and ape hand deformity?
Absolutely simply explained!!!
I just want to know, how many hours were spent creating this illustration and the overlying narration? Excellent job. Thanks.
EXCELLENT!!!!! Hand surgeon level master class!!!!
That was great. Never understood this well in 7 years of med school and internship thanks haha❤
Excellent method of clarification .
Isn't clawing of the 4 th and 5 th digits in Ulnar nerve palsy due to action of flexor digitorum superficialis at PIP and DIP. Since they is palsy of flexor digitorum profundus to the 4 th and 5 th digits.
Amazing video and animations. Never quite understood it.
With the sign of benediction, the video notes the only remaining functional flexor is the ulnar one half of flexor digitorum profundus...however, what about the third and fourth lumbricals? The lumbricals also flex the MP joint right? So being the 1st/2nd lumbricals are innervated by the median nerve and the 3rd/4th by the ulnar nerve, wouldnt this also play a significant role in the development of the sign of benediction?
Incredible video with excellent visuals. Thanks so much for this!
Thank you. The best one on the topic by far.
Truly a fruitful one! 🙌
Thank you so much sir! 🙏🌼
Incredibly clear explanations. Thank you!
You have saved my exam. THANK YOU
If the lumbricals and interossei assist in MCP extension, why is it that the loss of their innervation results in MCP hyperextension?
The Soviet school anatomists loved to ask about this during exams. Reminded me of medical school so many years back.
Can anyone explain why there is partial claw hand of ulnar nerve but not median nerve ? Lumbricals are seperately innervated right....also when both nerves are injured there is complete claw hand...
Can anyone explain in the case of ape hand, wouldn't the abductor pollicis longus (from the posterior interosseous radial nerve) still function in abduction and oppose the adductor pollicis?
Doctor My father is 63 years old and he now has clawing of fingers (Claw Hand) could this lead to something serious?? Since my country is in a complete lock down I am not able to take him to the hospital.. please do help
Amazing explanation and video! 👍🏻👏🏼
Thanks a lot! But why isn't there also hyperflexion of the mcp joint in hand of benediction?
Well your comment is old and you probably already know why or you just completely forgot about this whole thing. The reason is the median nerve innervates the 1st and 2nd lumbeicals which are responsible for flexion at the MCP, these are knocked out as well in a proximal median nerve injury, so no hyperflexion would occur.
Hello! Thank you for this amazing video. I have a question regarding the end of your video: I hear you mention that when the hand is relaxed, the clawed appearance goes away. I thought that it's the opposite, that when the hand is relaxed, the clawed appearance appears. Could you help me understand further please? Many thanks!
You make the best explanations i've seen! Thanks!
Appreciated! Love those animations and explanation you made.
Perfect explanation!
very good ilustration .. good job
Best explanation ever!! Thank you so much :)
wonderful ! very clear and complete .
Was always wondering when someone would make a clear video describing the differences, explaining the A & P along the way. Where was this in med school? U would put osmosis & UWORLD out of business
Excellent animation and explanation
Best explanation. Not even close
The best explanation ever!! Thankyou so much doc.
Thanks Dr. Eric. Great work!
Wow!! I loved the explanation and the visuals