Analysis of the Papal Benediction Sign: The ulnar neuropathy of St. Peter.

The origin of the Papal Benediction Sign has been a source of controversy for many generations of medical students. The question has been whether the Papal Benediction Sign posture is the result of an injury to the median nerve or to the ulnar nerve. The increasingly popular use of online "chat rooms" and the vast quantities of information available on the internet has led to an increasing level of confusion. Looking in major anatomy texts, anatomy and board review books as well as numerous internet sites the answer remains unresolved. Through the analysis of functional anatomy of the hand, cultural and religious practices of the early centuries of the Common Era and church art a clear answer emerges. It will become apparent that this hand posture results from an ulnar neuropathy.

Intraneural ganglion cyst: a 200-year-old mystery solved.

We describe the first reported case of an intraneural ganglion cyst, an ulnar ("cubital") intraneural cyst, which, on literature review, dated to 1810. For over 80 years, its original brief description by Beauchêne was wrongly attributed to Duchenne, effectively making the reference and specimen inaccessible to scrutiny. Fortunately, the intact cyst had been safely housed in the Musée Dupuytren, Paris, France, thus permitting its examination. Although originally described as a "serous" cyst, our present understanding of the anatomy of the ulnar nerve and of peripheral nerve pathology allowed us to reinterpret it as a mucin-filled, elbow-level, ulnar intraneural ganglion cyst. In addition to its description as a fusiform cystic enlargement of the nerve, we documented similar enlargement of a lumen-bearing branch, the articular branch at the level of the elbow. Based on our assessment of the specimen and with a modern perspective, we concluded that the origin of the cyst was from the postero-medial aspect of the elbow joint and that its fluid content, having dissected through a capsular defect, followed the path of the articular branch into the parent ulnar nerve. The purpose of this report is to clarify historical misconceptions regarding the pathogenesis of this controversial entity.