Benediction Sign After a Malunited Distal Radius Fracture: A Case Report of Flexor Tendon Rupture Mimicking Median Nerve Injury

The Benediction sign is a pathological hand posture that appears when a person tries to make a fist. It is characterized by the extension of the index and middle fingers, abduction of the thumb, and flexion of the ring and little fingers. Clinically, the appearance of the Benediction sign is closely associated with high median nerve neuropathy. However, in the following case described, a low-energy fall resulted in delayed presentation of a right distal radius fracture together with complete rupture of the flexor digitorum profundus (FDP) tendons to the index and middle fingers and flexor pollicis longus (FPL) within the carpal tunnel. This injury produced a hand posture resembling the Benediction sign, resulting in an initial clinical impression of median nerve injury. Further investigations suggested an alternative diagnosis, raising suspicion of FDP and FPL tendon rupture. Surgical intervention was then undertaken to reduce and fix the malunited distal radius fracture and to repair the ruptured FDP and FPL tendons. This case emphasizes the need to consider rupture of FDP and FPL tendons as a masquerade of the Benediction sign. We present clinical progression and effective management of this case to underscore the significance of this important diagnostic consideration.