Palm Print Sign and Prayer Sign

Q: What are prayer sign and palm print sign?

Answer: If a patient cannot place palms flat together, it suggests difficult intubation. This reflects generalized joint and cartilage immobility and tight waxy skin, particularly in diabetic patients. About 33% of diabetic patients are prone to difficult intubations. 

Another version of the prayer sign is the "palm print" method, in which grading the ink impression made by the palm of the hand has been proposed to screen diabetic patients in whom tracheal intubation may prove difficult. One study found it superior to three other indices: Mallampati classification, thyromental distance, and head extension (reference # 3).

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References:

1. Vakilian A, Tabari M, Emadzadeh M, Soltani G. Evaluation of Palm Print Sign and Prayer Sign in Prediction of Difficult Laryngoscopy in Diabetic Patients. Anesth Pain Med. 2023 Jan 16;13(1):e129076. doi: 10.5812/aapm-129076. PMID: 37489172; PMCID: PMC10363357.

2. Erden V, Basaranoglu G, Delatioglu H, Hamzaoglu NS. Relationship of difficult laryngoscopy to long-term non-insulin-dependent diabetes and hand abnormality detected using the 'prayer sign'. Br J Anaesth. 2003 Jul;91(1):159-60. doi: 10.1093/bja/aeg583. PMID: 12821580.

3. Nadal JL, Fernandez BG, Escobar IC, Black M, Rosenblatt WH. The palm print as a sensitive predictor of difficult laryngoscopy in diabetics. Acta Anaesthesiol Scand. 1998 Feb;42(2):199-203. doi: 10.1111/j.1399-6576.1998.tb05109.x. PMID: 9509203.