The design originates with the coat of arms worn by Godfrey of Bouillon during the First Crusade, and it remained in use as the armorial of the Kingdom of Jerusalem throughout its duration (1099–1291).

The symbolism of the five-fold cross is variously given as the Five Wounds of Christ, Christ and the four quarters of the world, Christ and the four evangelists. The symbolism of five crosses representing the Five Wounds is first recorded earlier in the 11th century, with the consecration of the St Brelade's Church under the patronage of Robert of Normandy (before 1035); the crosses are incised in the church's altar slab.

The Latin Empire of 1204–1261 used an extended variant of the Jerusalem cross, where each of the four crosslets was itself surrounded by four smaller crosslets (a "Jerusalem cross of Jerusalem crosses").

In late medieval heraldry, after the failure of the Crusades, the Crusader's cross was used for various Crusader states.