Upper Limb — MCQs

A 40-year-old man sustains a left elbow fracture in a car accident. He presents with numbness in his fourth and fifth fingers, and a weakened hand grip. Neurologic examination reveals diminished sensation over the fifth finger and the ulnar aspect of the fourth finger, along with weakness in finger abduction and adduction. What is the most likely diagnosis?

Q206Easy

Claw hand is seen in all conditions except?

Q207Easy

Which muscle is supplied by the dorsal scapular nerve?

Q208Easy

What is the sensory supply to the specified region?

Q209Easy

A patient presents with hypothenar muscle wasting and loss of sensation of the medial one and a half digits. Which nerve is involved?

Q210Medium

All the following are true regarding the Brachial plexus EXCEPT?

Upper Limb Indian Medical PG Practice Questions and MCQs

Question 201: Which of the following nerves carries fibers from all the roots of the brachial plexus?

A. Axillary
B. Ulnar
C. Median (Correct Answer)
D. Musculocutaneous

Explanation: The **Median nerve** is the correct answer because it is the only nerve listed that receives contributions from all five roots of the brachial plexus (**C5, C6, C7, C8, and T1**). ### **Explanation of the Correct Answer** The Median nerve is formed by the union of two heads: 1. **Lateral Head:** Derived from the Lateral Cord, carrying fibers from **C5, C6, and C7**. 2. **Medial Head:** Derived from the Medial Cord, carrying fibers from **C8 and T1**. By combining these two heads, the Median nerve encompasses the entire root value of the brachial plexus. ### **Analysis of Incorrect Options** * **Axillary Nerve (C5, C6):** A branch of the posterior cord; it only carries upper root fibers. * **Musculocutaneous Nerve (C5, C6, C7):** A branch of the lateral cord; it lacks the lower root (C8, T1) contributions. * **Ulnar Nerve (C8, T1, and often C7):** Primarily a branch of the medial cord. While it often receives C7 fibers via a communication from the lateral cord, it consistently lacks C5 and C6 fibers. * *Note:* The **Radial Nerve** also carries fibers from all roots (C5-T1), but it was not the designated correct option in this specific question set. ### **NEET-PG High-Yield Pearls** * **The "All-Root" Nerves:** Only two major nerves carry fibers from C5 to T1: the **Median nerve** and the **Radial nerve**. * **Clinical Sign:** Injury to the median nerve at the wrist (e.g., Carpal Tunnel Syndrome) leads to "Ape Thumb Deformity," while high injury leads to the "Pointing Index" or "Hand of Benediction." [1] * **Anatomical Relation:** The median nerve is the "content" of the cubital fossa and passes between the two heads of the pronator teres muscle.

Question 202: The Ligament of Testut is also known as which of the following ligaments?

A. Radio scapholunate ligament
B. Scapholunate ligament
C. Ulnolunate ligament
D. Ulnotriquetral ligament (Correct Answer)

Explanation: **Explanation:** The **Ligament of Testut**, also known as the **Radio-scapholunate (RSL) ligament**, is a structure of significant historical and clinical importance in wrist anatomy. **Why Option A is Correct (Note on Correction):** There appears to be a discrepancy in the provided key. In standard anatomical texts and orthopedic literature (e.g., Green’s Operative Hand Surgery), the **Ligament of Testut is the Radio-scapholunate ligament**. It is not a true mechanical ligament but rather a vascular tuft covered by synovium. It originates from the distal radius (interstyloid ridge) and inserts into the interval between the scaphoid and lunate. Its primary function is to carry neurovascular supply (anterior interosseous nerve and artery) to the scapholunate joint, rather than providing structural stability. **Analysis of Options:** * **A. Radio-scapholunate ligament:** This is the correct anatomical synonym for the Ligament of Testut. * **B. Scapholunate ligament:** This is a critical intrinsic ligament maintaining the stability of the proximal carpal row; injury leads to "Terry Thomas sign." * **C. Ulnolunate ligament:** Part of the ulnocarpal complex, providing stability to the medial wrist. * **D. Ulnotriquetral ligament:** Also part of the ulnocarpal complex; while important for the TFCC, it is not the Ligament of Testut. **NEET-PG High-Yield Pearls:** * **Vascularity:** The Ligament of Testut is a key landmark during wrist arthroscopy (located in the 3-4 portal). * **Weakness:** Because it lacks dense collagenous fibers, it is often referred to as a "vestigial" or "pseudo-ligament." * **Space of Poirier:** A weak area in the floor of the carpal tunnel between the radioscaphocapitate and long radiolunate ligaments; it is the site where the lunate displaces during a lunate dislocation.

Question 203: The lesion of Klumpke's paralysis is in which part of the nerve plexus?

A. Cervical plexus
B. Lower brachial plexus (Correct Answer)
C. Upper brachial plexus
D. Sacral plexus

Explanation: **Explanation:** **1. Why Option B is Correct:** Klumpke’s paralysis is a form of brachial plexus injury caused by an injury to the **lower trunk**, specifically the **C8 and T1 nerve roots**. This typically occurs due to hyperabduction of the arm (e.g., clutching an object while falling from a height or during a breech delivery). The T1 fibers primarily supply the intrinsic muscles of the hand; thus, their loss leads to the characteristic "total claw hand" deformity. **2. Why Other Options are Incorrect:** * **Option A (Cervical Plexus):** This plexus (C1-C4) supplies the skin and muscles of the head, neck, and the diaphragm (via the phrenic nerve). It is not involved in upper limb motor control. * **Option C (Upper Brachial Plexus):** Injury to the upper trunk (C5-C6) results in **Erb’s Paralysis**, characterized by the "Policeman’s tip" or "Waiter’s tip" deformity. * **Option D (Sacral Plexus):** This plexus (L4-S4) supplies the lower limbs and pelvic floor; it has no anatomical connection to the upper limb. **3. High-Yield Clinical Pearls for NEET-PG:** * **Deformity:** Klumpke’s paralysis results in a **Total Claw Hand** (hyperextension at MCP joints and flexion at IP joints) due to the paralysis of lumbricals and interossei. * **Horner’s Syndrome:** Often associated with Klumpke’s paralysis if the T1 root is avulsed proximal to the sympathetic chain (causing miosis, ptosis, and anhidrosis). * **Sensory Loss:** Occurs along the ulnar aspect of the forearm and hand (C8-T1 dermatomes). * **Contrast:** Remember **E**rb’s = **E**levated (Upper trunk) vs. **K**lumpke’s = **K**low (Lower trunk).

Question 204: A 42-year-old female presents with a shoulder injury requiring surgical repair of the supraspinatus muscle. Which of the following is true of the supraspinatus muscle?

A. It inserts on the lesser tubercle of the humerus.
B. It initiates abduction of the shoulder.
C. It is innervated chiefly by the C5 spinal nerve. (Correct Answer)
D. It is supplied by the upper subscapular nerve.

Explanation: ### Explanation **1. Why Option C is Correct:** The supraspinatus muscle is innervated by the **suprascapular nerve**, which arises from the **superior trunk** of the brachial plexus. Its fibers are derived primarily from the **C5** spinal nerve (with some contribution from C6). In the context of NEET-PG, C5 is considered the "chief" root for the supraspinatus and infraspinatus muscles. **2. Why the Other Options are Incorrect:** * **Option A:** The supraspinatus inserts on the **highest (superior) impression of the greater tubercle** of the humerus. The lesser tubercle is the insertion site for the subscapularis muscle. * **Option B:** While traditionally taught as the "initiator" (0–15°), current electromyographic studies show it is active throughout the entire range of abduction. However, the **deltoid** is the primary muscle for abduction beyond 15°. (Note: If this were a "best function" question, B is a common distractor, but C is an anatomical fact regarding innervation). * **Option D:** The supraspinatus is supplied by the **suprascapular nerve**, not the subscapular nerve. The upper and lower subscapular nerves (C5-C6) supply the subscapularis and teres major. **3. Clinical Pearls & High-Yield Facts:** * **Rotator Cuff (SITS):** Supraspinatus, Infraspinatus, Teres minor, and Subscapularis. * **Most Common Injury:** The supraspinatus is the most frequently torn tendon in the rotator cuff due to its location under the acromion (impingement zone). * **Suprascapular Notch:** The suprascapular nerve passes *under* the superior transverse scapular ligament (the "Army" goes over the bridge—artery; the "Navy" goes under—nerve). * **Painful Arc Syndrome:** Pain during abduction between 60° and 120° often indicates supraspinatus tendinitis.

Question 205: A 40-year-old man sustains a left elbow fracture in a car accident. He presents with numbness in his fourth and fifth fingers, and a weakened hand grip. Neurologic examination reveals diminished sensation over the fifth finger and the ulnar aspect of the fourth finger, along with weakness in finger abduction and adduction. What is the most likely diagnosis?

A. Ulnar nerve injury (Correct Answer)
B. Radial nerve injury
C. Median nerve injury
D. Carpal tunnel syndrome

Explanation: **Explanation:** The clinical presentation is a classic case of **Ulnar Nerve Injury**, likely occurring at the level of the medial epicondyle (cubital tunnel) following the elbow fracture. **1. Why Ulnar Nerve is Correct:** * **Sensory Loss:** The ulnar nerve provides sensation to the medial 1.5 fingers (5th finger and ulnar half of the 4th finger) [1]. * **Motor Deficit:** It innervates all **Interossei muscles** (Dorsal for abduction, Palmar for adduction). Weakness in finger abduction/adduction and a weakened grip (due to loss of intrinsic muscle power) are hallmark signs. * **Anatomical Context:** The ulnar nerve runs posterior to the medial epicondyle of the humerus, making it highly vulnerable in elbow fractures or dislocations. **2. Why Other Options are Incorrect:** * **Radial Nerve Injury:** Typically presents with **Wrist Drop** due to paralysis of the extensors. Sensory loss occurs on the dorsal aspect of the first web space. * **Median Nerve Injury:** Would result in "Ape Hand" deformity, loss of thumb opposition, and sensory loss over the lateral 3.5 fingers (palmar aspect) [1]. * **Carpal Tunnel Syndrome:** This involves compression of the **Median nerve** at the wrist. It would not cause weakness in finger abduction/adduction (interossei) and would not be caused by an elbow fracture [1]. **Clinical Pearls for NEET-PG:** * **Froment’s Sign:** Tests for adductor pollicis palsy (Ulnar nerve). * **Claw Hand:** Distal ulnar nerve lesions cause more prominent clawing than proximal lesions (the **Ulnar Paradox**). * **Point of Injury:** Elbow injuries affect the Flexor Carpi Ulnaris (FCU), whereas wrist injuries spare it.

Question 206: Claw hand is seen in all conditions except?

A. Scleroderma
B. Sarcoidosis (Correct Answer)
C. Leprosy
D. Hurler’s syndrome

Explanation: **Explanation:** The term **"Claw Hand"** refers to a clinical deformity characterized by hyperextension at the metacarpophalangeal (MCP) joints and flexion at the interphalangeal (IP) joints. This occurs due to an imbalance between the strong extrinsic extensors and the paralyzed intrinsic muscles (interossei and lumbricals). **Why Sarcoidosis is the Correct Answer:** Sarcoidosis is a multisystem granulomatous disease that primarily affects the lungs and lymph nodes. While it can cause neurosarcoidosis (mononeuritis multiplex), it is **not** a classic or recognized cause of a permanent claw hand deformity. The other options represent well-documented causes of either neurogenic or musculoskeletal clawing. **Analysis of Other Options:** * **Leprosy (Hansen’s Disease):** The most common cause of claw hand worldwide. It involves the **Ulnar nerve** (at the elbow or wrist) and/or the **Median nerve**, leading to intrinsic muscle paralysis. * **Scleroderma:** This systemic autoimmune disease causes progressive fibrosis and tightening of the skin (**Sclerodactyly**). The severe skin contractures pull the fingers into a fixed, claw-like position. * **Hurler’s Syndrome (MPS I):** A lysosomal storage disorder where the accumulation of glycosaminoglycans in the tendons and ligaments leads to joint stiffness and a characteristic **"claw-press" deformity**. **High-Yield Clinical Pearls for NEET-PG:** * **Ulnar Paradox:** The higher the lesion of the ulnar nerve (e.g., at the elbow), the *less* prominent the clawing, because the medial half of the Flexor Digitorum Profundus is also paralyzed. * **Klumpke’s Paralysis:** Injury to the **C8-T1** nerve roots (lower plexus) results in a total claw hand. * **Volkmann’s Ischemic Contracture:** Can also lead to a claw-like deformity due to ischemic fibrosis of the forearm flexors.

Question 207: Which muscle is supplied by the dorsal scapular nerve?

A. Teres minor
B. Serratus anterior
C. Trapezius
D. Levator scapulae (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. Levator scapulae** The **dorsal scapular nerve** arises from the **C5 root** of the brachial plexus. It pierces the middle scalene muscle and descends deep to the levator scapulae and the rhomboids. It provides motor innervation to: 1. **Rhomboid Major** 2. **Rhomboid Minor** 3. **Levator Scapulae** (along with branches from the cervical plexus C3, C4). The primary action of these muscles is to adduct (retract) and elevate the scapula. --- ### Analysis of Incorrect Options: * **A. Teres minor:** This muscle is part of the rotator cuff and is supplied by the **axillary nerve (C5, C6)**, which also supplies the deltoid. * **B. Serratus anterior:** This muscle is supplied by the **long thoracic nerve (C5, C6, C7)**, also known as the Nerve of Bell. Damage to this nerve results in "winging of the scapula." * **C. Trapezius:** This is a superficial back muscle supplied by the **spinal accessory nerve (CN XI)** for motor function and C3-C4 spinal nerves for proprioception. --- ### High-Yield NEET-PG Pearls: * **Root Value:** The dorsal scapular nerve is a branch of the **roots** (specifically C5) of the brachial plexus, not the trunks or cords. * **Clinical Sign:** Paralysis of the rhomboids (via dorsal scapular nerve injury) results in the inability to retract the scapula; on examination, the scapula on the affected side sits further from the midline than the normal side. * **Dual Supply:** Remember that the **Levator scapulae** has a dual nerve supply: the dorsal scapular nerve (C5) and direct branches from the cervical plexus (C3, C4).

Question 208: What is the sensory supply to the specified region?

A. Ulnar nerve
B. Radial nerve (Correct Answer)
C. Median nerve
D. Axillary nerve

Explanation: ***Radial nerve*** - The **superficial branch of the radial nerve** provides sensory innervation to the **dorsolateral aspect** of the hand, including the dorsal surfaces of the thumb, index, and middle fingers (proximal to the DIP joints). - It supplies the **anatomical snuffbox** region and the **dorsal web space** between the thumb and index finger. *Ulnar nerve* - Provides sensory supply to the **medial one and a half fingers** (little finger and medial half of ring finger) on both **palmar and dorsal surfaces**. - Also innervates the **hypothenar eminence** and medial palm, not the dorsolateral hand region. *Median nerve* - Supplies the **lateral three and a half fingers** on the **palmar surface** (thumb, index, middle, and lateral half of ring finger). - Does not provide significant sensory innervation to the **dorsal aspect** of the hand. *Axillary nerve* - Primarily provides sensory innervation to the **lateral deltoid region** (regimental badge area) over the shoulder. - Has no role in **hand sensation** and is involved in shoulder abduction through deltoid muscle innervation.

Question 209: A patient presents with hypothenar muscle wasting and loss of sensation of the medial one and a half digits. Which nerve is involved?

A. Ulnar nerve (Correct Answer)
B. Median nerve
C. Radial nerve
D. Musculocutaneous nerve

Explanation: ### Explanation The correct answer is **A. Ulnar nerve**. **1. Why the Ulnar Nerve is Correct:** The ulnar nerve (C8–T1) is often referred to as the "musician's nerve" because it controls the fine movements of the fingers. It provides motor innervation to the **hypothenar muscles** (abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi) and the medial two lumbricals. Sensory-wise, it supplies the **medial one and a half digits** (pinky and half of the ring finger) on both the palmar and dorsal aspects [1]. Wasting of the hypothenar eminence and sensory loss in this specific distribution are classic signs of ulnar nerve injury, often occurring at the medial epicondyle (cubital tunnel) or Guyon’s canal. **2. Why the Other Options are Incorrect:** * **B. Median Nerve:** Innervates the **thenar muscles** (LOAF: Lumbricals 1 & 2, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis) [1]. Injury leads to "Ape Hand" deformity and sensory loss over the lateral three and a half digits [1]. * **C. Radial Nerve:** Primarily supplies the extensors of the forearm. Injury typically results in **wrist drop** and sensory loss over the first dorsal web space [1]. * **D. Musculocutaneous Nerve:** Supplies the coracobrachialis, biceps brachii, and brachialis. Injury affects elbow flexion and forearm supination, with sensory loss on the **lateral** aspect of the forearm (via the lateral cutaneous nerve of the forearm). **3. Clinical Pearls for NEET-PG:** * **Ulnar Claw Hand:** Characterized by hyperextension at the MCP joints and flexion at the IP joints of the 4th and 5th digits. * **Froment’s Sign:** Positive in ulnar nerve palsy due to paralysis of the Adductor Pollicis (compensated by Flexor Pollicis Longus, supplied by the median nerve). * **Ulnar Paradox:** A high lesion (at the elbow) results in a *less* prominent clawing than a low lesion (at the wrist) because the medial half of the Flexor Digitorum Profundus is also paralyzed.

Question 210: All the following are true regarding the Brachial plexus EXCEPT?

A. Lateral cord gives rise to the Musculocutaneous nerve.
B. Medial cord gives rise to the Ulnar nerve.
C. Posterior cord gives rise to the Axillary nerve.
D. Erb's point gives rise to the Thoracodorsal nerve. (Correct Answer)

Explanation: ### Explanation The **Brachial Plexus** is a complex network of nerves (C5-T1) supplying the upper limb. To identify the incorrect statement, we must analyze the origin of each nerve. **Why Option D is the Correct Answer (The False Statement):** **Erb’s Point** is a specific site on the upper trunk where six nerves meet: C5 root, C6 root, Suprascapular nerve, Nerve to Subclavius, and the anterior and posterior divisions of the upper trunk. The **Thoracodorsal nerve** (nerve to Latissimus dorsi), however, arises from the **Posterior Cord** (C6, C7, C8) [1]. Therefore, it does not originate from Erb’s point. **Analysis of Incorrect Options (True Statements):** * **Option A:** The **Lateral Cord** (C5-C7) terminates by giving off the **Musculocutaneous nerve** and the lateral root of the Median nerve. * **Option B:** The **Medial Cord** (C8-T1) continues as the **Ulnar nerve** after giving off the medial root of the Median nerve and cutaneous nerves. * **Option C:** The **Posterior Cord** (C5-T1) gives off five branches (STARS: Subscapular, Thoracodorsal, Axillary, Radial, Subscapular). Thus, the **Axillary nerve** is a direct branch. **Clinical Pearls for NEET-PG:** 1. **Erb’s Palsy:** Injury to Erb’s point (Upper Trunk) results in a **"Policeman’s tip"** or "Waiter’s tip" deformity (arm adducted, medially rotated, forearm extended and pronated). 2. **Klumpke’s Palsy:** Injury to the Lower Trunk (C8-T1) leads to **"Claw hand"** due to involvement of the intrinsic muscles of the hand. 3. **Winged Scapula:** Caused by injury to the **Long Thoracic Nerve** (C5, C6, C7), which arises directly from the roots, not the cords. 4. **Mnemonic for Posterior Cord:** **ULTRA** (Upper subscapular, Lower subscapular, Thoracodorsal, Radial, Axillary).

Practice by Chapter

Pectoral Region and Axilla

Practice Questions

Arm and Cubital Fossa

Practice Questions

Forearm and Hand

Practice Questions

Joints of Upper Limb

Practice Questions

Nerves of Upper Limb

Practice Questions

Arterial Supply and Venous Drainage

Practice Questions

Lymphatic Drainage

Practice Questions

Muscles and Their Actions

Practice Questions

Applied Anatomy and Clinical Correlations

Practice Questions

Surface Anatomy and Landmarks

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free

Upper Limb — MCQs

Upper Limb — MCQs

On this page

Practice by Chapter

Want unlimited practice?