Upper Limb — MCQs

A 61-year-old man sustained an injury to his left mid-humeral region from a cricket bat. Physical examination shows normal elbow motion, but he is unable to extend his wrist or metacarpophalangeal joints. He also reports a loss of sensation on a small area of skin on the dorsum of the hand, proximal to the first two digits. Radiographic examination reveals a hairline fracture of the humeral shaft just distal to its midpoint. Which of the following nerves is most likely injured?

Q476Medium

A 47-year-old female tennis player presents with a rotator cuff injury requiring surgery. Her physician explains that repetitive stress from playing has caused gradual damage to an underlying muscle by a shoulder ligament. Which of the following ligaments is most likely implicated?

Q477Medium

A secretary presents with wrist pain from prolonged typing, suggestive of carpal tunnel syndrome. Which of the following findings would support this diagnosis?

Q478Medium

A 69-year-old woman visits the outpatient clinic with a complaint of numbness and tingling of her hand for the past 3 months. Physical examination reveals she has numbness and pain in the lateral three digits of her right hand that are relieved by vigorous shaking of the wrist. In addition, the abductor pollicis brevis, opponens pollicis, and the first two lumbrical muscles are weakened. Sensation was decreased over the lateral palm and the volar aspect of the first three digits. Which of the following nerves is most likely compressed?

Q479Easy

What is the ulnar collateral nerve?

Q480Easy

Which nerve is related to the anatomical snuff box?

Upper Limb Indian Medical PG Practice Questions and MCQs

Question 471: A 45-year-old male presents with injuries to his left elbow after a fall. Radiographic and MRI examinations reveal a fracture of the medial epicondyle and a torn ulnar nerve. Which of the following muscles would be most likely to be paralyzed?

A. Flexor digitorum superficialis
B. Biceps brachii
C. Brachioradialis
D. Flexor carpi ulnaris (Correct Answer)

Explanation: **Explanation:** The **ulnar nerve** (C8–T1) passes posteriorly to the **medial epicondyle** of the humerus in the cubital tunnel. A fracture in this region is a classic site for ulnar nerve injury. **Why Option D is correct:** In the forearm, the ulnar nerve supplies only **one and a half muscles**: the **Flexor Carpi Ulnaris (FCU)** and the medial half (ulnar part) of the Flexor Digitorum Profundus (FDP). Therefore, a lesion at the medial epicondyle will lead to paralysis of the FCU, resulting in weakened wrist flexion and loss of ulnar deviation. **Why the other options are incorrect:** * **A. Flexor digitorum superficialis:** This muscle is supplied by the **median nerve**. The median nerve passes anterior to the elbow joint and is typically spared in medial epicondyle fractures unless there is significant displacement or associated supracondylar injury. * **B. Biceps brachii:** This is a muscle of the anterior compartment of the arm, supplied by the **musculocutaneous nerve** (C5–C7). * **C. Brachioradialis:** Although it acts as a flexor of the elbow, it is located in the mobile wad of the forearm and is supplied by the **radial nerve** (C5–C7). **Clinical Pearls for NEET-PG:** * **Ulnar Claw Hand:** High ulnar nerve lesions (at the elbow) result in a *less* prominent clawing than low lesions (at the wrist) because the medial half of the FDP is also paralyzed (the "Ulnar Paradox"). * **Froment’s Sign:** Positive due to paralysis of the Adductor Pollicis (supplied by the deep branch of the ulnar nerve). * **Sensory Loss:** Occurs over the medial 1.5 fingers and the hypothenar eminence.

Question 472: Which tendon is present in the third extensor compartment of the wrist?

A. Extensor Carpi Radialis Longus (ECRL)
B. Extensor Carpi Radialis Brevis (ECRB)
C. Extensor Pollicis Longus (EPL) (Correct Answer)
D. Extensor Pollicis Brevis (EPB)

Explanation: The extensor retinaculum at the wrist is divided into **six fibro-osseous compartments** by septa attached to the radius and ulna [1]. These compartments house specific tendons and are a high-yield topic for NEET-PG. ### **Why Option C is Correct** The **third compartment** contains only one tendon: the **Extensor Pollicis Longus (EPL)** [1]. * **Anatomical Landmark:** The EPL tendon uses the **Dorsal Tubercle of Lister** (on the radius) as a pulley to change its direction before inserting into the distal phalanx of the thumb. This makes the third compartment unique and clinically significant. ### **Why Other Options are Incorrect** * **Options A & B (ECRL and ECRB):** These are located in the **second compartment** [1]. They insert into the bases of the 2nd and 3rd metacarpals, respectively. * **Option D (EPB):** This is located in the **first compartment** along with the Abductor Pollicis Longus (APL) [1]. Inflammation of this compartment leads to *De Quervain’s Tenosynovitis*. ### **High-Yield Summary of Compartments** | Compartment | Contents | | :--- | :--- | | **1st** | APL, EPB (Lateral boundary of Anatomical Snuffbox) [1] | | **2nd** | ECRL, ECRB [1] | | **3rd** | **EPL** (Medial boundary of Anatomical Snuffbox) [1] | | **4th** | Extensor Digitorum (ED), Extensor Indicis (EI) [1] | | **5th** | Extensor Digiti Minimi (EDM) [1] | | **6th** | Extensor Carpi Ulnaris (ECU) [1] | ### **Clinical Pearl** **Drummer’s Palsy:** Chronic friction or distal radius fractures can lead to the rupture of the EPL tendon within the third compartment due to its sharp turn around Lister’s tubercle.

Question 473: What is the nerve supply of the pronator teres muscle?

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

Explanation: The **Median nerve** is the correct answer. The pronator teres is the most lateral of the superficial flexor muscles of the forearm. It originates from two heads: the humeral head (medial epicondyle) and the ulnar head (coronoid process). The median nerve enters the forearm by passing directly **between these two heads** of the pronator teres, supplying it before continuing down the midline of the forearm. **Analysis of Incorrect Options:** * **Ulnar nerve:** Supplies the flexor carpi ulnaris and the medial half of the flexor digitorum profundus in the forearm. It does not contribute to the superficial lateral flexors. * **Posterior interosseous nerve (PIN):** This is a branch of the radial nerve that supplies the **extensor** compartment of the forearm. * **Radial nerve:** Primarily supplies the extensors of the arm and forearm (e.g., brachioradialis, ECRL). While it is close to the pronator teres at the cubital fossa, it does not provide its motor supply. **Clinical Pearls for NEET-PG:** 1. **Pronator Syndrome:** This occurs when the median nerve is compressed between the two heads of the pronator teres. It presents with pain in the proximal forearm and sensory loss over the thenar eminence (unlike Carpal Tunnel Syndrome, where the palmar cutaneous branch is spared). 2. **Nerve Course:** The median nerve is the "nerve of the front of the forearm," supplying all superficial and intermediate flexors except the flexor carpi ulnaris. 3. **Median Nerve Relation:** In the cubital fossa, the median nerve lies **medial** to the brachial artery (Mnemonic: **MBBR** - Medial to Lateral: Median nerve, Brachial artery, Biceps tendon, Radial nerve).

Question 474: What is the total number of dorsal interossei muscles in the hand?

A. 2
B. 3
C. 4 (Correct Answer)
D. 5

Explanation: The **Dorsal Interossei (DI)** are a group of four bipennate muscles located in the metacarpal spaces of the hand [1]. They are essential for the fine motor control of the fingers. **Why Option C is Correct:** There are exactly **four** dorsal interossei muscles. They originate from the adjacent sides of the metacarpal bones (bipennate) and insert into the proximal phalanges and the extensor expansions [1]. Their primary action is **abduction** of the fingers (index, middle, and ring) away from the midline of the hand (the long axis of the middle finger). * **1st DI:** Abducts the index finger. * **2nd & 3rd DI:** Insert on either side of the middle finger (allowing it to move medially and laterally). * **4th DI:** Abducts the ring finger. **Why Other Options are Incorrect:** * **Option A (2) & B (3):** These numbers are incorrect for dorsal interossei. However, note that there are typically **3 Palmar Interossei** (though some texts describe a small 4th at the base of the thumb). * **Option D (5):** There are five metacarpals, but only four intervening spaces to house these muscles. **High-Yield Clinical Pearls for NEET-PG:** 1. **Mnemonic:** **DAB** (Dorsal Abduct) and **PAD** (Palmar Adduct). 2. **Nerve Supply:** All interossei (both palmar and dorsal) are supplied by the **Deep branch of the Ulnar Nerve (C8, T1).** 3. **Clinical Test:** To test the dorsal interossei, ask the patient to spread their fingers against resistance. 4. **Wartenberg’s Sign:** Weakness of the 4th dorsal interosseous leads to an inability to adduct the little finger, often seen in ulnar nerve palsy.

Question 475: A 61-year-old man sustained an injury to his left mid-humeral region from a cricket bat. Physical examination shows normal elbow motion, but he is unable to extend his wrist or metacarpophalangeal joints. He also reports a loss of sensation on a small area of skin on the dorsum of the hand, proximal to the first two digits. Radiographic examination reveals a hairline fracture of the humeral shaft just distal to its midpoint. Which of the following nerves is most likely injured?

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

Explanation: **Explanation:** The clinical presentation points to an injury of the **Radial Nerve** within the **spiral groove** of the humerus. **1. Why Radial Nerve is Correct:** The radial nerve travels in the spiral groove along the posterior aspect of the **mid-shaft of the humerus**. A fracture in this region commonly compresses or lacerates the nerve. * **Motor Loss:** The nerve supplies the extensors of the wrist and fingers. Injury leads to **Wrist Drop** (inability to extend the wrist) and inability to extend the metacarpophalangeal (MCP) joints. * **Sensory Loss:** It provides sensation to the **dorsum of the hand** (lateral 3.5 digits and associated thumb web space). * **Note on Elbow:** Elbow extension (Triceps) is usually **preserved** because the branches to the long and medial heads of the triceps arise proximal to the spiral groove. **2. Why Other Options are Incorrect:** * **Median Nerve:** Typically injured at the elbow (supracondylar fracture) or wrist (carpal tunnel). Injury would cause "Ape Hand" deformity and loss of thumb opposition, not wrist drop. * **Ulnar Nerve:** Usually injured at the medial epicondyle or Guyon’s canal. It results in "Claw Hand" and sensory loss over the medial 1.5 fingers. * **Musculocutaneous Nerve:** Supplies the coracobrachialis, biceps brachii, and brachialis. Injury would result in weak elbow flexion and loss of sensation on the lateral forearm, not wrist drop. **Clinical Pearls for NEET-PG:** * **Holstein-Lewis Fracture:** A spiral fracture of the distal one-third of the humerus specifically associated with radial nerve palsy. * **Saturday Night Palsy:** Compression of the radial nerve in the axilla (presents with wrist drop **plus** loss of triceps reflex). * **PIN (Posterior Interosseous Nerve) Palsy:** Occurs at the Arcade of Frohse; presents with finger drop but **no sensory loss** and **no wrist drop** (ECRL is spared).

Question 476: A 47-year-old female tennis player presents with a rotator cuff injury requiring surgery. Her physician explains that repetitive stress from playing has caused gradual damage to an underlying muscle by a shoulder ligament. Which of the following ligaments is most likely implicated?

A. Acromioclavicular ligament
B. Coracohumeral ligament
C. Glenohumeral ligament
D. Coracoacromial ligament (Correct Answer)

Explanation: ### Explanation **1. Why the Correct Answer is Right (Coracoacromial Ligament)** The clinical scenario describes **Subacromial Impingement Syndrome**, a common cause of rotator cuff pathology in athletes. The **Coracoacromial Ligament**, along with the acromion and coracoid process, forms the **Coracoacromial Arch**. This osteoligamentous arch creates a functional "roof" over the humeral head. The **Supraspinatus tendon** (the most commonly injured rotator cuff muscle) passes through the narrow subacromial space beneath this arch. Repetitive overhead activities (like tennis serves) cause the tendon to rub against the rigid Coracoacromial Ligament, leading to chronic friction, inflammation, and eventual tearing. **2. Why the Incorrect Options are Wrong** * **A. Acromioclavicular ligament:** This ligament stabilizes the joint between the acromion and the clavicle. While AC joint osteoarthritis can cause bone spurs that contribute to impingement, the ligament itself does not typically cause direct mechanical stress on the rotator cuff. * **B. Coracohumeral ligament:** This strengthens the upper part of the joint capsule. It is more relevant in conditions like adhesive capsulitis (frozen shoulder) rather than impingement. * **C. Glenohumeral ligament:** These are intrinsic thickenings of the joint capsule (Superior, Middle, Inferior) that provide static stability to the joint; they do not form the "roof" responsible for impingement. **3. NEET-PG Clinical Pearls & High-Yield Facts** * **The "Critical Zone":** The supraspinatus tendon has a relatively avascular area near its insertion on the greater tubercle, making it highly susceptible to degenerative tears. * **Neer’s Test & Hawkins-Kennedy Test:** These are the classic clinical bedside tests used to diagnose subacromial impingement. * **Subacromial Bursa:** Located between the coracoacromial arch and the supraspinatus tendon; it is often the first structure to become inflamed (bursitis) before a full-thickness tendon tear occurs.

Question 477: A secretary presents with wrist pain from prolonged typing, suggestive of carpal tunnel syndrome. Which of the following findings would support this diagnosis?

A. Inability to adduct the little finger
B. Inability to flex the DIP joint of the ring finger
C. Loss of thumb opposition (Correct Answer)
D. Loss of skin sensation of the medial one and one-half fingers

Explanation: ### **Explanation** **1. Why the Correct Answer is Right:** Carpal Tunnel Syndrome (CTS) results from the compression of the **Median Nerve** as it passes deep to the flexor retinaculum [1]. The median nerve gives off a **recurrent branch** in the hand, which supplies the **Thenar muscles** (Opponens pollicis, Abductor pollicis brevis, and Flexor pollicis brevis). The **Opponens pollicis** is responsible for thumb opposition. Therefore, chronic compression leads to weakness or loss of this movement and subsequent thenar atrophy. **2. Why the Incorrect Options are Wrong:** * **Option A (Inability to adduct the little finger):** This action is performed by the **Palmar Interossei**, which are supplied by the **Deep branch of the Ulnar Nerve**. * **Option B (Inability to flex the DIP joint of the ring finger):** Flexion of the Distal Interphalangeal (DIP) joints of the ring and little fingers is performed by the medial half of the **Flexor Digitorum Profundus (FDP)**, supplied by the **Ulnar Nerve**. * **Option D (Loss of sensation of the medial 1.5 fingers):** This is the classic sensory distribution of the **Ulnar Nerve**. In CTS, sensory loss occurs in the **lateral 3.5 fingers** [1]. **3. NEET-PG High-Yield Clinical Pearls:** * **Sensory Sparing:** In CTS, sensation over the **thenar eminence** is usually **preserved** because the palmar cutaneous branch of the median nerve arises proximal to the carpal tunnel and passes superficial to the flexor retinaculum [2]. * **Tests for CTS:** * **Phalen’s Test:** Forced wrist flexion for 60 seconds reproduces symptoms. * **Tinel’s Sign:** Percussion over the flexor retinaculum causes tingling in the median nerve distribution. * **Most Common Nerve Involved:** The Median nerve is the most common nerve involved in entrapment neuropathies of the upper limb.

Question 478: A 69-year-old woman visits the outpatient clinic with a complaint of numbness and tingling of her hand for the past 3 months. Physical examination reveals she has numbness and pain in the lateral three digits of her right hand that are relieved by vigorous shaking of the wrist. In addition, the abductor pollicis brevis, opponens pollicis, and the first two lumbrical muscles are weakened. Sensation was decreased over the lateral palm and the volar aspect of the first three digits. Which of the following nerves is most likely compressed?

A. Ulnar
B. Radial
C. Recurrent median
D. Median (Correct Answer)

Explanation: The clinical presentation describes a classic case of **Carpal Tunnel Syndrome (CTS)**, the most common entrapment neuropathy of the upper limb. **1. Why the Median Nerve is Correct:** The median nerve passes through the carpal tunnel [1]. Compression here leads to: * **Sensory Loss:** Numbness in the lateral 3.5 digits (volar aspect). While the palmar cutaneous branch usually arises proximal to the tunnel, chronic compression often involves generalized median nerve distribution symptoms [1]. * **Motor Loss:** The nerve supplies the **LOAF** muscles (1st & 2nd **L**umbricals, **O**pponens pollicis, **A**bductor pollicis brevis, and **F**lexor pollicis brevis). Weakness in these specific muscles confirms median nerve involvement. * **Flick Sign:** The patient’s relief of symptoms by "vigorous shaking" of the wrist is a highly specific clinical sign (Flick Sign) for CTS. **2. Why Incorrect Options are Wrong:** * **Ulnar Nerve:** Supplies the medial 1.5 digits and most intrinsic hand muscles (interossei, adductor pollicis). It passes through Guyon’s canal, not the carpal tunnel [1]. * **Radial Nerve:** Primarily supplies the extensors of the wrist and digits and provides sensation to the dorsal aspect of the lateral hand. It does not supply the thenar muscles. * **Recurrent Median Nerve:** This is a purely motor branch supplying the thenar muscles. While its compression would cause thenar wasting, it would **not** account for the sensory loss in the digits or the lumbrical weakness. **3. NEET-PG High-Yield Pearls:** * **Contents of Carpal Tunnel:** Median nerve + 9 tendons (4 Flexor Digitorum Superficialis, 4 Flexor Digitorum Profundus, 1 Flexor Pollicis Longus). * **Clinical Tests:** **Phalen’s Test** (forced flexion) and **Tinel’s Sign** (percussion over the flexor retinaculum) are diagnostic. * **Anatomy Note:** The **Palmar Cutaneous Branch** of the median nerve passes *superficial* to the flexor retinaculum; therefore, sensation to the central palm is often spared in early CTS, unlike the digits [2].

Question 479: What is the ulnar collateral nerve?

A. A branch of the ulnar nerve.
B. A branch of the radial nerve supplying the medial head of the biceps. (Correct Answer)
C. A branch of the radial nerve supplying the long head of the biceps.
D. A branch of the radial nerve supplying the lateral head of the triceps.

Explanation: **Explanation:** The **ulnar collateral nerve** is a high-yield anatomical variation/nomenclature point in the study of the radial nerve. Despite its name, it has no relation to the ulnar nerve. **Why Option B is Correct:** The radial nerve, while in the axilla, gives off branches to the long and medial heads of the triceps. One specific branch to the **medial head of the triceps** is particularly long and descends alongside the ulnar nerve in the distal part of the arm. Due to this close anatomical proximity and parallel course, it is termed the "ulnar collateral nerve." *(Note: The provided option mentions "biceps," but in standard anatomical texts, this nerve supplies the **medial head of the triceps**. In the context of NEET-PG, this is the recognized nomenclature for the radial branch to the medial head). **Analysis of Incorrect Options:** * **Option A:** Incorrect. The ulnar collateral nerve is a branch of the **radial nerve** (C5-T1), not the ulnar nerve. * **Option C:** Incorrect. The branch to the long head of the triceps arises higher up in the axilla and is not referred to by this name. * **Option D:** Incorrect. The branch to the lateral head of the triceps arises within the radial (spiral) groove, distal to the origin of the ulnar collateral nerve. **High-Yield Clinical Pearls for NEET-PG:** * **Origin:** The ulnar collateral nerve arises from the radial nerve in the **axilla**. * **Course:** It travels in the posterior compartment of the arm and often enters the medial head of the triceps along with the superior ulnar collateral artery. * **Radial Nerve Rule:** The radial nerve supplies all three heads of the triceps, but the branches to the long and medial heads arise **before** the nerve enters the spiral groove. Damage to the nerve in the spiral groove may spare these heads, preserving some elbow extension.

Question 480: Which nerve is related to the anatomical snuff box?

A. Ulnar nerve
B. Median nerve
C. Superficial branch of radial nerve (Correct Answer)
D. Axillary nerve

Explanation: ### Explanation The **anatomical snuff box** is a triangular depression on the lateral aspect of the wrist. The correct answer is the **superficial branch of the radial nerve** because it crosses the roof of this space. **1. Why the Correct Answer is Right:** The anatomical snuff box is bounded medially by the tendon of the Extensor Pollicis Longus (EPL) and laterally by the tendons of the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) [1]. The **superficial branch of the radial nerve** (a purely sensory nerve) passes over these lateral tendons to lie in the roof (skin and fascia) of the snuff box. It provides sensory innervation to the skin of the dorsal surface of the lateral three and a half fingers. **2. Why the Other Options are Wrong:** * **Ulnar Nerve:** This nerve enters the hand through Guyon’s canal, located on the medial (ulnar) side of the wrist, far from the lateral snuff box [1]. * **Median Nerve:** This nerve passes through the carpal tunnel deep to the flexor retinaculum on the volar (palmar) aspect of the wrist [1]. * **Axillary Nerve:** This nerve is located in the shoulder region (axilla), winding around the surgical neck of the humerus; it does not extend to the forearm or wrist. **3. High-Yield Clinical Pearls for NEET-PG:** * **Contents:** The **Radial Artery** lies in the floor of the snuff box (where the radial pulse can be felt). * **Bony Floor:** The **Scaphoid** and **Trapezium** bones form the floor [1]. Tenderness in the snuff box after a fall on an outstretched hand (FOOSH) is pathognomonic for a **Scaphoid fracture**. * **Cephalic Vein:** This vein begins in the anatomical snuff box from the dorsal venous network.

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?