Upper Limb Practice Questions

Q: During hyperextension, the long head of triceps gets detached from which site?

Infraglenoid tubercle. ***Infraglenoid tubercle*** - The **long head of the triceps brachii** muscle originates from the **infraglenoid tubercle** of the scapula. - Violent or sudden hyperextension of the shoulder places maximum tensile stress on this specific origin site, predisposing it to avulsion or detachment. *Supraglenoid tubercle* - This tubercle is the origin point for the **long head of the biceps brachii** muscle, which is not the muscle relevant to this injury scenario. - Injuries involving the supraglenoid tubercle are classically associated with **SLAP lesions** and glenohumeral instability. *Shaft of humerus* - The **medial and lateral heads** of the triceps originate along the posterior surface of the shaft of the humerus. - These muscular origins are less prone to acute avulsion during hyperextension compared to the tendinous long head origin on the scapula. *Olecranon process* - The olecranon process of the ulna is the **insertion** point for all three heads of the triceps, not the origin. - Detachment at this site typically occurs due to direct impact or strong eccentric contraction during forced elbow flexion, often resulting in an **olecranon fracture**.

Q: Name the muscles being used in climbing a tree as shown in the figure.

Latissimus dorsi and pectoralis major. ***Latissimus dorsi and pectoralis major*** - The **latissimus dorsi** is a large, powerful muscle responsible for adduction, extension, and internal rotation of the arm, all crucial for pulling the body upward during climbing. - The **pectoralis major** is a large, fan-shaped muscle that helps with adduction, flexion, and internal rotation of the humerus, also vital for pulling oneself up against gravity. *Teres major and pectoralis major* - While the **pectoralis major** is involved, the **teres major** is a smaller muscle that primarily assists the latissimus dorsi in extension, adduction, and internal rotation of the humerus, but is not as dominant in the main pulling action as the latissimus dorsi. - The primary pulling force comes from larger muscles, making the teres major a less significant contributor to the overall climbing action. *Teres minor and pectoralis minor* - The **teres minor** is part of the rotator cuff and primarily functions in external rotation of the humerus, which is not a primary movement for pulling oneself up. - The **pectoralis minor** is a small, thin muscle that stabilizes the scapula and depresses the shoulder; it does not directly contribute to the powerful pulling action needed for climbing. *External oblique and pectoralis major* - The **external oblique** is an abdominal muscle involved in trunk rotation and flexion, providing core stability but not directly contributing to the primary upper body pulling motion for climbing. - While the **pectoralis major** is correctly identified, the external oblique is not a primary muscle used for the upward pulling motion in climbing.

Q: What is incorrect about the test being performed?

Due to action of flexor pollicis brevis. ***Due to action of flexor pollicis brevis (INCORRECT STATEMENT)*** - This is the **incorrect statement** about Froment's sign. - The compensatory thumb flexion is due to **flexor pollicis longus** (innervated by the anterior interosseous nerve, a branch of the median nerve), NOT flexor pollicis brevis. - Flexor pollicis brevis is innervated primarily by the recurrent branch of the median nerve and does not flex the interphalangeal joint. *Froment sign (Correct)* - The image depicts the characteristic **Froment's sign**, used to assess **ulnar nerve palsy**. - This is a correct description of the test being performed. - The sign demonstrates weakness of the **adductor pollicis** muscle. *Flexion of interphalangeal joint of thumb (Correct)* - The image shows **flexion at the interphalangeal joint of the thumb**. - This is a correct observation of the compensatory mechanism. - This flexion occurs to maintain grip strength when adductor pollicis is weak. *Due to paralysis of adductor pollicis (Correct)* - This correctly identifies the underlying pathology. - The **adductor pollicis muscle** (innervated by the **ulnar nerve**) is paralyzed or weak. - This muscle is primarily responsible for **thumb adduction**, and its weakness leads to the compensatory mechanism seen in Froment's sign.

Q: Identify the structure marked as X in the specimen of left cubital fossa

Brachial artery. ***Brachial artery*** - The structure marked X is a prominent, thick-walled vessel consistent with the **brachial artery**, which passes through the cubital fossa. - The brachial artery is typically found medial to the **biceps brachii tendon** and lateral to the **median nerve** in the cubital fossa. *Biceps brachii* - The **biceps brachii** is a muscle, and while its tendon passes through the cubital fossa, the structure marked X is clearly a vessel, not a muscle or tendon. - The biceps brachii muscle is usually much larger and fleshy, not a defined linear structure like X. *Radial recurrent artery* - The **radial recurrent artery** is a smaller branch arising from the radial artery, which subsequently branches off the brachial artery. - It is significantly smaller and less prominent than the structure marked X, which appears to be a main vessel. *Posterior interosseous nerve* - The **posterior interosseous nerve** is a branch of the radial nerve and is primarily a nerve structure, which appears white/yellowish and thinner than the structure marked X, which is a blood vessel. - It typically winds around the neck of the radius and passes into the posterior compartment of the forearm, not usually as prominently displayed within the cubital fossa in this manner.

Q: Name the ligament marked as $X$.

Conoid ligament. ***Conoid ligament*** - The image displays the **coracoclavicular ligaments**, which consist of the trapezoid and conoid ligaments. Ligament 'X' is positioned more **medially** and is shaped like an **inverted cone**. - The **conoid ligament** originates from the **conoid tubercle** on the inferior surface of the clavicle and inserts onto the **posteromedial aspect of the coracoid process** of the scapula. - It functions to stabilize the shoulder girdle and prevent **superior displacement** of the clavicle. *Trapezoid ligament* - This is the **lateral component** of the coracoclavicular ligament complex. - It is broader and quadrilateral in shape, located **lateral to the conoid ligament**. - It extends from the **trapezoid line on the clavicle** to the **superior surface of the coracoid process**. *Coracoacromial ligament* - This ligament extends from the **coracoid process to the acromion** of the scapula. - It forms part of the **coracoacromial arch**, which prevents superior displacement of the humeral head. - It is **not part of the coracoclavicular ligament complex**. *Coracohumeral ligament* - This ligament extends from the **coracoid process to the greater tubercle of the humerus**. - It strengthens the **superior aspect of the glenohumeral joint capsule**. - It is distinct from the coracoclavicular ligaments and attaches to the humerus, not the clavicle.

Q: Identify the nerve damaged in the picture:

Median. ***Median*** - The image illustrates a patient unable to form a perfect "O" shape with their thumb and index finger, a sign known as the **"A-OK" sign** or **"pinch sign"**, indicating weakness of the **flexor pollicis longus** and **flexor digitorum profundus** (index finger) muscles. - These muscles are innervated by the **anterior interosseous nerve (AIN)**, which is a pure motor branch of the **median nerve**. *Radial* - Radial nerve damage typically results in a **wrist drop** due to paralysis of the wrist extensors and finger extensors. - The patient in the image is holding their wrist and fingers in flexion, which is not characteristic of radial nerve palsy. *Ulnar* - Ulnar nerve damage would result in a **"claw hand" deformity**, where the 4th and 5th fingers are hyperextended at the metacarpophalangeal joints and flexed at the interphalangeal joints. - It would also affect the **adduction of the thumb** (Froment's sign) and the intrinsic muscles of the hand, which are not the primary issues depicted. *Posterior interosseous nerve* - Damage to the posterior interosseous nerve (PIN), a branch of the radial nerve, primarily affects the **extensors of the fingers and thumb** leading to an inability to extend them. - It does not typically affect the **flexor pollicis longus** or **flexor digitorum profundus to the index finger**, which are responsible for the 'pinch' movement shown.

Q: Which nerve supplies the highlighted muscle? (Recent NEET Pattern 2019)

Anterior interosseous nerve. ***Anterior interosseous nerve*** - The highlighted muscle is the **flexor pollicis longus**, which is innervated by the **anterior interosseous nerve**, a branch of the **median nerve**. - This muscle is responsible for **flexion of the interphalangeal joint of the thumb**. *Median Nerve* - While the anterior interosseous nerve is a branch of the median nerve, the median nerve itself innervates most of the **forearm flexors** and thenar muscles, but not directly the flexor pollicis longus by its main trunk. - Damage to the median nerve would affect the flexor pollicis longus, but the direct innervation is via its specific branch. *Ulnar nerve* - The ulnar nerve supplies most of the **intrinsic hand muscles** (except for the thenar muscles and first two lumbricals) and the **flexor carpi ulnaris** and medial half of the **flexor digitorum profundus**. - It does not innervate the flexor pollicis longus. *Radial Nerve* - The radial nerve primarily innervates the **extensor muscles** of the arm and forearm. - It has no role in the innervation of the flexor pollicis longus or other anterior compartment forearm muscles.

Q: Identify the function of the muscles marked in red:

Flexion at MCP joint. ***Flexion at MCP joint*** - The muscles shown in red are the **lumbricals**, which primarily function to **flex the metacarpophalangeal (MCP) joints** and **extend the interphalangeal (IP) joints**. - This is their most fundamental action when identifying lumbrical function, as they originate from **flexor digitorum profundus tendons** and insert into the **extensor expansion**, providing precise **MCP joint flexion**. - This unique action creates the **"lumbrical grip"** essential for precision handling. *Flexion at IP joint* - Lumbricals actually **extend the interphalangeal (IP) joints**, not flex them, making this option anatomically incorrect. - **Flexion at IP joints** is performed by the **flexor digitorum superficialis** (PIP joints) and **flexor digitorum profundus** (DIP joints). - The lumbrical insertion into the **extensor hood** produces IP extension, the opposite of this option. *Extension at MCP joint* - **Extension at the MCP joints** is primarily performed by the **extensor digitorum** and other **extrinsic extensor muscles**. - Lumbricals produce the opposite action, **flexing the MCP joints** rather than extending them. *Abduction at MCP joint* - **Abduction at the MCP joints** is primarily performed by the **dorsal interossei muscles** using the **DAB** (Dorsal ABduct) mnemonic. - Lumbricals do not contribute to **finger abduction** but rather focus on **MCP flexion, IP extension**, and **fine motor control**.

Q: Name the muscle marked as colour blue in the extensor compartment of forearm. (Recent NEET Pattern 2019)

Brachioradialis. ***Brachioradialis*** - The **brachioradialis** muscle is a prominent superficial muscle in the lateral compartment of the forearm, shown in **blue** in the diagram, originating from the **lateral supracondylar ridge of the humerus** and inserting into the **radial styloid process**. - It primarily functions to **flex the elbow** and helps to bring the forearm into a midprone position. *Extensor carpi radialis* - The extensor carpi radialis muscles (longus and brevis) are located deep to the brachioradialis and extend the wrist, often distinguishable by their more distal insertion on the **metacarpals**. - They are typically not the most superficial and most lateral muscle spanning the entire forearm length as depicted in blue. *Extensor digitorum* - The **extensor digitorum** is located more medially than the brachioradialis and its tendons diverge to attach to the four medial fingers, a configuration not shown by the blue muscle. - This muscle is responsible for **extending the medial four digits**. *Extensor carpi ulnaris* - The **extensor carpi ulnaris** is situated on the **ulnar side** of the forearm, furthest from the blue-highlighted muscle, and its primary action is **wrist extension and ulnar deviation**. - It would be found along the posterior medial aspect of the forearm, not in the relatively lateral position shown in blue.

Question 1

During hyperextension, the long head of triceps gets detached from which site?

Accepted Answer

Infraglenoid tubercle

Answer

Supraglenoid tubercle

Answer

Shaft of humerus

Answer

Olecranon process

Question 2

Name the muscles being used in climbing a tree as shown in the figure.

Accepted Answer

Latissimus dorsi and pectoralis major

Answer

Teres major and pectoralis major

Answer

Teres minor and pectoralis minor

Answer

External oblique and pectoralis major

Question 3

What is incorrect about the test being performed?

Accepted Answer

Due to action of flexor pollicis brevis

Answer

Froment sign

Answer

Flexion of interphalangeal joint of thumb

Answer

Due to paralysis of adductor pollicis

Question 4

Identify the structure marked as X in the specimen of left cubital fossa

Accepted Answer

Brachial artery

Answer

Biceps brachii

Answer

Radial recurrent artery

Answer

Posterior interosseous nerve

Question 5

Name the ligament marked as $X$.

Accepted Answer

Conoid ligament

Answer

Trapezoid ligament

Answer

Coracoacromial ligament

Answer

Coracohumeral ligament

Question 6

All are true about the triangle marked green except:

Accepted Answer

Medial border is formed by tendon of abductor pollicis longus and extensor pollicis brevis

Answer

Localised pain in this area after fall on outstretched hand indicates fracture of scaphoid

Answer

Cephalic vein in this area is used to make Ciminobrescia fistula in hemodialysis

Answer

Superficial branch of radial nerve runs to provide innervation to 3.5 digits

Question 7

Identify the nerve damaged in the picture:

Accepted Answer

Median

Answer

Radial

Answer

Ulnar

Answer

Posterior interosseous nerve

Question 8

Which nerve supplies the highlighted muscle? (Recent NEET Pattern 2019)

Accepted Answer

Anterior interosseous nerve

Answer

Median Nerve

Answer

Ulnar nerve

Answer

Radial Nerve

Question 9

Identify the function of the muscles marked in red:

Accepted Answer

Flexion at MCP joint

Answer

Flexion at IP joint

Answer

Extension at MCP joint

Answer

Abduction at MCP joint

Question 10

Name the muscle marked as colour blue in the extensor compartment of forearm. (Recent NEET Pattern 2019)

Accepted Answer

Brachioradialis

Answer

Extensor carpi radialis

Answer

Extensor digitorum

Answer

Extensor carpi ulnaris

Upper Limb — MCQs

Upper Limb — MCQs

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