Upper Limb Practice Questions

Q: Which nerve gives sensory supply to the region marked with an arrow?

Radial nerve. ***Radial nerve*** - The image shows the **dorsal (back) aspect of the hand**, specifically the region over the **anatomical snuffbox** or the dorsal part of the thumb and first web space. - The **superficial branch of the radial nerve** provides sensory innervation to this area, including the dorsal aspect of the thumb, index, and half of the middle finger, extending to the dorsal hand. *Median nerve* - The **median nerve** primarily provides sensory innervation to the **palmar aspect** of the lateral three and a half digits (thumb, index, middle, and radial half of the ring finger) and the corresponding palm. - It does not innervate the dorsal hand in the region indicated. *Ulnar nerve* - The **ulnar nerve** innervates the **medial 1.5 digits** (pinky and ulnar half of the ring finger) on both the palmar and dorsal aspects of the hand, as well as the ulnar part of the palm and dorsum of the hand. - The highlighted region is on the radial side of the hand, not the ulnar side. *Posterior interosseous nerve* - The **posterior interosseous nerve** is a **motor nerve** that innervates the muscles in the posterior compartment of the forearm. - It does **not provide sensory innervation** to any part of the hand.

Q: The test performed below shows testing of which of the following nerve: (Recent NEET Pattern 2016-17)

Ulnar nerve. ***Ulnar nerve*** - The image shows a patient with inability to adequately flex the **ring and little fingers**, a classic sign of **ulnar nerve palsy**. This is known as the **"ulnar claw"** when the patient attempts to make a fist or extend the fingers. - The ulnar nerve innervates most of the **intrinsic hand muscles**, including the **interossei** and the **medial two lumbricals (ring and little fingers)**, which are responsible for flexion at the metacarpophalangeal joints and extension at the interphalangeal joints of these digits. *Median nerve* - **Median nerve injury** typically results in inability to **oppose the thumb** (ape hand deformity) and sensory loss over the radial three and a half digits. - It affects the **flexor muscles of the forearm** and the **thenar muscles**, not primarily the ring and little finger flexion shown. *Radial nerve* - **Radial nerve injury** causes **wrist drop** and **finger drop** due to paralysis of the extensors of the wrist and fingers. - It primarily affects **extension** of the wrist and fingers, rather than the intrinsic hand function of flexion shown in the image. *Axillary nerve* - The **axillary nerve** primarily innervates the **deltoid muscle** and **teres minor**, responsible for shoulder abduction and external rotation. - Injury to the axillary nerve would result in **shoulder weakness** and sensory loss over the lateral shoulder, with no direct impact on hand or finger function.

Q: A patient came with inability to move his 4th and 5th digit and cannot hold pen or paper between his fingers. Which of the following sites shown below is the probable cause of nerve injury to this patient?

C. **C** - The symptoms described (inability to move the 4th and 5th digits and difficulty with adduction/abduction of fingers, e.g., holding a pen) are characteristic of **ulnar nerve injury**. - The ulnar nerve passes behind the **medial epicondyle** of the humerus, which corresponds to location **C** in the image, making it vulnerable to injury here. *A* - Location **A** represents the surgical neck of the humerus. Injury here primarily affects the **axillary nerve**, leading to weakness in shoulder abduction and loss of sensation over the deltoid. - This does not explain the specific loss of function in the 4th and 5th digits. *B* - Location **B** represents the mid-shaft of the humerus. Fractures here commonly injure the **radial nerve**, leading to "wrist drop" and sensory loss over the posterior forearm and hand. - This injury pattern does not match the patient's symptoms affecting the ulnar side of the hand. *D* - Location **D** represents the lateral epicondyle of the humerus. This area is associated with conditions like **tennis elbow** (lateral epicondylitis), which involves inflammation of the common extensor origin. - Nerve injuries related to this area typically involve the deep branch of the **radial nerve** (posterior interosseous nerve), leading to weakness in finger and thumb extension, not ulnar nerve symptoms.

Q: Which of the following bones is the first one to ossify?

C. ***C*** - The **capitate bone** is the first carpal bone to ossify, typically appearing around **1-3 months** of postnatal life. - As the largest carpal bone, its early ossification serves as an important radiological marker for assessing **skeletal maturity** in pediatric patients. *A* - The **scaphoid bone** ossifies much later, around **5-6 years** of age, making it one of the last carpal bones to develop. - Due to its **retrograde blood supply**, the scaphoid is particularly susceptible to **avascular necrosis** following fractures. *B* - The **trapezoid bone** typically begins ossification between **4-6 years** of age, significantly later than the capitate. - Located between the **trapezium and capitate**, it forms part of the distal carpal row and contributes to **index finger stability**. *D* - The **lunate bone** usually starts ossifying around **2-4 years** of age, making it the second carpal bone to ossify after the capitate. - The lunate is clinically significant as it's commonly affected by **Kienböck's disease** (avascular necrosis) and **perilunate dislocations**.

Q: The image displays a hand with a distinct palmar crease pattern where a transverse crease extends from the radial to the ulnar border, in addition to another proximal transverse crease. What is this specific crease pattern called?

Sydney line. ***Sydney line*** - The image illustrates a hand with a distinct palmar crease pattern where a **transverse crease extends from the radial to the ulnar border**, in addition to another proximal transverse crease. - This specific crease pattern, where the proximal transverse crease reaches the ulnar border of the hand, is known as a **Sydney line** and is often associated with certain chromosomal abnormalities like Down syndrome, though it can also occur in healthy individuals. *Simian crease* - A **simian crease**, also known as a single transverse palmar crease, involves only **one prominent crease spanning across the entire palm**, often replacing the usual two transverse creases. - The image shows a hand with **two distinct transverse creases**, one extending completely across and another shorter one, meaning it is not a simian crease. *Sandal gap* - A **sandal gap** refers to a **wide gap between the first and second toes**, which is a feature of the foot, not the hand. - This term is therefore **irrelevant** to the crease pattern observed on a hand. *Kennedy crease* - The term **Kennedy crease** is **not a recognized medical or anatomical term** for a palmar crease pattern. - This option is a **distractor** and does not describe any known crease variation.

Q: The inability to flex the index finger is a sign of

Median nerve injury. ***Median nerve injury*** - The **median nerve** innervates the **flexor digitorum superficialis** and the **flexor digitorum profundus** (radial half), which are responsible for flexing the index and middle fingers. [1] - Damage to this nerve at a high level (e.g., above the elbow) would impact these muscles, leading to an **inability to flex the index finger**. [1] *Radial nerve injury* - The **radial nerve** primarily innervates the **extensor muscles** of the arm and forearm. - Injury to this nerve would result in difficulty extending the wrist and fingers (e.g., **wrist drop**), not flexing them. *Ulnar nerve injury* - The **ulnar nerve** innervates the **flexor carpi ulnaris** and the **ulnar half of the flexor digitorum profundus** (ring and pinky finger). [1] - Damage would primarily affect the flexion of the ring and little fingers, as well as intrinsic hand muscles, leading to a **claw hand deformity**. *Dupuytren's contracture* - This condition involves **fibrosis and thickening of the palmar fascia**, causing the fingers (most commonly the ring and little fingers) to permanently flex towards the palm. - It is a **fibroproliferative disorder** of the hand, not a nerve injury, and typically affects flexibility in multiple fingers in a characteristic pattern, rather than a specific inability to flex one finger due to paralysis.

Q: A patient presents with loss of sensation on the lateral 3½ fingers and thenar atrophy. Which nerve is most likely involved?

Median. ***Median*** - The **median nerve** provides sensation to the **lateral 3½ fingers** (thumb, index, middle, and radial half of the ring finger) and innervates the **thenar muscles**, making its involvement consistent with the described symptoms [1]. - **Thenar atrophy** points directly to motor innervation loss of the thenar eminence, which is a key function of the median nerve. *Ulnar* - The **ulnar nerve** supplies sensation to the **medial 1½ fingers** (little finger and ulnar half of the ring finger) and innervates most of the **intrinsic hand muscles**, but not the thenar muscles [1]. - Damage typically causes **hypothenar atrophy** and **clawing** of the 4th and 5th digits, which are not described here. *Radial* - The **radial nerve** primarily provides sensation to the **dorsal aspect of the hand** and innervates the **extensor muscles of the forearm and hand**. - Its injury would typically lead to **wrist drop** and sensory loss in the dorsal hand, not thenar atrophy or lateral finger sensory loss. *Anterior interosseous nerve* - The **anterior interosseous nerve** is a **purely motor branch of the median nerve** that innervates muscles involved in **flexion of the thumb IP joint** and **index finger DIP joint**. - It does not have any sensory innervation, so loss of sensation in the lateral 3½ fingers would not be a symptom.

Q: Froment's sign (book test) is used to assess the function of adductor pollicis. Which of the following nerves supplies this muscle?

Ulnar nerve. The adductor pollicis muscle is primarily innervated by the deep branch of the ulnar nerve [1]. This muscle is crucial for thumb adduction, and its function is assessed by the Froment's sign (often referred to as the book test) to detect ulnar nerve palsy. The radial nerve primarily innervates the muscles of the posterior compartment of the arm and forearm, responsible for wrist and finger extension [1]. It does not supply any intrinsic muscles of the hand, including the adductor pollicis [1]. The posterior interosseous nerve is a terminal branch of the deep radial nerve, supplying most of the extensors in the forearm [1]. It does not innervate any of the intrinsic hand muscles. The median nerve innervates most of the flexors of the forearm and the thenar muscles of the hand (abductor pollicis brevis, opponens pollicis, and superficial head of flexor pollicis brevis) [1]. It does not supply the adductor pollicis muscle; median nerve palsy would affect thumb opposition and abduction, not adduction [1].

Q: What is the action of the muscle shown in the image below?

Retracts the scapula. ***Retracts the scapula*** - The image highlights the **rhomboid major** muscle, which originates from the spinous processes of T2-T5 vertebrae and inserts onto the medial border of the scapula. - Its primary action is to **retract** (pull medially) and rotate the scapula inferiorly, and also to help hold the scapula against the thoracic wall. *Medial rotation of the shoulder* - Medial rotation of the shoulder is primarily performed by muscles like the **subscapularis**, **pectoralis major**, **latissimus dorsi**, and **teres major**. - The rhomboids do not directly act on the glenohumeral joint for shoulder rotation. *Adduction of the shoulder* - Adduction of the shoulder (bringing the arm towards the body) is mainly performed by the **latissimus dorsi**, **pectoralis major**, and **teres major**. - The rhomboids' action on the scapula indirectly influences shoulder movement but does not directly adduct the shoulder joint. *Extension of the shoulder* - Shoulder extension is primarily achieved by the **latissimus dorsi**, **teres major**, and the posterior fibers of the **deltoid**. - The rhomboid major muscle's action focuses solely on the scapula, not direct extension of the shoulder joint.

Question 1

Which nerve gives sensory supply to the region marked with an arrow?

Accepted Answer

Radial nerve

Answer

Median nerve

Answer

Ulnar nerve

Answer

Posterior interosseous nerve

Question 2

The test performed below shows testing of which of the following nerve: (Recent NEET Pattern 2016-17)

Accepted Answer

Ulnar nerve

Answer

Median nerve

Answer

Radial nerve

Answer

Axillary nerve

Question 3

A patient came with inability to move his 4th and 5th digit and cannot hold pen or paper between his fingers. Which of the following sites shown below is the probable cause of nerve injury to this patient?

Accepted Answer

C

Answer

A

Answer

B

Answer

D

Question 4

Which of the following bones is the first one to ossify?

Accepted Answer

C

Answer

A

Answer

B

Answer

D

Question 5

The image displays a hand with a distinct palmar crease pattern where a transverse crease extends from the radial to the ulnar border, in addition to another proximal transverse crease. What is this specific crease pattern called?

Accepted Answer

Sydney line

Answer

Simian crease

Answer

Sandal gap

Answer

Kennedy crease

Question 6

Lesion at \qquad level leads to deformity shown in neonate born after prolonged labor?

Accepted Answer

C5-C8

Answer

C1-C3

Answer

C3-C5

Answer

C8-T1

Question 7

The inability to flex the index finger is a sign of

Accepted Answer

Median nerve injury

Answer

Radial nerve injury

Answer

Ulnar nerve injury

Answer

Dupuytren's contracture

Question 8

A patient presents with loss of sensation on the lateral 3½ fingers and thenar atrophy. Which nerve is most likely involved?

Accepted Answer

Median

Answer

Ulnar

Answer

Radial

Answer

Anterior interosseous nerve

Question 9

Froment's sign (book test) is used to assess the function of adductor pollicis. Which of the following nerves supplies this muscle?

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Posterior interosseous nerve

Answer

Median nerve

Question 10

What is the action of the muscle shown in the image below?

Accepted Answer

Retracts the scapula

Answer

Medial rotation of the shoulder

Answer

Adduction of the shoulder

Answer

Extension of the shoulder

Upper Limb — MCQs

Upper Limb — MCQs

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