Upper Limb Practice Questions

Q: Dupuytren's contracture is seen in

Palmar fascia. ***Palmar fascia*** - **Dupuytren's contracture** is characterized by the thickening and shortening of the **palmar fascia (palmar aponeurosis)**, leading to progressive flexion contracture of fingers. - It results in the inability to fully extend the affected fingers, predominantly the **ring finger (4th)** and **little finger (5th)**. - The condition involves **nodular thickening** and cord formation in the palmar fascia, with fibroblast proliferation and collagen deposition. *Plantar fascia* - While the **plantar fascia** can be affected by a similar fibrotic condition called **Ledderhose disease (plantar fibromatosis)**, this is distinct from Dupuytren's contracture. - Plantar fasciitis (inflammation) is different from plantar fibromatosis (nodular thickening). - Dupuytren's contracture specifically refers to the palmar fascia involvement. *Cremaster fascia* - The **cremaster fascia** is associated with the **cremaster muscle** in the male inguinal canal, playing a role in testicular elevation. - It has no involvement in the formation or pathology of Dupuytren's contracture. *Leg muscle* - **Leg muscles** are involved in locomotion and various lower limb movements. - There is no anatomical or pathological connection between leg muscles and Dupuytren's contracture, which is a fascial (not muscular) disorder.

Q: Which of the following is an aberrant epiphysis?

Base of 1st metacarpal. ***Base of 1st metacarpal*** - The **base of the 1st metacarpal** is considered an **aberrant epiphysis** because its epiphysial plate is located at the base, similar to a phalanx, rather than at the head, like other metacarpals. - This anatomical variation is important for understanding bone growth and potential injury patterns in the **thumb**. *Coracoid process* - The coracoid process is a **secondary ossification center** with its own epiphyseal plate, but it is not typically classified as an aberrant epiphysis in the same context as the 1st metacarpal. - It forms part of the **scapula** and provides attachment for several muscles and ligaments. *Greater tubercle of humerus* - The greater tubercle of the humerus is a prominent feature that develops from a **secondary ossification center** and fuses with the shaft of the humerus. - It is an important site for the attachment of **rotator cuff muscles**, but it's not defined as an aberrant epiphysis. *Base of 2nd metacarpal* - The 2nd through 5th metacarpals typically have their **epiphysial plates at their heads** (distal ends), making the base a part of the diaphysis. - This is the standard pattern for metacarpals, in contrast to the unique arrangement of the 1st metacarpal.

Q: Which of the following is true about nerve injuries?

Median nerve is also named as labourer's nerve. ***Median nerve is also named as labourer's nerve*** - The median nerve is sometimes called the "laborer's nerve" because it innervates many of the muscles essential for **fine motor control** and **dexterous hand movements** predominantly used in manual labor. [1] - It supplies most of the **flexors in the forearm** and several intrinsic hand muscles, making it crucial for a strong grip and coordinated hand actions. [1] *Froment sign seen in median nerve palsy is due to Flexor pollicis longus action* - **Froment's sign** is observed in **ulnar nerve palsy**, not median nerve palsy. - It occurs when the adductor pollicis is weak, and the **flexor pollicis longus** (median nerve-innervated) compensates by hyperflexing the interphalangeal joint of the thumb to grasp an object. *All lumbricals are supplied by median nerve* - The **first two lumbricals** (from the radial side) are typically supplied by the **median nerve**. [1] - The **third and fourth lumbricals** (from the ulnar side) are supplied by the **ulnar nerve**. [1] *Waenburg sign is seen in median nerve palsy* - There is no widely recognized clinical sign called "Waenburg sign" associated with median nerve palsy. - Common signs of **median nerve palsy** include **ape hand deformity**, **hand of benediction**, and sensory loss in the radial three and a half digits. [1]

Q: Nerve supply of the marked muscle is

Median nerve. ***Median nerve*** - The marked muscle is the **flexor digitorum superficialis (FDS)**, which is primarily innervated by the **median nerve** - This muscle is responsible for **flexion of the middle phalanges** at the proximal interphalangeal joints - The median nerve (C7, C8, T1) supplies most flexor muscles in the anterior forearm compartment *Radial nerve* - The radial nerve innervates muscles of the **posterior compartment of the arm and forearm**, which are mainly extensors - It handles functions like **wrist and finger extension** - Does not supply flexor digitorum superficialis *Posterior interosseous nerve* - This is a **deep branch of the radial nerve** and primarily innervates muscles of the **deep posterior forearm compartment** - It is involved in **extension of the digits** and wrist stabilization - Does not supply anterior compartment muscles *Ulnar nerve* - The ulnar nerve innervates most **intrinsic hand muscles**, the **flexor carpi ulnaris**, and ulnar half of the **flexor digitorum profundus** - It is crucial for **finger adduction and abduction**, and wrist flexion - Does not supply flexor digitorum superficialis

Q: Rotator interval is between:

Supraspinatus and subscapularis. ***Supraspinatus and subscapularis*** - The **rotator interval** is a triangular space found between the **supraspinatus** tendon superiorly and the **subscapularis** tendon inferiorly. - This anatomical space is covered by the **rotator interval capsule** and contains structures like the **long head of the biceps tendon** and the **superior glenohumeral ligament**. *Subscapularis and infraspinatus* - This space is not recognized as the rotator interval; the **infraspinatus** lies posterior to the **supraspinatus** and **subscapularis**. - The rotator interval refers specifically to the anterior superior aspect of the shoulder capsule. *Teres major and teres minor* - The **teres major** and **teres minor** muscles are located more inferiorly and posteriorly in the shoulder compared to the rotator interval. - The interval between these two muscles is not anatomically defined as the rotator interval. *Supraspinatus and teres minor* - The **teres minor** is situated posterior to the rotator cuff and is separated from the **supraspinatus** by the **infraspinatus** muscle. - Therefore, the space between the supraspinatus and teres minor is not the rotator interval, which is more anterior.

Q: A 6-week-old boy is brought to the pediatrician. His parents report that he has not had significant use of his right arm since birth. Birth history is significant for a prolonged labor with difficult breech delivery. On physical examination, his arm hangs at his side and is in a medially rotated position with the forearm in pronation. He will actively use his left arm but does not move his affected right arm or hand. Injury to which of the following cervical nerve roots accounts for this patient's posture?

C5 and C6. ***C5 and C6*** - The described "waiter's tip" posture – arm adducted, internally rotated, and forearm pronated – is classic for **Erb-Duchenne palsy**, resulting from damage to the **C5 and C6 nerve roots** [1]. - This injury commonly occurs during **difficult deliveries** involving shoulder traction, as seen in **breech presentations** [1]. *C7 and C8* - Damage to **C7 and C8** (and often T1) typically results in **Klumpke's palsy**, affecting the **intrinsic hand muscles** and causing a **claw hand deformity** [1]. - While a difficult birth can cause this, the patient's posture (medially rotated arm, pronated forearm) is not characteristic of Klumpke's palsy, which primarily affects lower brachial plexus elements. *C4 and C5* - Injury to **C4** can affect the **diaphragm** via the phrenic nerve, and along with C5, would primarily cause weakness of the **shoulder abductors** and **external rotators**. - While C5 is involved in the observed posture, isolated C4-C5 injury does not fully explain the severe adduction and internal rotation with forearm pronation that defines Erb's palsy. *C6 and C7* - Involvement of **C6 and C7** would lead to weakness in wrist extension, finger extension, and some elbow flexion. - While C6 is involved in Erb's palsy, the additional involvement of C7 alone would alter the specific presentation, often leading to more prominent wrist and finger extensor weakness, which is not the dominant feature described.

Q: True about the Serratus anterior muscle is

Helps in forced inspiration. ***Helps in forced inspiration*** - The **serratus anterior muscle** elevates the ribs when the scapula is fixed, aiding in **forced inspiration**. [1] - It is a significant accessory muscle of respiration, particularly during strenuous breathing. [1] *Supplied by the subscapular nerve* - The serratus anterior muscle is innervated by the **long thoracic nerve** (from the C5, C6, C7 nerve roots), not the subscapular nerve. - Damage to the long thoracic nerve can lead to **"winged scapula,"** characterized by medial scapular protraction. *Bipennate muscle* - The serratus anterior muscle has a **multi-pennate (or serrated)** arrangement, not bipennate. - Its shape is described as fan-shaped, with multiple slips attaching to the ribs. *Originates from the lower four ribs* - The serratus anterior muscle originates from the **first eight or nine ribs**, not just the lower four. - Its extensive origin allows it to spread broadly over the thoracic wall.

Q: Muscle inserting on medial border of scapula -

Serratus anterior. ***Serratus anterior*** - The **serratus anterior** muscle originates from the outer surface of the upper eight or nine ribs and inserts along the entire medial border of the scapula. - Its primary action is to **protract the scapula** (pull it forward around the chest wall) and stabilize it against the thoracic wall. *Subscapularis* - The **subscapularis** muscle originates from the **subscapular fossa** (anterior surface) of the scapula and inserts onto the **lesser tubercle of the humerus**. - It is a rotator cuff muscle involved in **medial rotation of the humerus**. *Teres minor* - The **teres minor** muscle originates from the lateral border of the scapula and inserts onto the **greater tubercle of the humerus**. - It is another rotator cuff muscle, primarily responsible for **lateral rotation and adduction of the humerus**. *Latissimus dorsi* - The **latissimus dorsi** is a large, broad muscle of the back that originates from the thoracolumbar fascia, iliac crest, and lower ribs, inserting into the **intertubercular groove of the humerus** [1]. - It has no direct insertion on the medial border of the scapula; it primarily extends, adducts, and internally rotates the humerus.

Q: Wasting of the intrinsic muscles of the hand can be expected to follow injury of the -

Ulnar nerve. Ulnar nerve - The ulnar nerve innervates most of the intrinsic muscles of the hand, including all interossei, medial two lumbricals, adductor pollicis, and hypothenar muscles [1]. - While the median nerve also supplies some intrinsic muscles (thenar eminence and lateral two lumbricals), the ulnar nerve innervates the majority (~15 of 20 intrinsic hand muscles) [1]. - Injury to the ulnar nerve significantly compromises function and leads to prominent wasting of these muscles, classic for a claw hand deformity. Brachial plexus - Injury to the brachial plexus can certainly affect hand muscles, but it's a more generalized deficit involving multiple nerves or distributions. - Wasting of the intrinsic hand muscles would be one of many symptoms, not necessarily the sole or most specific one to brachial plexus injury over ulnar nerve injury. Radial nerve - The radial nerve primarily innervates the extensor muscles of the forearm and hand, as well as the supinator. - Injury typically results in wrist drop and weakness in extending the wrist and fingers, not wasting of the intrinsic hand muscles. Axillary nerve - The axillary nerve innervates the deltoid and teres minor muscles. - Injury leads to weakness in shoulder abduction and external rotation, with sensory loss over the lateral shoulder, and does not directly affect the intrinsic hand muscles.

Q: A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to be damaged in this patient -

Median nerve. ***Median nerve*** - The **median nerve** innervates the muscles of the **thenar eminence** (abductor pollicis brevis, opponens pollicis, and superficial head of flexor pollicis brevis), and sensory supply to the radial side of the palm and digits [1]. - Damage to the median nerve would therefore cause **wasting of the thenar eminence** (motor loss) and **hypoaesthesia** in its sensory distribution [1]. *Radial nerve* - The **radial nerve** primarily innervates the **extensor muscles** of the forearm and hand, as well as providing sensory supply to the posterior arm, forearm, and radial side of the dorsal hand. - Damage would typically result in **wrist drop** and sensory loss on the posterior aspect of the hand, not thenar wasting. *Ulnar nerve* - The **ulnar nerve** innervates most of the intrinsic hand muscles, including the **hypothenar eminence** and interossei, and provides sensory supply to the ulnar side of the hand. - Damage leads to a "claw hand" deformity and wasting of the **hypothenar eminence**, not the thenar eminence. *Musculocutaneous nerve* - The **musculocutaneous nerve** innervates the muscles of the **anterior compartment of the arm** (biceps brachii, brachialis, coracobrachialis) and provides sensory supply to the lateral forearm. - Damage would result in weakness of elbow flexion and sensory loss on the lateral forearm, with no direct impact on the thenar eminence.

Question 1

Dupuytren's contracture is seen in

Accepted Answer

Palmar fascia

Answer

Cremaster fascia

Answer

Plantar fascia

Answer

Leg muscle

Question 2

Which of the following is an aberrant epiphysis?

Accepted Answer

Base of 1st metacarpal

Answer

Coracoid process

Answer

Greater tubercle of humerus

Answer

Base of 2nd metacarpal

Question 3

Which of the following is true about nerve injuries?

Accepted Answer

Median nerve is also named as labourer's nerve

Answer

Froment sign seen in median nerve palsy is due to Flexor pollicis longus action

Answer

All lumbricals are supplied by median nerve

Answer

Waenburg sign is seen in median nerve palsy

Question 4

Nerve supply of the marked muscle is

Accepted Answer

Median nerve

Answer

Radial nerve

Answer

Posterior interosseus nerve

Answer

Ulnar nerve

Question 5

Rotator interval is between:

Accepted Answer

Supraspinatus and subscapularis

Answer

Subscapularis and infraspinatus

Answer

Teres major and teres minor

Answer

Supraspinatus and teres minor

Question 6

A 6-week-old boy is brought to the pediatrician. His parents report that he has not had significant use of his right arm since birth. Birth history is significant for a prolonged labor with difficult breech delivery. On physical examination, his arm hangs at his side and is in a medially rotated position with the forearm in pronation. He will actively use his left arm but does not move his affected right arm or hand. Injury to which of the following cervical nerve roots accounts for this patient's posture?

Accepted Answer

C5 and C6

Answer

C7 and C8

Answer

C4 and C5

Answer

C6 and C7

Question 7

True about the Serratus anterior muscle is

Accepted Answer

Helps in forced inspiration

Answer

Supplied by the subscapular nerve

Answer

Bipennate muscle

Answer

Originates from the lower four ribs

Question 8

Muscle inserting on medial border of scapula -

Accepted Answer

Serratus anterior

Answer

Subscapularis

Answer

Teres minor

Answer

Latissimus dorsi

Question 9

Wasting of the intrinsic muscles of the hand can be expected to follow injury of the -

Accepted Answer

Ulnar nerve

Answer

Brachial plexus

Answer

Radial nerve

Answer

Axillary nerve

Question 10

A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to be damaged in this patient -

Accepted Answer

Median nerve

Answer

Radial nerve

Answer

Ulnar nerve

Answer

Musculocutaneous nerve

Upper Limb — MCQs

Upper Limb — MCQs

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