Upper Limb Practice Questions

Q: Which of the following is not intracapsular -

Lateral epicondyle. **Lateral epicondyle** - The **lateral epicondyle** is an extracapsular structure, sitting superior and lateral to the capitulum and serving as an attachment site for the **radial collateral ligament** and the **common extensor tendon**. - Its position outside the joint capsule means it does not directly articulate within the synovial space of the elbow joint. *Olecranon fossa* - The **olecranon fossa** is a deep depression on the posterior aspect of the **distal humerus** that accommodates the **olecranon process** of the ulna during full elbow extension. - It is located within the joint capsule, allowing the olecranon to articulate freely within the joint. *Coronoid fossa* - The **coronoid fossa** is an anterior depression on the **distal humerus** that receives the **coronoid process** of the ulna during elbow flexion. - This fossa is located within the joint capsule, facilitating the articulation of the ulna with the humerus. *Radial fossa* - The **radial fossa** is a shallow depression on the anterior surface of the distal humerus, superior to the capitulum, that accommodates the **head of the radius** during elbow flexion. - It is located within the joint capsule, enabling smooth movement between the radius and the humerus.

Q: Serratus anterior is supplied by which nerve?

Long thoracic nerve. **Long thoracic nerve** - The **serratus anterior muscle** is innervated exclusively by the **long thoracic nerve**. - Damage to this nerve can lead to **"winged scapula,"** as the serratus anterior is responsible for holding the scapula against the thoracic wall. *Axillary nerve* - The **axillary nerve** innervates the **deltoid** and **teres minor muscles**. - It is responsible for shoulder abduction and external rotation. *Dorsal scapular nerve* - The **dorsal scapular nerve** supplies the **rhomboid major**, **rhomboid minor**, and **levator scapulae muscles**. - These muscles primarily act to retract and elevate the scapula. *Spinal accessory nerve* - The **spinal accessory nerve** (cranial nerve XI) innervates the **sternocleidomastoid** and **trapezius muscles**. - It is primarily involved in head and shoulder movements.

Q: Middle palmar space ends distally:

Into the web space. ***Into the web space*** - The **middle palmar space** is a potential space in the palm that communicates distally with the **web spaces** between the fingers [1]. - Infections in the middle palmar space can spread to the web spaces, causing characteristic swelling and pain between the digits [1]. *By connecting with the superficial palmar space.* - The concept of a separate "superficial palmar space" distinct from the thenar and midpalmar spaces is not anatomically accurate; the main deep palmar spaces are the **thenar** and **midpalmar (middle palmar)** spaces [1]. - These deep spaces are generally separated by fascial septa and do not directly connect with a broad superficial palmar space in the manner suggested for distal spread [1]. *Extending into the flexor tendon sheaths.* - While the **flexor tendons** pass through the palm, the middle palmar space is lateral to the flexor tendon sheaths of the index, middle, ring, and little fingers, not directly extending into them. - Infections of the middle palmar space can affect these sheaths indirectly via communication with the **lumbrical canals**, but it's not a direct extension. *Extending along the digital sheaths.* - The digital flexor tendon sheaths are distinct enclosed structures surrounding the tendons within the fingers. - The middle palmar space primarily communicates with the loose connective tissue in the **web spaces**, which then allows for indirect spread to the digital sheaths or to the fingers via the lumbrical canals, rather than directly extending into the sheaths themselves [1].

Q: A cut injury on wrist causes the inability of thumb to touch the tip of little finger, the nerve likely to be damaged is -

Median. ***Median*** - The inability of the thumb to touch the tip of the little finger, known as **"ape hand"** or **"median claw,"** results from paralysis of the thenar muscles, which are primarily innervated by the **median nerve** [1]. - The median nerve supplies the **opponens pollicis**, **abductor pollicis brevis**, and superficial head of the **flexor pollicis brevis**, all crucial for intricate thumb movements including opposition [1]. *Radial* - Damage to the radial nerve primarily affects **wrist and finger extension**, leading to **"wrist drop"** [1]. - It would not specifically impair the ability of the thumb to touch the little finger. *Ulnar* - An ulnar nerve injury would primarily cause **"ulnar claw hand,"** affecting the little and ring fingers' flexion, and loss of **adduction and abduction of fingers** [1]. - While it causes weakness in some intrinsic hand muscles, it does not directly prevent thumb opposition in the way described [1]. *Deep branch of ulnar nerve* - Damage to the deep branch of the ulnar nerve affects most of the **interossei** and **lumbricals**, leading to a more pronounced ulnar claw and affecting fine motor control and grip [1]. - However, the primary muscles for thumb opposition are innervated by the median nerve [1].

Q: Pronator teres syndrome is related to which nerve?

Median Nerve. ***Median Nerve*** - **Pronator teres syndrome** is a **compression neuropathy** of the **median nerve** as it passes between the two heads of the pronator teres muscle [1]. - Symptoms include pain in the proximal forearm, paresthesia in the median nerve distribution, and weakness in forearm pronation and thumb/finger flexion [1]. *Axillary Nerve* - The **axillary nerve** innervates the **deltoid** and **teres minor** muscles and supplies sensation to the lateral shoulder. - Its compression or injury would lead to shoulder weakness and sensory deficits, not forearm symptoms. *Ulnar Nerve* - The **ulnar nerve** passes through **Guyon's canal** at the wrist and the cubital tunnel at the elbow [1]. - Compression leads to symptoms in the **medial 1.5 digits** and weakness of intrinsic hand muscles, not related to the pronator teres. *Radial Nerve* - The **radial nerve** innervates the **extensor muscles** of the arm and forearm. - Compression or injury would result in wrist drop or sensory deficits on the dorsal hand, symptoms not associated with pronator teres syndrome.

Q: Which of the following is not a flexor of the forearm?

Anconeus. ***Anconeus*** - The **anconeus muscle** assists the **triceps** in extending the elbow and is not involved in forearm flexion. - It is located posteriorly to the elbow joint, originating from the **lateral epicondyle of the humerus** and inserting onto the ulna. *Brachialis* - The **brachialis muscle** is a primary **flexor of the elbow joint** and acts to flex the forearm at the elbow. - It is often considered the **workhorse of elbow flexion** as it provides pure flexion regardless of forearm pronation or supination. *Pronator teres* - The **pronator teres** is a muscle in the forearm that primarily functions to **pronate the forearm** (turn the palm downwards). - It also acts as a **weak flexor of the elbow joint**, contributing to forearm flexion. *Brachioradialis* - The **brachioradialis muscle** is located in the superficial layer of the posterior compartment of the forearm but acts as a **flexor of the elbow joint**. - It is particularly active during rapid or resisted elbow flexion, especially when the forearm is in a **neutral position** (thumb up).

Q: What are the attachments of the ulnar collateral ligament?

Medial epicondyle of humerus to coronoid process of ulna. ***Medial epicondyle of humerus to coronoid process of ulna*** - The **ulnar collateral ligament (UCL)** complex is a primary stabilizer of the **elbow joint**, preventing valgus stress. - It consists of anterior, posterior, and transverse bundles, with the **anterior bundle** being the strongest and most important, extending from the **medial epicondyle of the humerus** to the **coronoid process of the ulna**. *Lateral epicondyle of humerus to annular ligament* - This description corresponds to a portion of the **radial collateral ligament (RCL)** complex, specifically connecting the lateral epicondyle to structures around the radial head. - The **annular ligament** encircles the radial head, but the UCL is on the medial side of the elbow. *Lateral epicondyle of humerus to radial notch of ulna* - This anatomical location describes part of the **radial collateral ligament** or structures related to the radiohumeral joint. - The **UCL** is on the medial side of the elbow and connects to the ulna, but not to the **radial notch**. *Medial epicondyle of humerus to radial tuberosity* - While the UCL originates from the **medial epicondyle of the humerus**, it inserts onto the ulna, not the **radial tuberosity**. - The **radial tuberosity** is an insertion site for the biceps brachii muscle, located on the radius.

Q: Power grip of hand depends on?

Long flexors of the fingers. ***Long flexors of the fingers*** - The **power grip** involves strong flexion of the **metacarpophalangeal (MCP)** and **interphalangeal (IP) joints**, primarily accomplished by the **flexor digitorum profundus** and **flexor digitorum superficialis**. - These muscles originate in the forearm and insert into the fingers, providing the **necessary force** for firmly grasping objects. *Lumbricals of hand* - The lumbricals primarily **flex the MCP joints** and **extend the IP joints** (intrinsic plus action) [1]. - While they contribute to precise movements, they are not the main drivers of the strong, forceful flexion required for a **power grip**. *Short flexor of fingers* - There are no primary "short flexors of the fingers" apart from the intrinsic muscles already discussed (lumbricals and interossei), which perform precise movements rather than **power grip**. - The primary flexors for power are the **long flexors**. *Palmaris brevis* - The **palmaris brevis** is a superficial muscle in the hypothenar eminence that tenses the palmar aponeurosis. - Its main function is to **deepen the hollow of the palm** to improve grip with small objects, not to provide the essential force for a **power grip** [1].

Q: Which of the following nerves has the shaded cutaneous territory

Radial. ***Radial*** - The shaded area (dorsal aspect of the thumb, index finger, middle finger, and radial half of the ring finger) corresponds to the **cutaneous innervation of the radial nerve**, specifically its superficial branch. - The radial nerve also supplies extensor muscles in the forearm and hand, but this question specifically addresses its cutaneous distribution. *Posterior interosseous* - The posterior interosseous nerve is a **motor nerve** that primarily supplies muscles in the forearm. - It has **no significant cutaneous sensory distribution**. *Median* - The **median nerve** provides sensory innervation to the palmar aspect of the thumb, index, middle, and radial half of the ring finger, and the dorsal tips of these digits. - Its cutaneous territory does **not extend to the dorsal hand** over the shaded region. *Ulnar* - The **ulnar nerve** innervates the one and a half fingers (little finger and ulnar half of the ring finger) on both the palmar and dorsal aspects. - This distribution is distinct from the shaded area, which covers the radial side of the dorsal hand.

Question 1

Which of the following is not intracapsular -

Accepted Answer

Lateral epicondyle

Answer

Olecranon fossa

Answer

Coronoid fossa

Answer

Radial fossa

Question 2

Serratus anterior is supplied by which nerve?

Accepted Answer

Long thoracic nerve

Answer

Axillary nerve

Answer

Dorsal scapular nerve

Answer

Spinal accessory nerve

Question 3

Middle palmar space ends distally:

Accepted Answer

Into the web space

Answer

By connecting with the superficial palmar space

Answer

Extending into the flexor tendon sheaths

Answer

Extending along the digital sheaths

Question 4

A cut injury on wrist causes the inability of thumb to touch the tip of little finger, the nerve likely to be damaged is -

Accepted Answer

Median

Answer

Radial

Answer

Ulnar

Answer

Deep branch of ulnar nerve

Question 5

Pronator teres syndrome is related to which nerve?

Accepted Answer

Median Nerve

Answer

Axillary Nerve

Answer

Ulnar Nerve

Answer

Radial Nerve

Question 6

Which of the following is not a flexor of the forearm?

Accepted Answer

Anconeus

Answer

Brachialis

Answer

Pronator teres

Answer

Brachioradialis

Question 7

Clinical testing of the function of the long thoracic nerve is done by:

Accepted Answer

Push the wall with outstretched arms and observe for scapular winging

Answer

Perform resisted flexion of the arm at the shoulder joint

Answer

Perform resisted external rotation of the arm at the shoulder joint

Answer

Raise the arm above the head on the affected side

Question 8

What are the attachments of the ulnar collateral ligament?

Accepted Answer

Medial epicondyle of humerus to coronoid process of ulna

Answer

Lateral epicondyle of humerus to annular ligament

Answer

Lateral epicondyle of humerus to radial notch of ulna

Answer

Medial epicondyle of humerus to radial tuberosity

Question 9

Power grip of hand depends on?

Accepted Answer

Long flexors of the fingers

Answer

Lumbricals of hand

Answer

Short flexor of fingers

Answer

Palmaris brevis

Question 10

Which of the following nerves has the shaded cutaneous territory

Accepted Answer

Radial

Answer

Posterior interosseous

Answer

Median

Answer

Ulnar

Upper Limb — MCQs

Upper Limb — MCQs

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