Upper Limb — MCQs
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A 29-year-old patient comes in; he cannot flex the distal interphalangeal (DIP) joint of the index finger. His physician determines that he has nerve damage from a supracondylar fracture. Which of the following conditions is also a symptom of this nerve damage?
All of the following are affected in Erb's palsy EXCEPT
Traumatic anterior dislocation of shoulder with sensory loss in lateral side of forearm and weakness of flexion of elbow joint, most likely injured nerve is:
Posterolateral Anconeus triangle is formed by all, except
Crutch palsy is injury to which nerve?
Which of the rotator cuff muscles was not given its due importance and was called the forgotten muscle of the rotator cuff?
Which muscle is affected in winging of the scapula?
What is the normal orientation of the humeral head relative to the transepicondylar axis of the elbow?
All of the following muscles are paralyzed in trauma to median nerve at the wrist except -
Damage to median nerve produces:
Upper Limb Indian Medical PG Practice Questions and MCQs
Question 681: A 29-year-old patient comes in; he cannot flex the distal interphalangeal (DIP) joint of the index finger. His physician determines that he has nerve damage from a supracondylar fracture. Which of the following conditions is also a symptom of this nerve damage?
- A. Paralysis of all the thumb muscles
- B. Atrophy of the hypothenar eminence
- C. Loss of sensation over the distal part of the second digit (Correct Answer)
- D. Inability to flex the DIP joint of the ring finger
Explanation: ***Loss of sensation over the distal part of the second digit*** - A supracondylar fracture of the humerus can damage the **median nerve**. [2] - The **anterior interosseous nerve (AIN)**, a branch of the median nerve, innervates the **flexor digitorum profundus (FDP)** muscle to the index and middle fingers, which is responsible for flexing the DIP joint of the index finger. - The median nerve also provides **sensory innervation** to the palmar aspect of the thumb, index finger, middle finger, and radial half of the ring finger, including the distal part of the second digit (index finger). [1] - Median nerve injury at the supracondylar level can affect both motor function (via the AIN distally) and sensory function, making this the correct associated symptom. *Paralysis of all the thumb muscles* - The median nerve innervates most of the **thenar muscles** (flexor pollicis brevis, abductor pollicis brevis, opponens pollicis) via the recurrent motor branch, which are responsible for thumb opposition and abduction. - However, the **adductor pollicis** and the deep head of flexor pollicis brevis are innervated by the **ulnar nerve**, and the **extensor muscles of the thumb** (extensor pollicis longus and brevis, abductor pollicis longus) are innervated by the **radial nerve**. [1] - Therefore, not *all* thumb muscles would be paralyzed with median nerve injury alone. *Atrophy of the hypothenar eminence* - The **hypothenar eminence** (muscles controlling the little finger: abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi) is innervated by the **ulnar nerve**. [2] - Median nerve damage would cause atrophy of the **thenar eminence**, not the hypothenar eminence. *Inability to flex the DIP joint of the ring finger* - Flexion of the DIP joint of the ring finger is performed by the **flexor digitorum profundus (FDP)** muscle. - The FDP to the ring and little fingers is innervated by the **ulnar nerve**, not the median nerve. [2] - The median nerve (via the AIN) only innervates the FDP to the index and middle fingers.
Question 682: All of the following are affected in Erb's palsy EXCEPT
- A. Dorsal scapular nerve
- B. Suprascapular nerve
- C. Lower trunk of brachial plexus (Correct Answer)
- D. Upper trunk of brachial plexus
Explanation: ***Lower trunk of brachial plexus*** - Erb's palsy primarily involves the **upper trunk** of the brachial plexus (C5-C6 nerve roots), which affects muscles innervated by these roots. - The **lower trunk** (C8-T1 nerve roots) is typically spared in Erb's palsy, distinguishing it from **Klumpke's palsy**. *Dorsal scapular nerve* - The dorsal scapular nerve originates from the **C5 root of the brachial plexus** and innervates the **rhomboids** and **levator scapulae**. - As Erb's palsy involves the C5 root, the dorsal scapular nerve and its associated muscles are commonly affected. *Suprascapular nerve* - The suprascapular nerve arises from the **upper trunk** of the brachial plexus (C5-C6) and innervates the **supraspinatus** and **infraspinatus** muscles. - Damage to the upper trunk in Erb's palsy directly impacts the function of the suprascapular nerve. *Upper trunk of brachial plexus* - Erb's palsy is specifically defined by an injury to the **upper trunk** of the brachial plexus, involving the C5 and C6 nerve roots. - This damage leads to weakness in muscles such as the **deltoid**, **biceps**, and **brachialis**, resulting in the characteristic **"waiter's tip"** posture.
Question 683: Traumatic anterior dislocation of shoulder with sensory loss in lateral side of forearm and weakness of flexion of elbow joint, most likely injured nerve is:
- A. Ulnar nerve
- B. Axillary nerve
- C. Radial nerve
- D. Musculocutaneous nerve (Correct Answer)
Explanation: ***Musculocutaneous nerve*** - The **musculocutaneous nerve** innervates the biceps brachii and brachialis muscles, responsible for **elbow flexion**. - It also provides sensory innervation to the **lateral forearm** via the **lateral cutaneous nerve of the forearm**, explaining the sensory loss described. *Ulnar nerve* - The ulnar nerve primarily innervates muscles of the **hand** and gives sensory supply to the medial 1 and 1/2 digits. - Its injury would typically lead to weakness in **finger adduction/abduction** and sensory loss in the medial hand, not the lateral forearm. *Axillary nerve* - The axillary nerve innervates the **deltoid** and **teres minor** muscles, causing weakness in **shoulder abduction** and external rotation upon injury. - Sensory loss would be over the **regimental badge area** (lateral shoulder), not the lateral forearm. *Radial nerve* - The radial nerve innervates the **extensor muscles of the wrist and fingers**, and the triceps. - Injury would result in **wrist drop** and sensory loss over the **posterior arm, forearm, and hand**, not lateral forearm sensory loss.
Question 684: Posterolateral Anconeus triangle is formed by all, except
- A. Lateral epicondyle
- B. Olecranon
- C. Head of the radius
- D. Medial epicondyle (Correct Answer)
Explanation: ***Medial epicondyle*** - The **medial epicondyle** is part of the **medial column** of the distal humerus and is therefore not involved in forming the posterolateral anconeus triangle. - This triangle is specifically defined by structures on the posterior and lateral aspects of the elbow joint. *Lateral epicondyle* - The **lateral epicondyle** forms the **apex** or superior boundary of the anconeus triangle when viewed from the posterior aspect. - It serves as a key bony landmark for the posterolateral region of the elbow. *Olecranon* - The **olecranon** of the ulna constitutes the **inferomedial** boundary of the anconeus triangle. - It forms a prominent point on the posterior aspect of the elbow. *Head of the radius* - The **head of the radius** forms the **inferior-lateral** boundary of the anconeus triangle. - It is an important structure for defining the lateral and distal limits of this anatomical region.
Question 685: Crutch palsy is injury to which nerve?
- A. Ulnar nerve
- B. Musculocutaneous nerve
- C. Radial nerve (Correct Answer)
- D. Median nerve
Explanation: ***Radial nerve*** - **Crutch palsy** is a form of **compression neuropathy** that specifically affects the **radial nerve** due to improper crutch use. - The crutch top places pressure on the **axilla**, compressing the radial nerve in the **axillary region** as it travels along the posterior cord. - This results in **wrist drop** and weakness of finger/thumb extension due to paralysis of extensor muscles. *Ulnar nerve* - The **ulnar nerve** is commonly injured at the **cubital tunnel** (medial epicondyle) or Guyon's canal in the wrist. [1] - Injuries typically result in **claw hand deformity** and sensory loss in the medial 1.5 digits, not associated with crutch pressure. [1] *Musculocutaneous nerve* - The **musculocutaneous nerve** innervates the **biceps brachii** and **brachialis** muscles, responsible for elbow flexion. - Injury to this nerve is rare from external compression and would primarily affect **forearm flexion** and sensation on the lateral forearm. *Median nerve* - The **median nerve** is most commonly entrapped in the **carpal tunnel** at the wrist, leading to carpal tunnel syndrome. - Injury typically results in **ape hand deformity** and sensory loss in the lateral 3.5 digits, not compression in the axilla from crutches.
Question 686: Which of the rotator cuff muscles was not given its due importance and was called the forgotten muscle of the rotator cuff?
- A. Teres minor
- B. Subscapularis (Correct Answer)
- C. Infraspinatus
- D. Supraspinatus
Explanation: ***Subscapularis*** - The **subscapularis** was historically considered less important than other rotator cuff muscles in clinical assessment and treatment, earning it the moniker **"the forgotten muscle"** - However, its critical role in **internal rotation** and dynamic anterior stability of the glenohumeral joint is now well-recognized - Located on the anterior surface of the scapula, it was often overlooked in clinical examinations and its tears were under-diagnosed before advanced imaging techniques *Teres minor* - The teres minor is part of the rotator cuff and is crucial for **external rotation** and stabilization of the shoulder joint - While clinically important, it has not been specifically singled out as "the forgotten muscle" in the same way the subscapularis was - It is the smallest of the rotator cuff muscles and works synergistically with infraspinatus *Infraspinatus* - The infraspinatus is a primary **external rotator** of the humerus and plays a significant role in shoulder stability - Its function has always been well understood and is commonly assessed in rotator cuff examinations - It is easily palpable posteriorly and readily evaluated clinically *Supraspinatus* - The supraspinatus is often considered the **most commonly injured** rotator cuff muscle due to its location and function in initiating **abduction** - It has never been "forgotten" and is consistently emphasized in clinical evaluations of shoulder pain and dysfunction - It is the most frequently assessed muscle in rotator cuff pathology
Question 687: Which muscle is affected in winging of the scapula?
- A. Latissimus dorsi
- B. Subscapularis
- C. Serratus anterior (Correct Answer)
- D. Teres minor
Explanation: ***Serratus anterior*** - Damage to the **long thoracic nerve**, which innervates the serratus anterior muscle, leads to paralysis of this muscle. - The **serratus anterior** is crucial for holding the scapula against the thoracic wall and for **scapular protraction**, so its weakness results in a prominent medial border of the scapula, known as **winging**. *Latissimus dorsi* - The **latissimus dorsi** is an important muscle for **adduction**, **extension**, and **internal rotation** of the shoulder. - Injury to this muscle or its innervation (thoracodorsal nerve) primarily affects these movements, not causing scapular winging. *Subscapularis* - The **subscapularis** is part of the rotator cuff and is primarily involved in **internal rotation** of the humerus. - Dysfunction of the subscapularis would manifest as weakness in internal rotation and possibly shoulder instability, but not scapular winging. *Teres minor* - The **teres minor** is another rotator cuff muscle responsible for **external rotation** and stabilization of the humeral head. - Weakness of the teres minor would impair external rotation and contribute to rotator cuff dysfunction, but it is not associated with scapular winging.
Question 688: What is the normal orientation of the humeral head relative to the transepicondylar axis of the elbow?
- A. Anteversion of 50 degrees
- B. Retroversion of 80 degrees
- C. Anteversion of 15 degrees (Correct Answer)
- D. Retroversion of 30 degrees
Explanation: ***Anteversion of 15 degrees*** - The humeral head normally exhibits approximately **15-30 degrees of anteversion** (also called torsion) relative to the **transepicondylar axis of the elbow**. - This **anteversion** means the humeral head is rotated **anteriorly (forward)** compared to the plane of the elbow. - This orientation allows for optimal range of motion at the glenohumeral joint, particularly during **internal and external rotation**. - The value of **15 degrees falls within the normal anatomical range** and represents the lower end of normal variation. *Anteversion of 50 degrees* - While anteversion is the correct direction, **50 degrees is excessive** and beyond the normal range (typically 15-30 degrees). - Excessive anteversion can lead to **anterior instability** of the shoulder and altered biomechanics. *Retroversion of 80 degrees* - **Retroversion** means posterior rotation, which is the **opposite direction** from normal humeral anatomy. - The humerus normally demonstrates **anteversion, not retroversion**. - 80 degrees would be an extremely abnormal orientation. *Retroversion of 30 degrees* - This option confuses the direction: the humerus exhibits **anteversion (forward rotation), not retroversion (backward rotation)**. - While 30 degrees is within the normal magnitude, the **direction is incorrect**.
Question 689: All of the following muscles are paralyzed in trauma to median nerve at the wrist except -
- A. Muscles of the Thenar eminence
- B. First two lumbicals
- C. Adductor pollicis (Correct Answer)
- D. Abductor pollicis brevis
Explanation: ***Adductor pollicis*** - The **adductor pollicis** muscle is primarily innervated by the **ulnar nerve**, specifically its deep branch [2]. - Therefore, it would **not be paralyzed** by a median nerve injury at the wrist [2]. *Muscles of the Thenar eminence* - The thenar muscles (**abductor pollicis brevis**, **flexor pollicis brevis** (superficial head), and **opponens pollicis**) are innervated by the **recurrent branch of the median nerve** [2]. - A median nerve injury at the wrist, especially involving the recurrent branch, would paralyze these muscles, leading to loss of thumb opposition and abduction [1]. *First two lumbicals* - The **first and second lumbrical muscles** are innervated by the **median nerve** [2]. - Trauma to the median nerve at the wrist would impair their function, affecting flexion of the metacarpophalangeal joints and extension of the interphalangeal joints of the index and middle fingers. *Abductor pollicis brevis* - The **abductor pollicis brevis** is a thenar muscle innervated by the **recurrent branch of the median nerve** [2]. - Its paralysis would be a direct consequence of a median nerve injury at the wrist, resulting in inability to abduct the thumb.
Question 690: Damage to median nerve produces:
- A. Ape thumb (Correct Answer)
- B. Winging of scapula
- C. Claw hand
- D. Wrist drop
Explanation: Ape thumb - Damage to the median nerve specifically affects the thenar muscles (via the recurrent branch): abductor pollicis brevis, opponens pollicis, and the superficial head of flexor pollicis brevis [1]. - Loss of these muscles results in the characteristic "ape thumb" deformity, where the thumb lies in the same plane as the palm and cannot be opposed [1]. - The patient loses the ability to perform thumb opposition, which is essential for precision grip and many hand functions [1]. Winging of scapula - Winging of the scapula is caused by damage to the long thoracic nerve, which innervates the serratus anterior muscle. - This condition is not associated with median nerve injury. Claw hand - A claw hand deformity is typically caused by damage to the ulnar nerve, affecting the lumbricals and interossei muscles. - It results in hyperextension of the metacarpophalangeal joints and flexion of the interphalangeal joints, particularly of the 4th and 5th digits. - This is distinct from median nerve pathology. Wrist drop - Wrist drop is a classic sign of radial nerve damage, affecting the extensor muscles of the wrist and fingers. - It results in the inability to extend the wrist and digits, which is not a feature of median nerve injury.
Practice by Chapter
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