Upper Limb Practice Questions

Q: Axillary nerve is accompanied by which artery ?

Posterior circumflex humeral artery. ***Posterior circumflex humeral artery*** - The **axillary nerve** and the **posterior circumflex humeral artery** both pass through the **quadrangular space** in the axilla. - This anatomical relationship makes them vulnerable to injury together, particularly in cases of **shoulder dislocation** or **fractures of the surgical neck of the humerus**. *Axillary artery* - The **axillary artery** is the main arterial trunk of the axilla, but the axillary nerve is not typically described as directly accompanying the main trunk. - While branches of the axillary artery do supply the region where the axillary nerve travels, the specific artery that accompanies the nerve is a direct branch. *Subscapular artery* - The **subscapular artery** is the largest branch of the axillary artery and gives rise to the circumflex scapular and thoracodorsal arteries. - It does not directly accompany the axillary nerve through the quadrangular space; instead, it mostly supplies muscles like the **subscapularis** and **latissimus dorsi**. *Anterior circumflex humeral artery* - The **anterior circumflex humeral artery** also branches from the axillary artery and wraps around the surgical neck of the humerus. - However, it typically runs anteriorly and does not accompany the axillary nerve as it emerges from the quadrangular space posteriorly.

Q: Which of the following statements regarding axillary lymph nodes is incorrect?

Lateral group lies along lateral thoracic vessels. ***Lateral group lies along lateral thoracic vessels*** - The **lateral group** of axillary lymph nodes is located along the **axillary vein**, receiving lymph primarily from the upper limb [1]. - The **lateral thoracic vessels** are associated with the central and posterior groups of axillary lymph nodes, not the lateral group. *Posterior group lies along subscapular vessels* - The **posterior (subscapular) group** of axillary lymph nodes is indeed located along the **subscapular vessels**. - This group receives lymph from the posterior wall of the trunk and the posterior shoulder region. *Apical group is terminal lymph nodes* - The **apical group** (also known as the subclavian group) is considered the **terminal lymph nodes** of the axilla. - Lymph from all other axillary nodes eventually drains into the apical group before continuing to the supraclavicular nodes and then into the subclavian lymphatic trunk [2]. *Apical group lies along axillary vessels* - The **apical group** of axillary lymph nodes is situated in the apex of the axilla, superior to the pectoralis minor muscle, and lies in close proximity to the **axillary vessels** [1]. - This location allows it to receive lymph from other axillary groups and drain into the supraclavicular lymph nodes.

Q: All are infraclavicular branches of brachial plexus except ?

Long thoracic nerve. Long thoracic nerve - The long thoracic nerve originates directly from the roots (C5, C6, C7) of the brachial plexus, making it a supraclavicular branch. - It does not arise from the cords of the brachial plexus, which are located infraclavicularly. Ulnar nerve - The ulnar nerve arises from the medial cord of the brachial plexus, which is an infraclavicular structure. - It supplies many intrinsic hand muscles and the ulnar half of the flexor digitorum profundus. Axillary nerve - The axillary nerve is a branch of the posterior cord of the brachial plexus, classifying it as an infraclavicular branch. - It innervates the deltoid and teres minor muscles. Thoracodorsal nerve - The thoracodorsal nerve also originates from the posterior cord of the brachial plexus, making it an infraclavicular branch [1]. - It provides motor innervation to the latissimus dorsi muscle [1].

Q: All are supplied by the anterior interosseous nerve except which of the following?

Flexor carpi ulnaris. ***Flexor carpi ulnaris*** - The **flexor carpi ulnaris** (FCU) is innervated by the **ulnar nerve**, not the anterior interosseous nerve [1]. - This is the correct answer as it is NOT supplied by the AIN. *Pronator quadratus* - The **pronator quadratus** IS supplied by the **anterior interosseous nerve**. - This deep muscle is responsible for **pronation of the forearm** and is one of the three muscles innervated by the AIN. *Flexor digitorum profundus (lateral half)* - The **lateral half of flexor digitorum profundus** (to index and middle fingers) IS supplied by the **anterior interosseous nerve**. - The medial half (to ring and little fingers) is supplied by the ulnar nerve. *Flexor pollicis longus* - The **flexor pollicis longus** (FPL) IS supplied by the **anterior interosseous nerve**. - This muscle is responsible for **flexion of the thumb's interphalangeal joint** and is one of the three muscles innervated by the AIN.

Q: Which nerve is primarily involved in cubital tunnel syndrome?

Ulnar nerve. Ulnar nerve - **Cubital tunnel syndrome** is a condition caused by compression of the **ulnar nerve** as it passes through the cubital tunnel at the medial epicondyle of the elbow. - Symptoms typically include numbness and tingling in the **little finger** and **half of the ring finger**, along with weakness of intrinsic hand muscles [2]. *Radial nerve* - The **radial nerve** is primarily involved in conditions like **radial tunnel syndrome** or radial nerve palsy (**wrist drop**), affecting primarily extensor muscles of the forearm and hand. - Its compression site is typically in the **radial tunnel** near the elbow, distinct from the cubital tunnel. *Median nerve* - The **median nerve** is involved in **carpal tunnel syndrome** at the wrist, causing numbness and tingling in the thumb, index, middle, and radial half of the ring finger [2]. - Compression around the elbow (e.g., pronator teres syndrome) can also affect the median nerve, but this is less common than cubital tunnel syndrome [1]. *Axillary nerve* - The **axillary nerve** is responsible for sensation over the deltoid region and motor function of the deltoid and teres minor muscles. - It is often injured with **shoulder dislocations** or fractures of the surgical neck of the humerus, unrelated to cubital tunnel syndrome.

Q: Which muscle stabilizes the clavicle during movement of the shoulder?

Subclavius. ***Subclavius*** - The **subclavius muscle** originates from the first rib and inserts into the inferior surface of the clavicle, acting to **depress the clavicle** and prevent its displacement, thus enhancing shoulder stability during movement. - It plays a crucial role in protecting the underlying **neurovascular structures** (brachial plexus and subclavian vessels) from external trauma to the shoulder. *Pectoralis major* - This large, fan-shaped muscle primarily functions in **adduction, medial rotation, and flexion of the humerus** at the shoulder joint [1]. - It does not directly stabilize the clavicle but rather acts on the arm. *Latissimus dorsi* - The **latissimus dorsi** is a broad muscle of the back responsible for **extension, adduction, and internal rotation of the humerus** [1]. - Its actions are mainly on the humerus and it does not directly stabilize the clavicle. *Serratus anterior* - The **serratus anterior** muscle primarily **protracts and rotates the scapula**, keeping it pressed against the thoracic wall. - While it's essential for **scapular stability** and overhead arm movements, it does not directly stabilize the clavicle.

Q: Sensory supply of the palm is from which nerves?

Ulnar nerve and Median nerve. **Ulnar nerve and Median nerve** *(Correct)* - The **median nerve** provides sensory innervation to the lateral palm, including the thumb, index, middle, and radial half of the ring finger [1]. - The **ulnar nerve** supplies sensory innervation to the medial palm, including the little finger and the ulnar half of the ring finger [1]. - Together, these two nerves provide complete sensory coverage of the palm [1]. *Median nerve and Radial nerve* (Incorrect) - While the **median nerve** innervates a significant portion of the palm, the **radial nerve** primarily supplies the dorsal aspect of the hand and a small area of the thenar eminence, not the entire palm. - The radial nerve's sensory supply to the palm is usually limited to a very small area at the base of the thumb. - This combination does not provide complete palmar sensory coverage. *Radial nerve and ulnar nerve* (Incorrect) - The **radial nerve** mainly supplies the dorsum of the hand and digits, with minimal palmar contribution, making this option incorrect for primary palmar sensory supply. - The **ulnar nerve** does innervate part of the palm, but the combination with the radial nerve for complete palmar supply is inaccurate. - The median nerve, not the radial nerve, is the other major contributor to palmar sensation. *Musculocutaneous nerve and Radial nerve* (Incorrect) - The **musculocutaneous nerve** primarily innervates the lateral aspect of the forearm (as the lateral antebrachial cutaneous nerve) and does not contribute to the sensory supply of the palm. - The **radial nerve** also has a limited role in palmar sensation. - Neither of these nerves provides significant sensory innervation to the palm.

Q: What type of joint is the 1st carpometacarpal joint?

Saddle. ***Saddle*** - The **1st carpometacarpal joint** (thumb CMC joint) is a classic example of a **saddle joint** due to the reciprocal concave-convex opposing surfaces of the trapezium and the first metacarpal [1]. - This unique shape allows for a wide range of motion, including **flexion/extension**, **abduction/adduction**, and **opposition**, which is crucial for thumb function. *Pivot* - A **pivot joint** allows for rotational movement around a single axis, like the **atlantoaxial joint** (C1-C2) or the **proximal radioulnar joint**. - This type of motion is not characteristic of the 1st carpometacarpal joint. *Hinge* - A **hinge joint** permits movement in only one plane, like the **elbow** or **interphalangeal joints**, allowing for **flexion and extension**. - The 1st carpometacarpal joint has a greater degree of freedom than a hinge joint. *Ball and Socket* - A **ball and socket joint** offers the greatest range of motion, allowing for movement in all planes, including **circumduction and rotation**, such as the **shoulder** and **hip joints**. - While the 1st carpometacarpal joint is highly mobile, it does not achieve the full range of motion of a ball and socket joint.

Q: Long thoracic nerve arises from which nerve roots?

C5 C6 C7. ***C5 C6 C7*** - The long thoracic nerve is formed from the **anterior rami** of the fifth, sixth, and seventh **cervical nerves (C5, C6, C7)**. - This nerve uniquely descends posterior to the **brachial plexus** and innervates the **serratus anterior muscle**. *C6 C7 T1* - While these roots contribute to other brachial plexus nerves, the **long thoracic nerve** specifically excludes T1. - T1 is more commonly associated with the **lower trunk** of the brachial plexus and nerves like the **ulnar nerve**. *C7 T1 T2* - The long thoracic nerve arises primarily from **cervical roots** and does not typically include T2. - **T2 involvement** in neural innervation of the upper limb is less common for the main nerves. *C5, C6, C7, T1* - The inclusion of T1 in this option makes it incorrect for the **long thoracic nerve**. - The T1 root contributes to other nerves of the **brachial plexus**, not the long thoracic nerve.

Question 1

Axillary nerve is accompanied by which artery ?

Accepted Answer

Posterior circumflex humeral artery

Answer

Axillary artery

Answer

Subscapular artery

Answer

Anterior circumflex humeral artery

Question 2

Which of the following statements regarding axillary lymph nodes is incorrect?

Accepted Answer

Lateral group lies along lateral thoracic vessels

Answer

Posterior group lies along subscapular vessels

Answer

Apical group is terminal lymph nodes

Answer

Apical group lies along axillary vessels

Question 3

All are infraclavicular branches of brachial plexus except ?

Accepted Answer

Long thoracic nerve

Answer

Axillary nerve

Answer

Thoracodorsal nerve

Answer

Ulnar nerve

Question 4

All are supplied by the anterior interosseous nerve except which of the following?

Accepted Answer

Flexor carpi ulnaris

Answer

Pronator quadratus

Answer

Flexor digitorum profundus (lateral half)

Answer

Flexor pollicis longus

Question 5

Which nerve is primarily involved in cubital tunnel syndrome?

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Median nerve

Answer

Axillary nerve

Question 6

In axillary nerve paralysis, which of the following statements is false?

Accepted Answer

Extension of shoulder with arm abducted to 90 degrees is impossible

Answer

Deltoid muscle is wasted

Answer

Small area of numbness is present over the shoulder region

Answer

Patient cannot initiate abduction

Question 7

Which muscle stabilizes the clavicle during movement of the shoulder?

Accepted Answer

Subclavius

Answer

Pectoralis major

Answer

Latissimus dorsi

Answer

Serratus anterior

Question 8

Sensory supply of the palm is from which nerves?

Accepted Answer

Ulnar nerve and Median nerve

Answer

Median nerve and Radial nerve

Answer

Radial nerve and ulnar nerve

Answer

Musculocutaneous nerve and Radial nerve

Question 9

What type of joint is the 1st carpometacarpal joint?

Accepted Answer

Saddle

Answer

Pivot

Answer

Hinge

Answer

Ball and Socket

Question 10

Long thoracic nerve arises from which nerve roots?

Accepted Answer

C5 C6 C7

Answer

C6 C7 T1

Answer

C7 T1 T2

Answer

C5 C6 C7 T1

Upper Limb — MCQs

Upper Limb — MCQs

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