Upper Limb Practice Questions

Q: All of the following muscles have dual nerve supply except which one?

Biceps brachii. ***Biceps brachii*** - The **biceps brachii** muscle is solely innervated by the **musculocutaneous nerve (C5, C6, C7)**. - This muscle is a prime mover for forearm supination and elbow flexion and does not receive nerve supply from any other nerve. *Subscapularis* - The **subscapularis** muscle has a dual nerve supply from both the **upper and lower subscapular nerves (C5, C6)**. - This dual innervation ensures motor control of the subscapularis, which is an important medial rotator of the humerus. *Pectoralis major* - The **pectoralis major** muscle receives a dual nerve supply from both the **medial and lateral pectoral nerves** [1]. - The **lateral pectoral nerve** primarily supplies the clavicular head, while the **medial pectoral nerve** supplies both the sternocostal head and a portion of the clavicular head [1]. *Flexor digitorum profundus* - The **flexor digitorum profundus** muscle has a dual nerve supply from the **median nerve** (innervating the lateral half for digits 2 and 3) and the **ulnar nerve** (innervating the medial half for digits 4 and 5). - This dual innervation allows for independent or coordinated flexion of the distal phalanges of the fingers.

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: 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: Which muscle will be paralyzed when the radial nerve is injured just below the spiral groove?

Extensor Carpi Radialis Brevis. Extensor Carpi Radialis Brevis - The radial nerve travels in the spiral groove of the humerus and gives off branches in a specific sequence. - Proximal to the spiral groove: Branches to triceps and anconeus - Within/at the spiral groove: Branches to brachioradialis and extensor carpi radialis longus (ECRL) - Just distal to the spiral groove: Branch to extensor carpi radialis brevis (ECRB) [1] - this is the first branch after exiting the spiral groove - More distally: The nerve divides into superficial and deep branches (posterior interosseous nerve) [1] - An injury just below the spiral groove would paralyze ECRB while sparing muscles innervated proximal to or within the groove (triceps, anconeus, brachioradialis, ECRL). Supinator - The supinator is innervated by the deep branch of the radial nerve (posterior interosseous nerve), which branches off more distally in the proximal forearm. - This muscle would only be affected by injuries distal to the bifurcation of the radial nerve into superficial and deep branches, not by an injury just below the spiral groove. Extensor Digitorum - The extensor digitorum is supplied by the posterior interosseous nerve, which is a continuation of the deep branch [1]. - This innervation occurs significantly distal to the spiral groove in the posterior forearm compartment. - It would be affected by posterior interosseous nerve injuries, not by lesions just below the spiral groove. Abductor Pollicis Longus - The abductor pollicis longus is innervated by the posterior interosseous nerve in the distal forearm [1]. - This is the most distal of all the options and would only be affected by posterior interosseous nerve palsy, not by radial nerve injury at the spiral groove level [1].

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: 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: 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: Not seen in carpal tunnel syndrome is:

Sensory loss on lateral 3½ of palm. ***Sensory loss on lateral 3½ of palm*** - In **carpal tunnel syndrome**, sensory loss typically affects the **lateral 3½ digits** (thumb, index, middle, and radial half of the ring finger) and the corresponding palm *distal to the wrist crease*. The palm *proximal to the wrist crease* is spared because its sensation is supplied by the **palmar cutaneous branch of the median nerve**, which originates proximal to the carpal tunnel. - Therefore, **sensory loss on the lateral 3½ of the palm *before the wrist crease*** is not characteristic of carpal tunnel syndrome, as this area is innervated by the palmar cutaneous branch which passes *outside* the carpal tunnel. The wording implies a broader palmar involvement, which would be inconsistent. *Pain of medial 3 fingers* - This is a common and characteristic symptom of carpal tunnel syndrome, as the **median nerve** innervates the lateral side of the hand, including the thumb, index, middle, and radial half of the ring finger. - Patients often describe **numbness, tingling, and pain** radiating into these fingers, particularly during activities that involve sustained wrist flexion or extension. *Ape thumb deformity* - This deformity is a sign of **chronic, severe median nerve compression** in carpal tunnel syndrome, leading to atrophy of the **thenar muscles** (abductor pollicis brevis, opponens pollicis, and superficial head of flexor pollicis brevis). - The thumb becomes **adducted and externally rotated**, lying in the same plane as the other fingers, resembling an ape's thumb. *Symptoms worsen at night* - This is a classic presentation of carpal tunnel syndrome, often due to **fluid accumulation** in the wrist and prolonged wrist flexion during sleep. - Patients frequently report being **woken up by numbness and pain** in their hands, requiring them to shake or move their hands for relief.

Question 1

All of the following muscles have dual nerve supply except which one?

Accepted Answer

Biceps brachii

Answer

Pectoralis major

Answer

Flexor digitorum profundus

Answer

Subscapularis

Question 2

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 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

Which muscle will be paralyzed when the radial nerve is injured just below the spiral groove?

Accepted Answer

Extensor Carpi Radialis Brevis

Answer

Extensor Digitorum

Answer

Supinator

Answer

Abductor 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

What type of joint is the 1st carpometacarpal joint?

Accepted Answer

Saddle

Answer

Pivot

Answer

Hinge

Answer

Ball and Socket

Question 9

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 10

Not seen in carpal tunnel syndrome is:

Accepted Answer

Sensory loss on lateral 3½  of palm

Answer

Pain of medial 3 fingers

Answer

Ape thumb deformity

Answer

Symptoms worsen at night

Upper Limb — MCQs

Upper Limb — MCQs

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