Upper Limb Practice Questions

Q: Which of the following muscles carries out shoulder abduction from 15 to 90 degrees?

Deltoid. ***Deltoid*** - The **deltoid muscle** is the primary mover for **shoulder abduction** between **15 and 90 degrees**, continuing the initial movement started by the supraspinatus. - Its **middle fibers** are most effective in this range, pulling the humerus laterally away from the body. *Supraspinatus* - The **supraspinatus muscle** initiates **shoulder abduction** from **0 to 15 degrees**. - Beyond 15 degrees, its contribution to abduction becomes less significant compared to the deltoid. *Trapezius* - The **trapezius muscle** primarily acts to **rotate**, **retract**, and **elevate the scapula**. - It assists in shoulder abduction above **90 degrees** by upwardly rotating the scapula, but it is not directly responsible for abduction in the 15-90 degree range. *Serratus Anterior* - The **serratus anterior** is crucial for **scapular protraction** and **upward rotation** of the scapula. - It contributes to **shoulder abduction** above **90 degrees** by positioning the glenoid cavity upwards, but it does not directly abduct the arm.

Q: Where does the flexor carpi radialis insert?

Base of 2nd and 3rd metacarpal. ***Base of 2nd and 3rd metacarpal*** - The **flexor carpi radialis** muscle, as its name suggests, is a powerful wrist flexor and **radial deviator**. - Its tendon typically inserts onto the **palmar aspect of the base of the second and third metacarpal bones**. *Base of 5th metacarpal* - The **5th metacarpal** is located on the **ulnar side** of the hand, which is not the insertion site for the flexor carpi radialis. - Muscles inserting near the 5th metacarpal include the **flexor carpi ulnaris** and the **extensor carpi ulnaris**. *Scaphoid and trapezium* - The **scaphoid** and **trapezium** are **carpal bones** of the wrist, but they do not serve as the direct insertion point for the flexor carpi radialis [1]. - These bones form part of the **carpal tunnel** and are involved in complex wrist movements [1]. *Capitate and hamate* - The **capitate** and **hamate** are also **carpal bones** located in the distal row of the wrist. - While they are functionally involved in wrist movements, they are not the primary insertion site for the flexor carpi radialis.

Q: Which muscle protects the brachial plexus in case of clavicle fractures?

Subclavius. ***Subclavius*** - The **subclavius muscle** lies inferior to the clavicle, between the clavicle and the first rib, acting as a **cushion** during trauma. - Its strategic position provides a **protective barrier** for the underlying neurovascular structures, including the **brachial plexus** and subclavian vessels, against clavicular fragments. *Supraspinatus* - The **supraspinatus muscle** is located in the **supraspinous fossa** of the scapula, superior to the spine of the scapula. - Its primary role is in **shoulder abduction** and stabilization of the glenohumeral joint, not providing direct protection to the brachial plexus during clavicle fractures. *Subscapularis* - The **subscapularis muscle** is situated in the **subscapular fossa** on the anterior surface of the scapula. - It functions in **internal rotation** of the humerus and stabilization of the shoulder joint, and does not lie in a position to protect the brachial plexus from clavicular trauma. *Teres Minor* - The **teres minor muscle** is one of the rotator cuff muscles, located on the **posterior aspect of the scapula**, inferior to the infraspinatus. - Its main actions are **external rotation** and adduction of the humerus, and it is anatomically distant from the clavicle and brachial plexus in this context.

Q: Pulp of the index finger is supplied by

Median nerve. ***Median nerve*** - The **median nerve** innervates the **radial side of the hand**, including the palmar surface of the thumb, index finger, middle finger, and the radial half of the ring finger [1]. - Sensation to the **pulp of the index finger** is specifically provided by the **median nerve** [1]. *Radial nerve* - The **radial nerve** primarily supplies the **dorsum of the hand** and fingers, except for the distal phalanges. - It does not provide sensory innervation to the palmar surface or pulp of the index finger. *Ulnar nerve* - The **ulnar nerve** innervates the **ulnar side of the hand**, specifically the palmar and dorsal surfaces of the little finger and the ulnar half of the ring finger [1]. - It plays no role in the sensation of the index finger pulp. *Axillary nerve* - The **axillary nerve** innervates the **deltoid muscle** and provides sensation to the skin over the deltoid region, often referred to as the "regimental badge area." - It is located in the shoulder region and has no sensory distribution in the hand.

Q: Which of the following arteries contributes MOST to the deep palmar arch?

Radial artery. ***Radial artery*** - The **radial artery** is the primary contributor to the **deep palmar arch**, giving off the **princeps pollicis artery** and the **radialis indicis artery** before continuing as the main part of the arch. - It anastomoses with the deep branch of the ulnar artery to complete the arch. *Ulnar artery* - The **deep branch of the ulnar artery** contributes to the deep palmar arch, but it is a smaller, anastomotic component rather than the primary contributor itself. - The ulnar artery is the primary contributor to the **superficial palmar arch**. *Posterior interosseous artery* - The **posterior interosseous artery** supplies muscles in the posterior compartment of the forearm and does not directly contribute to the deep palmar arch. - It arises from the common interosseous artery and terminates in the wrist region, supplying the dorsal carpal network. *Anterior interosseous artery* - The **anterior interosseous artery** supplies muscles of the deep anterior forearm compartment and gives off branches to the wrist but does not directly form the deep palmar arch. - It also contributes to the **palmar carpal arch** but not the deep palmar arch.

Q: Which of the following is a sensory region of the ulnar nerve?

Tip of little finger. ***Tip of little finger*** - The **ulnar nerve** innervates the medial side of the hand, including the **little finger** and the medial half of the ring finger, both dorsally and palmarly [1]. - Sensation to the **tip of the little finger** is exclusively supplied by the ulnar nerve, making it a reliable indicator of its sensory function. *Tip of index finger* - The **tip of the index finger** receives its sensory innervation from the **median nerve**, specifically via its digital branches [1]. - Testing sensation here assesses the function of the median nerve, not the ulnar nerve. *1st web space* - The sensory innervation of the **1st web space** (between the thumb and index finger) is primarily by the **radial nerve**, via its superficial branch. - This area is crucial for assessing radial nerve function. *Lateral upper aspect of arm* - The sensation of the **lateral upper aspect of the arm** is primarily supplied by the **axillary nerve** (via the superior lateral cutaneous nerve of the arm) and partially by the **radial nerve**. - This region is distant from the hand and not innervated by the ulnar nerve.

Q: Which muscle is primarily involved in the action of pulling oneself up while climbing a tree?

Latissimus Dorsi. ***Latissimus Dorsi*** - The **latissimus dorsi** is the widest muscle in the back and is crucial for adduction, extension, and internal rotation of the arm, making it the primary muscle for **pulling motions** such as climbing, chin-ups, and rowing [1]. - Its broad origins from the thoracolumbar fascia, iliac crest, and lower ribs allow it to exert significant force on the humerus, effectively pulling the body upward relative to the fixed upper limbs [1]. *Rhomboideus* - The **rhomboid major** and **minor** muscles are primarily responsible for retracting, elevating, and rotating the scapula downwards. - While they stabilize the scapula during pulling motions, they are not the main movers responsible for the overall body-raising action against gravity. *Trapezius* - The **trapezius** muscle has several parts, primarily involved in elevating, depressing, retracting, and rotating the scapula. - While it assists in stabilizing the shoulder girdle during pulling, its main role is not the direct pulling of the entire body upward. *Levator scapulae* - The **levator scapulae** muscle primarily elevates and rotates the scapula downwards. - It plays a minor role in maintaining shoulder posture but is not a significant contributor to the powerful pulling action required to lift oneself while climbing.

Q: What movements does the coracoacromial ligament resist?

Upward displacement of humeral head. Upward displacement of humeral head - The **coracoacromial ligament** extends from the coracoid process to the acromion, forming the **coracoacromial arch** which acts as a protective roof over the humeral head. - This anatomical position allows it to act as a **passive restraint against superior migration** or upward displacement of the **humeral head**, especially important when the rotator cuff (particularly supraspinatus) is deficient. - It prevents **superior subluxation** of the humerus and protects the joint from impingement against the acromion. *Abduction of shoulder* - **Abduction** of the shoulder is primarily limited by the **inferior capsule** and **adductor muscles** (latissimus dorsi, pectoralis major, teres major). - The coracoacromial ligament does not play a significant role in limiting the range of abduction movements. *Inferior displacement of humerus* - **Inferior displacement** of the humerus is primarily resisted by the **superior capsule**, the **supraspinatus tendon**, and the **coracohumeral ligament**. - The coracoacromial ligament is positioned superiorly and therefore does not prevent downward movement of the humeral head. *External rotation* - **External rotation** of the shoulder is limited by the **anterior capsule**, **anterior glenohumeral ligaments**, and the **subscapularis muscle**. - The coracoacromial ligament's orientation and function do not contribute to resisting rotational movements of the humerus.

Q: Inability to pronate forearm is due to injury to which nerve ?

Median. Median nerve - The median nerve innervates the pronator teres and pronator quadratus muscles, which are the primary muscles responsible for forearm pronation. - Damage to the median nerve would therefore lead to an inability or significant difficulty in performing this action. Ulnar - The ulnar nerve primarily controls most intrinsic muscles of the hand and some forearm flexors, but it does not play a direct role in forearm pronation. - Injury to the ulnar nerve would typically manifest as weakness in finger adduction/abduction and wrist flexion, not pronation issues. Radial - The radial nerve innervates the supinator muscle and the extensors of the forearm and hand, facilitating forearm supination and wrist/finger extension. - Damage to the radial nerve would impair supination and extension, not pronation. Musculocutaneous - The musculocutaneous nerve innervates the biceps brachii, brachialis, and coracobrachialis muscles, which are primarily involved in flexion of the elbow and supination of the forearm (biceps). - Injury to this nerve would compromise flexion and supination, but not pronation directly.

Q: Anterior axillary fold is due to which muscle?

Pectoralis major. ***Pectoralis major*** - The **pectoralis major muscle** forms the bulk of the chest and constitutes the anterior wall of the axilla, hence it forms the **anterior axillary fold** [1]. - Its large size and superficial position make it the primary anatomical structure defining this fold [1]. *Pectoralis minor* - The **pectoralis minor** is a smaller muscle located beneath the pectoralis major and does not contribute significantly to the surface anatomy of the axillary fold [2]. - It plays a role in stabilizing the scapula but is not palpable as part of the anterior axillary fold. *Subscapularis* - The **subscapularis muscle** is part of the rotator cuff and is located on the anterior surface of the scapula, deep within the axilla. - It lies too deep to contribute to the visible surface anatomy of the axillary folds. *Teres major* - The **teres major muscle** forms the inferior border of the posterior wall of the axilla, in conjunction with the latissimus dorsi. - It contributes to the **posterior axillary fold**, not the anterior one.

Question 1

Which of the following muscles carries out shoulder abduction from 15 to 90 degrees?

Accepted Answer

Deltoid

Answer

Trapezius

Answer

Serratus Anterior

Answer

Supraspinatus

Question 2

Where does the flexor carpi radialis insert?

Accepted Answer

Base of 2nd and 3rd metacarpal

Answer

Base of 5th metacarpal

Answer

Scaphoid and trapezium

Answer

Capitate and hamate

Question 3

Which muscle protects the brachial plexus in case of clavicle fractures?

Accepted Answer

Subclavius

Answer

Supraspinatus

Answer

Subscapularis

Answer

Teres Minor

Question 4

Pulp of the index finger is supplied by

Accepted Answer

Median nerve

Answer

Radial nerve

Answer

Ulnar nerve

Answer

Axillary nerve

Question 5

Which of the following arteries contributes MOST to the deep palmar arch?

Accepted Answer

Radial artery

Answer

Ulnar artery

Answer

Posterior interosseous artery

Answer

Anterior interosseous artery

Question 6

Which of the following is a sensory region of the ulnar nerve?

Accepted Answer

Tip of little finger

Answer

Tip of index finger

Answer

1st web space

Answer

Lateral upper aspect of arm

Question 7

Which muscle is primarily involved in the action of pulling oneself up while climbing a tree?

Accepted Answer

Latissimus Dorsi

Answer

Rhomboideus

Answer

Trapezius

Answer

Levator scapulae

Question 8

What movements does the coracoacromial ligament resist?

Accepted Answer

Upward displacement of humeral head

Answer

Abduction of shoulder

Answer

Inferior displacement of humerus

Answer

External rotation

Question 9

Inability to pronate forearm is due to injury to which nerve ?

Accepted Answer

Median

Answer

Ulnar

Answer

Radial

Answer

Musculocutaneous

Question 10

Anterior axillary fold is due to which muscle?

Accepted Answer

Pectoralis major

Answer

Pectoralis minor

Answer

Subscapularis

Answer

Teres major

Upper Limb — MCQs

Upper Limb — MCQs

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