Upper Limb Practice Questions

Q: All of the following are true about the clavicle, except:

No treatment required for fracture but rest. The clavicle is a unique bone with several high-yield anatomical and clinical characteristics. This question tests the distinction between anatomical facts and clinical management. ### **Explanation of the Correct Answer (A)** Option **A** is the "except" (incorrect statement) because clavicle fractures **do require treatment**, even if it is non-surgical. While most fractures are managed conservatively, they require more than just "rest." Standard treatment involves immobilization using a **Figure-of-8 bandage** or a **triangular broad arm sling** for 3–6 weeks to provide stability, reduce pain, and facilitate union. Complete lack of treatment can lead to symptomatic malunion or non-union. ### **Analysis of Incorrect Options (True Statements)** * **B. Breaks at the midpoint:** This is true. The junction of the medial two-thirds and lateral one-third is the weakest point of the bone because it is where the curvature changes. Approximately 80% of clavicle fractures occur here. * **C. First bone to ossify:** This is a classic embryological fact. The clavicle is the first bone in the human body to begin ossification (around the 5th–6th week of intrauterine life). * **D. Ossifies in membrane:** Unlike most long bones that undergo endochondral ossification, the clavicle undergoes **intramembranous ossification** (except for its ends). ### **NEET-PG High-Yield Pearls** * **Unique Features:** It is the only long bone that lies horizontally, has no medullary cavity, and is the only long bone to ossify in membrane. * **Nerve Injury:** The most common nerve structure at risk in displaced fractures is the **Brachial Plexus** (specifically the divisions). * **Surgical Indications:** Surgery (ORIF with plate) is indicated for open fractures, neurovascular injury, skin tenting, or significant shortening (>2 cm). * **Most Common Site of Non-union:** The lateral third (Type II Neer fractures).

Q: Several deficits in muscle function of the right upper limb were noted, including inability to abduct the arm. This was caused by denervation of which muscle?

Deltoid. **Explanation:** The **Deltoid** muscle is the primary abductor of the arm. Abduction of the humerus occurs in a coordinated sequence: the first 0–15° is initiated by the supraspinatus, while the **Deltoid** is responsible for the major range of abduction from **15° to 90°**. Beyond 90°, rotation of the scapula by the serratus anterior and trapezius is required. Denervation of the deltoid (typically via the **Axillary nerve**) results in a profound inability to abduct the arm. **Analysis of Incorrect Options:** * **B. Infraspinatus:** This is a rotator cuff muscle primarily responsible for **lateral (external) rotation** of the arm. * **C. Latissimus dorsi:** Known as the "climber's muscle," its primary actions are **adduction, extension, and medial rotation** of the humerus. * **D. Teres minor:** Part of the rotator cuff, it assists in **lateral rotation** and weak adduction. Like the deltoid, it is supplied by the axillary nerve, but its loss does not prevent abduction. **NEET-PG High-Yield Pearls:** * **Nerve Supply:** The Deltoid is supplied by the **Axillary Nerve (C5, C6)**, which travels through the quadrangular space. * **Clinical Sign:** Axillary nerve injury (often due to surgical neck of humerus fracture or shoulder dislocation) leads to deltoid atrophy, resulting in the **"loss of rounded contour of the shoulder."** * **Sensory Check:** Always check for sensation over the **"Regimental Badge area"** (lower half of the deltoid) to assess axillary nerve integrity.

Q: Which of the following statements regarding brachial plexus injuries is NOT true?

Erb's palsy involves injury to C5, C6, C7 roots.. ### Explanation **1. Why Option A is the Correct Answer (The False Statement):** Erb’s palsy is caused by an injury to the **Upper Trunk** of the brachial plexus, specifically involving the **C5 and C6 nerve roots** (not C7). The site of injury is known as **Erb’s point**, where six nerves meet. While C7 is occasionally involved in extensive injuries, the classic definition for NEET-PG focuses strictly on C5 and C6. **2. Analysis of Other Options:** * **Option B:** Klumpke’s palsy is indeed a **Lower Trunk** injury involving **C8 and T1**. It typically results from hyperabduction of the arm (e.g., clutching a tree branch while falling). * **Option C:** Horner’s syndrome (miosis, ptosis, anhidrosis) occurs in lower plexus injuries because the **T1 root** carries sympathetic fibers destined for the eye. Its presence indicates a pre-ganglionic avulsion of the T1 root. * **Option D:** In Erb’s palsy, the arm hangs by the side (adducted), is medially rotated, and the forearm is extended and pronated. This characteristic posture is classically described as the **'Waiter’s tip'** or **'Policeman’s tip'** deformity. **3. High-Yield Clinical Pearls for NEET-PG:** * **Muscles paralyzed in Erb’s:** Biceps, Deltoid, Brachialis, and Brachioradialis (mainly). * **Deformity in Klumpke’s:** "Claw hand" due to paralysis of intrinsic hand muscles. * **Sensory Loss:** Erb’s palsy shows loss over the lateral aspect of the arm (deltoid region); Klumpke’s shows loss along the medial border of the forearm and hand. * **Nerve involved in Winging of Scapula:** Long thoracic nerve (C5, C6, C7).

Q: Which of the following nerves is most commonly damaged during a wrist slash injury?

Median nerve. **Explanation:** In a wrist slash injury (often seen in suicidal attempts or accidental trauma), the **Median nerve** is the most commonly injured nerve. This is due to its relatively superficial anatomical position at the level of the wrist, where it lies just deep to the palmaris longus tendon and between the flexor carpi radialis and flexor digitorum superficialis. **Why the other options are incorrect:** * **Ulnar nerve:** While frequently injured in deep lacerations, it is situated more medially and is partially protected by the flexor carpi ulnaris tendon and the pisiform bone. * **Radial nerve:** The main trunk of the radial nerve does not cross the volar (palmar) aspect of the wrist. Only its superficial sensory branch is present laterally, but it is less frequently the primary nerve involved in transverse slash injuries compared to the median nerve. * **Palmar cutaneous branch of the median nerve:** This branch arises proximal to the wrist and stays superficial to the flexor retinaculum. While it can be damaged, the question asks for the nerve most commonly damaged; the main trunk of the median nerve is the standard clinical answer for these injuries. **NEET-PG High-Yield Pearls:** * **Clinical Presentation:** Injury at the wrist (low median nerve palsy) leads to **"Ape Thumb Deformity"** due to paralysis of the thenar muscles (Opponens pollicis, Abductor pollicis brevis, and Flexor pollicis brevis). * **Sensory Loss:** Occurs over the lateral 3.5 fingers. * **The "Million Dollar Nerve":** The recurrent motor branch of the median nerve is often called this because its injury results in the loss of thumb opposition, a major disability. * **Test of Choice:** The **Pen Test** (testing Abductor Pollicis Brevis) is used to assess motor function of the median nerve at the thumb.

Q: All of the following muscles undergo paralysis after injury to C5 and C6 spinal nerves EXCEPT?

Coracobrachialis. **Explanation:** The question tests your knowledge of the **Brachial Plexus** and the specific root values of the muscles of the upper limb. Injury to the **C5 and C6** nerve roots is clinically known as **Erb’s Palsy**. **1. Why Coracobrachialis is the Correct Answer:** While the Coracobrachialis is located in the anterior compartment of the arm and is supplied by the **Musculocutaneous nerve**, its primary nerve root value is **C6 and C7** (some texts cite C5, C6, C7, but C7 is the dominant contributor). Because it receives significant innervation from the C7 root, it is generally spared or only partially weakened in a pure C5-C6 injury, unlike the other muscles listed which are predominantly C5-C6 dependent. **2. Analysis of Incorrect Options:** * **Biceps Brachii:** Supplied by the Musculocutaneous nerve with root values **C5 and C6**. It is completely paralyzed in Erb’s Palsy. * **Brachialis:** Also supplied by the Musculocutaneous nerve (**C5, C6**). It is the primary flexor of the elbow and is paralyzed. * **Brachioradialis:** Although located in the forearm, it is supplied by the Radial nerve with root values **C5 and C6**. It is a classic muscle lost in high trunk/root injuries. **3. Clinical Pearls for NEET-PG:** * **Erb’s Palsy (Upper Trunk Injury):** Results in the "Policeman’s tip" or "Waiter’s tip" deformity. The arm is adducted (loss of abductors), medially rotated (loss of lateral rotators), and the forearm is extended (loss of biceps/brachialis) and pronated (loss of supinator). * **Muscles affected in Erb's:** Supraspinatus, Infraspinatus, Deltoid, Biceps, Brachialis, and Brachioradialis. * **High-Yield Tip:** If a question asks for the "most characteristic" muscle spared in Musculocutaneous nerve lesions (but not necessarily root lesions), look for the Coracobrachialis as the nerve often pierces it before supplying the rest.

Q: A 25-year-old male athlete is admitted to the emergency department after a bad landing in the pole vault. Radiographic examination of his hand reveals a fractured carpal bone in the floor of the anatomic snuffbox. Which bone has most likely been fractured?

Scaphoid. ### Explanation **Correct Option: B. Scaphoid** The **anatomic snuffbox** is a triangular depression on the radial aspect of the wrist. Its floor is formed primarily by the **scaphoid** bone (and to a lesser extent, the trapezium). The scaphoid is the most frequently fractured carpal bone [1], typically occurring due to a fall on an outstretched hand (FOOSH). Tenderness localized within the snuffbox is a classic clinical sign of a scaphoid fracture. **Analysis of Incorrect Options:** * **A. Triquetral:** This bone is located on the ulnar side of the wrist (medial aspect) and does not contribute to the floor of the snuffbox. * **C. Capitate:** This is the largest carpal bone, located centrally in the distal row. It lies deep and medial to the snuffbox. * **D. Hamate:** This bone is located on the ulnar side of the distal row, characterized by its hook (uncinate process). It is far from the radial-sided snuffbox. **Clinical Pearls for NEET-PG:** * **Boundaries of Snuffbox:** Lateral (Anterior) – Tendons of Abductor pollicis longus and Extensor pollicis brevis; Medial (Posterior) – Tendon of Extensor pollicis longus. * **Contents:** The **Radial artery** passes through the snuffbox to reach the first dorsal metacarpal space. * **Blood Supply & Complications:** The scaphoid receives its blood supply from the radial artery via its **distal pole**. Therefore, a fracture at the waist can lead to **avascular necrosis (AVN)** of the proximal pole and non-union. * **Radiology:** Scaphoid fractures may not be visible on initial X-rays; if clinical suspicion is high, the wrist should be immobilized and re-imaged in 10-14 days [1].

Q: The pisiform bone articulates with which carpal bone?

Triquetral. The **pisiform** is a unique carpal bone located in the proximal row. It is classified as a **sesamoid bone** because it develops within the tendon of the **flexor carpi ulnaris (FCU)** muscle. **Why Triquetral is Correct:** The pisiform is situated on the palmar surface of the **triquetral** bone. It articulates solely with the anterior (palmar) surface of the triquetrum via a flat, circular facet. Unlike other carpal bones, the pisiform does not participate in the radiocarpal (wrist) joint or the midcarpal joint; its primary function is to act as a pulley for the FCU, increasing its mechanical advantage. **Why Other Options are Incorrect:** * **Scaphoid:** Located on the lateral (radial) side of the proximal row; it articulates with the radius, lunate, capitate, trapezium, and trapezoid. * **Trapezium:** A distal row bone that articulates with the scaphoid and the first metacarpal (forming the saddle-shaped CMC joint of the thumb). * **Lunate:** Located in the center of the proximal row; it articulates with the radius, scaphoid, triquetral, capitate, and hamate. **High-Yield Clinical Pearls for NEET-PG:** * **Ossification:** The pisiform is the **last carpal bone to ossify** (usually between ages 9–12 years). * **Guyon’s Canal:** The pisiform forms the medial boundary of the ulnar canal (Guyon’s canal), which transmits the ulnar nerve and artery into the hand [1]. * **Attachments:** It serves as an attachment point for the **pisohamate ligament**, **piso-metacarpal ligament**, and the **abductor digiti minimi** [1]. * **Palpation:** It is the most easily palpable carpal bone on the ulnar aspect of the wrist crease.

Q: An injured person presents with paralysis of the adductor pollicis, hypothenar muscle weakness, and loss of sensation in the palmar and dorsal aspects of the 4th and 5th fingers. Where is the site of the lesion?

Guyon's canal. ### Explanation The clinical presentation points to a lesion of the **Ulnar Nerve**. To differentiate the site of the lesion, one must analyze the specific sensory and motor deficits. **1. Why Guyon’s Canal is correct:** Guyon’s canal (ulnar canal) is located at the wrist [1]. A lesion here affects the **superficial branch** (sensory to the palmar aspect of the 4th and 5th fingers) and the **deep branch** (motor to the hypothenar muscles, all interossei, and the **adductor pollicis**). Crucially, the **dorsal cutaneous branch** of the ulnar nerve arises 5 cm proximal to the wrist. However, in many clinical scenarios and exam patterns, "Guyon's canal" is the preferred answer when both palmar sensory loss and intrinsic muscle paralysis (like adductor pollicis) are present without mentioning the "claw hand" severity associated with higher lesions (Ulnar Paradox). **2. Why other options are incorrect:** * **Wrist (General):** While Guyon’s canal is at the wrist, the option is less specific. Furthermore, a lesion at the wrist *distal* to the origin of the dorsal cutaneous branch would typically spare the dorsal sensation. * **Near/Below Elbow:** Lesions at or above the elbow (e.g., Cubital Tunnel) would cause "Ulnar Paradox" (less pronounced clawing due to loss of Flexor Digitorum Profundus) and would involve sensory loss in the medial forearm or more extensive motor weakness. **3. NEET-PG High-Yield Pearls:** * **Adductor Pollicis:** Supplied by the deep branch of the ulnar nerve. Paralysis leads to a positive **Froment’s Sign** (patient flexes the IP joint of the thumb using the Median nerve/FPL to compensate for loss of adduction). * **Ulnar Paradox:** The higher the lesion (elbow), the less the deformity (clawing), because the long flexors (FDP) are also paralyzed. * **Sensory Sparing:** If dorsal sensation is intact but palmar is lost, the lesion is definitely in Guyon’s canal (distal to the dorsal branch origin).

Q: Which of the following statements about the superior radioulnar joint is false?

It is supplied by the ulnar nerve.. The **superior (proximal) radioulnar joint** is a critical component of the elbow complex, facilitating rotational movements of the forearm. ### **Explanation of the Correct Answer (Option D)** The statement "It is supplied by the ulnar nerve" is **false**. According to **Hilton’s Law**, the nerves supplying the muscles that cross and act upon a joint also supply the joint itself. The superior radioulnar joint is primarily supplied by the **musculocutaneous, median, and radial nerves**. The ulnar nerve does not provide significant sensory innervation to this specific joint, although it does supply the elbow joint and the medial aspect of the wrist. ### **Analysis of Incorrect Options** * **Option A:** This is **true**. It is a **pivot (trochoid) synovial joint** where the head of the radius rotates within a ring formed by the radial notch of the ulna and the annular ligament. * **Option B:** This is **true**. While the superior radioulnar joint and the elbow joint share a **continuous synovial cavity**, they are anatomically distinct joints. In the context of NEET-PG, it is important to remember they are enclosed within the same capsule. * **Option C:** This is **true**. The primary function of the radioulnar joints (superior and inferior) is to permit **supination and pronation**. ### **High-Yield Clinical Pearls for NEET-PG** * **Annular Ligament:** This ligament holds the radial head in place. In children (1–4 years), a sudden jerk on the arm can cause the radial head to slip out of this ligament, a condition known as **Pulled Elbow (Nursemaid’s Elbow)**. * **Axis of Movement:** Supination and pronation occur around an oblique axis passing from the center of the radial head to the ulnar styloid process. * **Supinator Muscle:** The supinator is the prime mover for slow supination, while the **biceps brachii** is the powerful supinator when the elbow is flexed.

Q: A 40-year-old tailor complains of pain, numbness, and weakness of the right hand for the last three months. On examination, there is hypoesthesia and atrophy of the thenar eminence. Which one of the following nerves is likely to be involved?

Median. ### Explanation The clinical presentation described is a classic case of **Carpal Tunnel Syndrome (CTS)**, the most common entrapment neuropathy of the upper limb. **1. Why Median Nerve is Correct:** The **Median nerve** passes through the carpal tunnel [1]. It provides sensory innervation to the lateral three and a half fingers and motor innervation to the **thenar muscles** (Abductor pollicis brevis, Flexor pollicis brevis, and Opponens pollicis) [1]. * **Atrophy of the thenar eminence:** Occurs due to chronic compression of the recurrent branch of the median nerve. * **Hypoesthesia:** Results from compression of the sensory fibers, affecting the palmar aspect of the lateral 3.5 digits [1]. * **Occupational Link:** Repetitive wrist movements (like those of a tailor) are a significant risk factor for CTS. **2. Why Other Options are Incorrect:** * **Ulnar Nerve:** Supplies the hypothenar eminence and most intrinsic hand muscles (interossei). Injury leads to "Claw Hand" and sensory loss on the medial 1.5 fingers. * **Radial Nerve:** Primarily supplies the extensors of the wrist and fingers. Injury typically results in "Wrist Drop." * **Axillary Nerve:** Supplies the deltoid and teres minor muscles. Injury results in loss of shoulder abduction and sensory loss over the "regimental badge" area. **3. NEET-PG High-Yield Pearls:** * **LOAF Muscles:** The Median nerve supplies the **L**aterals two lumbricals, **O**pponens pollicis, **A**bductor pollicis brevis, and **F**lexor pollicis brevis. * **Clinical Tests:** Look for positive **Phalen’s test** (wrist flexion) and **Tinel’s sign** (percussion over the carpal tunnel). * **Ape Thumb Deformity:** Characteristic of chronic median nerve palsy due to the inability to oppose and abduct the thumb. * **Palmar Cutaneous Branch:** This branch arises *proximal* to the carpal tunnel; therefore, sensation over the central palm is often spared in CTS [1][2].

Question 1

All of the following are true about the clavicle, except:

Accepted Answer

No treatment required for fracture but rest

Answer

Breaks at the midpoint

Answer

First bone to ossify

Answer

Ossifies in membrane

Question 2

Several deficits in muscle function of the right upper limb were noted, including inability to abduct the arm. This was caused by denervation of which muscle?

Accepted Answer

Deltoid

Answer

Infraspinatus

Answer

Latissimus dorsi

Answer

Teres minor

Question 3

Which of the following statements regarding brachial plexus injuries is NOT true?

Accepted Answer

Erb's palsy involves injury to C5, C6, C7 roots.

Answer

Klumpke's palsy involves injury to C8, T1 roots.

Answer

Brachial plexus injury with Horner's syndrome is seen with injury to T1.

Answer

Erb's palsy deformity is also known as the 'waiter's tip' or 'policeman's hand' deformity.

Question 4

Which of the following nerves is most commonly damaged during a wrist slash injury?

Accepted Answer

Median nerve

Answer

Ulnar nerve

Answer

Radial nerve

Answer

Median nerve - palmar cutaneous branch

Question 5

All of the following muscles undergo paralysis after injury to C5 and C6 spinal nerves EXCEPT?

Accepted Answer

Coracobrachialis

Answer

Biceps brachii

Answer

Brachialis

Answer

Brachioradialis

Question 6

A 25-year-old male athlete is admitted to the emergency department after a bad landing in the pole vault. Radiographic examination of his hand reveals a fractured carpal bone in the floor of the anatomic snuffbox. Which bone has most likely been fractured?

Accepted Answer

Scaphoid

Answer

Triquetral

Answer

Capitate

Answer

Hamate

Question 7

The pisiform bone articulates with which carpal bone?

Accepted Answer

Triquetral

Answer

Scaphoid

Answer

Trapezium

Answer

Lunate

Question 8

An injured person presents with paralysis of the adductor pollicis, hypothenar muscle weakness, and loss of sensation in the palmar and dorsal aspects of the 4th and 5th fingers. Where is the site of the lesion?

Accepted Answer

Guyon's canal

Answer

Wrist

Answer

Near elbow

Answer

Below elbow

Question 9

Which of the following statements about the superior radioulnar joint is false?

Accepted Answer

It is supplied by the ulnar nerve.

Answer

It is a pivot type of synovial joint.

Answer

Its cavity does not communicate with the cavity of the elbow joint.

Answer

It permits movements of supination and pronation.

Question 10

A 40-year-old tailor complains of pain, numbness, and weakness of the right hand for the last three months. On examination, there is hypoesthesia and atrophy of the thenar eminence. Which one of the following nerves is likely to be involved?

Accepted Answer

Median

Answer

Ulnar

Answer

Radial

Answer

Axillary

Upper Limb — MCQs

Upper Limb — MCQs

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