Upper Limb Practice Questions

Q: A 50-year-old male patient presented with a fracture as shown in the x-ray. On examination, there was paralysis of most of the intrinsic muscles of the hand and loss of sensation from the medial 1.5 palmar surface of fingers. Which of the following nerves arise from the same cord as the injured nerve, except?

Thoracodorsal nerve. ***Thoracodorsal nerve*** - Arises from the **posterior cord** (C6-C8), not the medial cord like the injured **ulnar nerve**. - Innervates the **latissimus dorsi muscle** and does not share the same cord origin as the ulnar nerve. *Medial cutaneous nerve of arm* - Arises from the **medial cord** (C8-T1), same as the injured **ulnar nerve**. - Provides **sensory innervation** to the medial aspect of the arm and shares the medial cord origin. *Medial pectoral nerve* - Originates from the **medial cord** (C8-T1), identical to the **ulnar nerve** origin. - Innervates the **pectoralis minor** and part of **pectoralis major**, sharing the same cord as the ulnar nerve. *Medial branch of the median nerve* - The **median nerve** receives contributions from both **medial cord** (C8-T1) and lateral cord. - Its medial component arises from the **medial cord**, same as the **ulnar nerve** that causes the described symptoms.

Q: You order a wrist X-RAY for a 2-month-old child. Which carpal bone are you expecting to be present?

Capitate. **Explanation:** The ossification of carpal bones follows a predictable chronological sequence, which is a high-yield topic for assessing skeletal age in pediatric patients. At birth, no carpal bones are ossified; they are entirely cartilaginous and therefore radiolucent on X-ray. **1. Why Capitate is Correct:** The **Capitate** is the first carpal bone to begin ossification, typically appearing at **1–3 months** of age. In a 2-month-old child, it is the most likely (and often only) bone visible on a wrist radiograph. It is closely followed by the Hamate (approx. 3–4 months). **2. Why the other options are incorrect:** * **Scaphoid:** This is one of the last bones to ossify, usually appearing between **4–6 years**. * **Lunate:** Ossification typically occurs around **2–4 years**. * **Trapezoid:** Along with the Trapezium and Scaphoid, it ossifies much later, generally between **4–6 years**. **Clinical Pearls for NEET-PG:** * **Mnemonic for Order of Ossification:** **"C-H-T-L-T-T-S-P"** (Capitate, Hamate, Triquetrum, Lunate, Trapezium, Trapezoid, Scaphoid, Pisiform). * **The "Rule of 1 to 12":** * Capitate & Hamate: <1 year * Triquetrum: 3 years * Lunate: 4 years * Trapezium, Trapezoid, Scaphoid: 5–6 years * Pisiform: 10–12 years (Last to ossify; sesamoid bone in the Flexor Carpi Ulnaris tendon). * **Skeletal Age Assessment:** In clinical practice, the **Greulich and Pyle atlas** is used to compare the child's radiograph (usually of the left hand and wrist) against standard references to determine bone age.

Q: Which artery is NOT involved in the vascular anastomosis around the acromion?

Anterior circumflex humeral artery. ### Explanation The vascular anastomosis around the **acromion process** of the scapula is a network formed by branches of the subclavian and axillary arteries. **Why Option C is Correct:** The **Anterior Circumflex Humeral Artery (ACHA)** primarily supplies the head of the humerus and the glenohumeral joint. While it anastomoses with the Posterior Circumflex Humeral Artery (PCHA) around the **surgical neck of the humerus**, it does not ascend high enough to participate in the acromial network. **Analysis of Other Options:** The acromial anastomosis is formed by the "Acromial branches" of the following three arteries: * **A. Thyrocervical Trunk:** Specifically via the **Suprascapular artery** (a branch of the thyrocervical trunk from the 1st part of the subclavian artery). * **B. Thoracoacromial Trunk:** Specifically via its **Acromial branch** (from the 2nd part of the axillary artery). * **D. Posterior Circumflex Humeral Artery:** It gives off an **Acromial branch** that ascends to the network (from the 3rd part of the axillary artery). **High-Yield NEET-PG Pearls:** 1. **Scapular vs. Acromial Anastomosis:** Do not confuse the two. The *Scapular* anastomosis (around the body/fossa) involves the Suprascapular, Circumflex Scapular, and Dorsal Scapular arteries. The *Acromial* anastomosis is more superior, located over the acromion process. 2. **The "CAD" Mnemonic:** The Acromial anastomosis involves branches from **C**ircumflex posterior humeral, **A**cromiothoracic (Thoracoacromial), and **D**orsal scapular/Suprascapular. 3. **Clinical Significance:** These anastomoses provide collateral circulation between the subclavian and axillary arteries, ensuring blood flow to the limb if the axillary artery is obstructed between its 1st and 3rd parts.

Q: A 45-year-old male presents with injuries to his left elbow after a fall. Radiographic and MRI examinations reveal a fracture of the medial epicondyle and a torn ulnar nerve. Which of the following muscles would be most likely to be paralyzed?

Flexor carpi ulnaris. **Explanation:** The **ulnar nerve** (C8–T1) passes posteriorly to the **medial epicondyle** of the humerus in the cubital tunnel. A fracture in this region is a classic site for ulnar nerve injury. **Why Option D is correct:** In the forearm, the ulnar nerve supplies only **one and a half muscles**: the **Flexor Carpi Ulnaris (FCU)** and the medial half (ulnar part) of the Flexor Digitorum Profundus (FDP). Therefore, a lesion at the medial epicondyle will lead to paralysis of the FCU, resulting in weakened wrist flexion and loss of ulnar deviation. **Why the other options are incorrect:** * **A. Flexor digitorum superficialis:** This muscle is supplied by the **median nerve**. The median nerve passes anterior to the elbow joint and is typically spared in medial epicondyle fractures unless there is significant displacement or associated supracondylar injury. * **B. Biceps brachii:** This is a muscle of the anterior compartment of the arm, supplied by the **musculocutaneous nerve** (C5–C7). * **C. Brachioradialis:** Although it acts as a flexor of the elbow, it is located in the mobile wad of the forearm and is supplied by the **radial nerve** (C5–C7). **Clinical Pearls for NEET-PG:** * **Ulnar Claw Hand:** High ulnar nerve lesions (at the elbow) result in a *less* prominent clawing than low lesions (at the wrist) because the medial half of the FDP is also paralyzed (the "Ulnar Paradox"). * **Froment’s Sign:** Positive due to paralysis of the Adductor Pollicis (supplied by the deep branch of the ulnar nerve). * **Sensory Loss:** Occurs over the medial 1.5 fingers and the hypothenar eminence.

Q: Which tendon is present in the third extensor compartment of the wrist?

Extensor Pollicis Longus (EPL). The extensor retinaculum at the wrist is divided into **six fibro-osseous compartments** by septa attached to the radius and ulna [1]. These compartments house specific tendons and are a high-yield topic for NEET-PG. ### **Why Option C is Correct** The **third compartment** contains only one tendon: the **Extensor Pollicis Longus (EPL)** [1]. * **Anatomical Landmark:** The EPL tendon uses the **Dorsal Tubercle of Lister** (on the radius) as a pulley to change its direction before inserting into the distal phalanx of the thumb. This makes the third compartment unique and clinically significant. ### **Why Other Options are Incorrect** * **Options A & B (ECRL and ECRB):** These are located in the **second compartment** [1]. They insert into the bases of the 2nd and 3rd metacarpals, respectively. * **Option D (EPB):** This is located in the **first compartment** along with the Abductor Pollicis Longus (APL) [1]. Inflammation of this compartment leads to *De Quervain’s Tenosynovitis*. ### **High-Yield Summary of Compartments** | Compartment | Contents | | :--- | :--- | | **1st** | APL, EPB (Lateral boundary of Anatomical Snuffbox) [1] | | **2nd** | ECRL, ECRB [1] | | **3rd** | **EPL** (Medial boundary of Anatomical Snuffbox) [1] | | **4th** | Extensor Digitorum (ED), Extensor Indicis (EI) [1] | | **5th** | Extensor Digiti Minimi (EDM) [1] | | **6th** | Extensor Carpi Ulnaris (ECU) [1] | ### **Clinical Pearl** **Drummer’s Palsy:** Chronic friction or distal radius fractures can lead to the rupture of the EPL tendon within the third compartment due to its sharp turn around Lister’s tubercle.

Q: What is the nerve supply of the pronator teres muscle?

Median nerve. The **Median nerve** is the correct answer. The pronator teres is the most lateral of the superficial flexor muscles of the forearm. It originates from two heads: the humeral head (medial epicondyle) and the ulnar head (coronoid process). The median nerve enters the forearm by passing directly **between these two heads** of the pronator teres, supplying it before continuing down the midline of the forearm. **Analysis of Incorrect Options:** * **Ulnar nerve:** Supplies the flexor carpi ulnaris and the medial half of the flexor digitorum profundus in the forearm. It does not contribute to the superficial lateral flexors. * **Posterior interosseous nerve (PIN):** This is a branch of the radial nerve that supplies the **extensor** compartment of the forearm. * **Radial nerve:** Primarily supplies the extensors of the arm and forearm (e.g., brachioradialis, ECRL). While it is close to the pronator teres at the cubital fossa, it does not provide its motor supply. **Clinical Pearls for NEET-PG:** 1. **Pronator Syndrome:** This occurs when the median nerve is compressed between the two heads of the pronator teres. It presents with pain in the proximal forearm and sensory loss over the thenar eminence (unlike Carpal Tunnel Syndrome, where the palmar cutaneous branch is spared). 2. **Nerve Course:** The median nerve is the "nerve of the front of the forearm," supplying all superficial and intermediate flexors except the flexor carpi ulnaris. 3. **Median Nerve Relation:** In the cubital fossa, the median nerve lies **medial** to the brachial artery (Mnemonic: **MBBR** - Medial to Lateral: Median nerve, Brachial artery, Biceps tendon, Radial nerve).

Q: A 61-year-old man sustained an injury to his left mid-humeral region from a cricket bat. Physical examination shows normal elbow motion, but he is unable to extend his wrist or metacarpophalangeal joints. He also reports a loss of sensation on a small area of skin on the dorsum of the hand, proximal to the first two digits. Radiographic examination reveals a hairline fracture of the humeral shaft just distal to its midpoint. Which of the following nerves is most likely injured?

Radial. **Explanation:** The clinical presentation points to an injury of the **Radial Nerve** within the **spiral groove** of the humerus. **1. Why Radial Nerve is Correct:** The radial nerve travels in the spiral groove along the posterior aspect of the **mid-shaft of the humerus**. A fracture in this region commonly compresses or lacerates the nerve. * **Motor Loss:** The nerve supplies the extensors of the wrist and fingers. Injury leads to **Wrist Drop** (inability to extend the wrist) and inability to extend the metacarpophalangeal (MCP) joints. * **Sensory Loss:** It provides sensation to the **dorsum of the hand** (lateral 3.5 digits and associated thumb web space). * **Note on Elbow:** Elbow extension (Triceps) is usually **preserved** because the branches to the long and medial heads of the triceps arise proximal to the spiral groove. **2. Why Other Options are Incorrect:** * **Median Nerve:** Typically injured at the elbow (supracondylar fracture) or wrist (carpal tunnel). Injury would cause "Ape Hand" deformity and loss of thumb opposition, not wrist drop. * **Ulnar Nerve:** Usually injured at the medial epicondyle or Guyon’s canal. It results in "Claw Hand" and sensory loss over the medial 1.5 fingers. * **Musculocutaneous Nerve:** Supplies the coracobrachialis, biceps brachii, and brachialis. Injury would result in weak elbow flexion and loss of sensation on the lateral forearm, not wrist drop. **Clinical Pearls for NEET-PG:** * **Holstein-Lewis Fracture:** A spiral fracture of the distal one-third of the humerus specifically associated with radial nerve palsy. * **Saturday Night Palsy:** Compression of the radial nerve in the axilla (presents with wrist drop **plus** loss of triceps reflex). * **PIN (Posterior Interosseous Nerve) Palsy:** Occurs at the Arcade of Frohse; presents with finger drop but **no sensory loss** and **no wrist drop** (ECRL is spared).

Question 1

A 50-year-old male patient presented with a fracture as shown in the x-ray. On examination, there was paralysis of most of the intrinsic muscles of the hand and loss of sensation from the medial 1.5 palmar surface of fingers. Which of the following nerves arise from the same cord as the injured nerve, except?

Accepted Answer

Thoracodorsal nerve

Answer

Medial cutaneous nerve of arm

Answer

Medial pectoral nerve

Answer

Medial branch of the median nerve

Question 2

You order a wrist X-RAY for a 2-month-old child. Which carpal bone are you expecting to be present?

Accepted Answer

Capitate

Answer

Scaphoid

Answer

Lunate

Answer

Trapezoid

Question 3

Which artery is NOT involved in the vascular anastomosis around the acromion?

Accepted Answer

Anterior circumflex humeral artery

Answer

Thyrocervical trunk

Answer

Thoracoacromial trunk

Answer

Posterior circumflex humeral artery

Question 4

Which of the following statements about the first metacarpal is false?

Accepted Answer

Its base has a saddle-shaped articular surface for the trapezium.

Answer

It is the shortest and stoutest of all metacarpals.

Answer

It does not articulate with any other metacarpal bone.

Answer

It is rotated medially through 90 degrees with respect to other metacarpals.

Question 5

A 45-year-old male presents with injuries to his left elbow after a fall. Radiographic and MRI examinations reveal a fracture of the medial epicondyle and a torn ulnar nerve. Which of the following muscles would be most likely to be paralyzed?

Accepted Answer

Flexor carpi ulnaris

Answer

Flexor digitorum superficialis

Answer

Biceps brachii

Answer

Brachioradialis

Question 6

Which tendon is present in the third extensor compartment of the wrist?

Accepted Answer

Extensor Pollicis Longus (EPL)

Answer

Extensor Carpi Radialis Longus (ECRL)

Answer

Extensor Carpi Radialis Brevis (ECRB)

Answer

Extensor Pollicis Brevis (EPB)

Question 7

What is the nerve supply of the pronator teres muscle?

Accepted Answer

Median nerve

Answer

Ulnar nerve

Answer

Posterior interosseous nerve

Answer

Radial nerve

Question 8

A 61-year-old man sustained an injury to his left mid-humeral region from a cricket bat. Physical examination shows normal elbow motion, but he is unable to extend his wrist or metacarpophalangeal joints. He also reports a loss of sensation on a small area of skin on the dorsum of the hand, proximal to the first two digits. Radiographic examination reveals a hairline fracture of the humeral shaft just distal to its midpoint. Which of the following nerves is most likely injured?

Accepted Answer

Radial

Answer

Median

Answer

Ulnar

Answer

Musculocutaneous

Question 9

A 47-year-old female tennis player presents with a rotator cuff injury requiring surgery. Her physician explains that repetitive stress from playing has caused gradual damage to an underlying muscle by a shoulder ligament. Which of the following ligaments is most likely implicated?

Accepted Answer

Coracoacromial ligament

Answer

Acromioclavicular ligament

Answer

Coracohumeral ligament

Answer

Glenohumeral ligament

Question 10

A 69-year-old woman visits the outpatient clinic with a complaint of numbness and tingling of her hand for the past 3 months. Physical examination reveals she has numbness and pain in the lateral three digits of her right hand that are relieved by vigorous shaking of the wrist. In addition, the abductor pollicis brevis, opponens pollicis, and the first two lumbrical muscles are weakened. Sensation was decreased over the lateral palm and the volar aspect of the first three digits. Which of the following nerves is most likely compressed?

Accepted Answer

Median

Answer

Ulnar

Answer

Radial

Answer

Recurrent median

Upper Limb — MCQs

Upper Limb — MCQs

On this page

Practice by Chapter

Want unlimited practice?