Upper Limb Practice Questions

Q: Muscles primarily involved in a tight grip of the hand are?

Long flexors. Long flexors - The long flexor muscles of the forearm, such as the flexor digitorum profundus and flexor pollicis longus, are critical for producing the powerful flexion needed for a tight grip [1]. - These muscles have long tendons that cross the wrist and insert into the distal phalanges, providing the necessary leverage and force for strong pinching and gripping [1]. Short flexors - Short flexors, like the flexor digiti minimi brevis and flexor pollicis brevis, primarily contribute to fine motor control and positioning of the digits rather than generating the main power for a tight grip [1]. - Their shorter moment arms and limited bulk mean they provide less overall force compared to the powerful long flexors. Opponens pollicis - The opponens pollicis is essential for opposition of the thumb, which is the movement of the thumb across the palm to touch the fingertips of other fingers [1]. - While integral to prehension and fine manipulation, it doesn't primarily contribute to the overall strength of a tight grip which involves all fingers. Long extensors - Long extensors (e.g., extensor digitorum, extensor pollicis longus) are responsible for extending the fingers and wrist. - They work in opposition to the flexors and are not directly involved in generating the force required to create a tight grip.

Q: A 45-year-old patient presents with numbness in the skin over the hypothenar eminence. Which nerve is responsible for this sensory innervation?

Ulnar nerve. ***Ulnar nerve*** - The **ulnar nerve** provides sensory innervation to the **hypothenar eminence** (the fleshy mass at the base of the little finger), the palmar and dorsal aspects of the little finger, and the ulnar half of the ring finger [1]. - Numbness in this specific area is a classic symptom of **ulnar nerve compression** or damage, often occurring at the elbow (**cubital tunnel syndrome**) or wrist (**Guyon's canal syndrome**). *Radial nerve* - The **radial nerve** primarily innervates the posterior aspect of the arm and forearm, and the dorsum of the hand, including the thumb, index, middle, and radial half of the ring finger. - It does not supply sensory innervation to the hypothenar eminence. *Median nerve* - The **median nerve** provides sensory innervation to the palmar surface of the thumb, index, middle, and radial half of the ring finger, and the dorsal tips of these fingers [1]. - It is responsible for sensation over the **thenar eminence** (at the base of the thumb), not the hypothenar eminence. *Anterior interosseous nerve* - The **anterior interosseous nerve (AIN)** is a motor branch of the median nerve that primarily innervates deep forearm muscles [2]. - It has **no sensory function** and therefore does not provide sensation to any part of the hand [2].

Q: Which of the following is seen in median nerve injury?

Pointing index. ***Pointing index*** - **Median nerve injury** at the elbow or higher often results in the inability to flex the **index and middle fingers** due to paralysis of the **flexor digitorum profundus (lateral half)** and **flexor digitorum superficialis**. - When trying to make a fist, the index and middle fingers remain extended, leading to a characteristic "pointing index" or **"Benediction hand" deformity**. *Inability to extend the wrist* - Inability to extend the wrist (also known as **wrist drop**) is characteristic of **radial nerve injury**, which innervates the **extensor muscles of the wrist and fingers**. - The median nerve primarily innervates **flexor muscles** in the forearm and hand. *Difficulty adducting the little finger* - Difficulty adducting the little finger indicates injury to the **ulnar nerve**, which innervates the **palmar interossei** (which adduct digits) and the **abductor digiti minimi**. - The median nerve generally affects thumb movements and flexion of the index and middle fingers. *Weakness of the deltoid muscle* - Weakness of the deltoid muscle is associated with **axillary nerve injury**, as the **axillary nerve** innervates the deltoid and teres minor muscles. - The median nerve does not innervate muscles in the shoulder region.

Q: All of the following movements occur during abduction of the shoulder except which of the following?

Medial rotation of scapula. ***Medial rotation of scapula*** - During **shoulder abduction**, the scapula primarily performs **upward rotation**, not medial rotation. - **Upward rotation** helps to position the glenoid fossa for wider range of motion, while medial rotation would restrict abduction. *Elevation of humerus* - This is the fundamental movement of **abduction**, where the arm actually lifts away from the body. - The **deltoid** and **supraspinatus muscles** are key players in elevating the humerus. *Axial rotation of clavicle* - The **clavicle rotates posteriorly** around its longitudinal axis during abduction, particularly beyond 90 degrees. - This rotation allows the **scapula** to further rotate upward, contributing to the full range of motion. *Acromioclavicular joint movement* - The **acromioclavicular (AC) joint** moves to facilitate **scapular rotation**, which is essential for achieving full shoulder abduction. - Specifically, the scapula rotates on the clavicle at the AC joint, enabling the glenoid to track the humeral head.

Q: Inability to adduct the thumb is due to the injury of which nerve?

Ulnar nerve. ***Ulnar nerve*** - The **adductor pollicis muscle**, responsible for thumb adduction, is solely innervated by the **deep branch of the ulnar nerve** [1]. - Injury to the ulnar nerve proximally or to its deep branch will result in weakness or paralysis of this muscle, leading to the inability to adduct the thumb. *Median nerve* - The median nerve primarily innervates the **thenar muscles** responsible for **thumb flexion**, abduction, and opposition (e.g., abductor pollicis brevis, flexor pollicis brevis, opponens pollicis) [1]. - Its injury would impair these movements, but not directly thumb adduction, which is distinctly an ulnar nerve function. *Radial nerve* - The radial nerve innervates muscles responsible for **wrist and finger extension**, including extensors of the thumb [1]. - While it plays a role in thumb movement, it does not directly control adduction. *Musculocutaneous nerve* - The musculocutaneous nerve primarily innervates the muscles of the **anterior compartment of the arm**, such as the biceps brachii and brachialis, which are responsible for elbow flexion and forearm supination. - It does not innervate any muscles involved in hand or thumb movements.

Q: The ape thumb deformity occurs due to a lesion of the:

Median nerve. ***Median nerve*** - A lesion of the **median nerve** paralyses the thenar muscles, which are responsible for **opposition** and **abduction of the thumb** [1]. - This results in the characteristic "ape thumb" position where the thumb falls back into the plane of the other fingers and cannot be properly opposed [1]. *Radial nerve* - A radial nerve lesion primarily affects the **extensor muscles** of the wrist and fingers, leading to **wrist drop**. - It does not directly cause the ape thumb deformity, as the thenar muscles are supplied by the median nerve [1]. *Ulnar nerve* - An ulnar nerve lesion typically results in a **claw hand deformity**, affecting the medial two fingers due to paralysis of the interossei and medial two lumbricals. - It does not involve the thenar muscles in a way that would produce an ape thumb deformity. *Musculocutaneous nerve* - The musculocutaneous nerve innervates muscles in the **anterior compartment of the arm** (e.g., biceps brachii, brachialis), affecting forearm flexion. - It has no direct involvement in the innervation of the muscles of the hand responsible for thumb movement or the ape thumb deformity.

Q: The cubital fossa is bounded laterally by the:

Brachioradialis. ***Brachioradialis*** - The **brachioradialis** muscle forms the lateral boundary of the cubital fossa. - This muscle arises from the lateral supracondylar ridge of the humerus and inserts onto the distal radius. *Biceps brachii* - The **biceps brachii** muscle lies within the cubital fossa, but it is not a boundary. - Its tendon passes through the fossa to insert onto the radial tuberosity. *Triceps brachii* - The **triceps brachii** is located in the posterior compartment of the arm and does not form a boundary of the cubital fossa. - It functions to extend the elbow joint. *Coracobrachialis* - The **coracobrachialis** muscle is situated in the medial compartment of the upper arm, far from the cubital fossa. - It acts to flex and adduct the arm at the shoulder joint.

Q: Ulnar nerve injury at the wrist involves all of the following except:

Opponens pollicis. ***Opponens pollicis*** - The **opponens pollicis** is innervated by the **median nerve**, specifically its recurrent branch, therefore it would not be affected by an ulnar nerve injury at the wrist [1]. - Its action is to **oppose the thumb**, a function preserved if only the ulnar nerve is damaged. *Palmar interossei* - The **palmar interossei** muscles are entirely innervated by the **deep branch of the ulnar nerve** [1]. - Injury to the ulnar nerve at the wrist would therefore directly affect the function of these muscles, leading to loss of **adduction of the fingers**. *Dorsal interossei* - The **dorsal interossei** muscles are also innervated by the **deep branch of the ulnar nerve** [1]. - Damage to the ulnar nerve at the wrist would impair their function, resulting in difficulty with **abduction of the fingers**. *Adductor pollicis* - The **adductor pollicis** muscle is innervated by the **deep branch of the ulnar nerve** [1]. - An ulnar nerve injury at the wrist would cause weakness or paralysis of this muscle, affecting **thumb adduction** and strength [1].

Q: Muscles attached to the greater tubercle of the humerus include which of the following?

Supraspinatus. ***Supraspinatus*** - The **supraspinatus muscle** is one of the four rotator cuff muscles and inserts onto the **superior facet of the greater tubercle** of the humerus. - Its primary function is to **abduct the arm** in the initial 15 degrees. *Latissimus dorsi* - The **latissimus dorsi** inserts onto the **floor of the bicipital groove** of the humerus, not the greater tubercle. - It is primarily responsible for **extension, adduction, and internal rotation** of the arm. *Teres major* - The **teres major muscle** inserts onto the **medial lip of the bicipital groove** (intertubercular sulcus) of the humerus. - Its actions are similar to the latissimus dorsi, including **adduction, extension, and internal rotation** of the arm. *Pectoralis major* - The **pectoralis major muscle** inserts onto the **lateral lip of the bicipital groove** (intertubercular sulcus) of the humerus. - Its main actions are **adduction, internal rotation**, and **flexion of the humerus**.

Question 1

In obstruction of the second part of the axillary artery, the anastomosis between which arteries will maintain the blood supply to the upper limb?

Accepted Answer

Dorsal scapular artery and subscapular artery

Answer

Anterior and posterior circumflex humeral arteries

Answer

Posterior circumflex humeral and circumflex scapular arteries

Answer

Suprascapular and anterior circumflex humeral arteries

Question 2

Muscles primarily involved in a tight grip of the hand are?

Accepted Answer

Long flexors

Answer

Opponens pollicis

Answer

Short flexors

Answer

Long extensors

Question 3

A 45-year-old patient presents with numbness in the skin over the hypothenar eminence. Which nerve is responsible for this sensory innervation?

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Median nerve

Answer

Anterior interosseous nerve

Question 4

Which of the following is seen in median nerve injury?

Accepted Answer

Pointing index

Answer

Inability to extend the wrist

Answer

Difficulty adducting the little finger

Answer

Weakness of the deltoid muscle

Question 5

All of the following movements occur during abduction of the shoulder except which of the following?

Accepted Answer

Medial rotation of scapula

Answer

Elevation of humerus

Answer

Acromioclavicular joint movement

Answer

Axial rotation of clavicle

Question 6

Inability to adduct the thumb is due to the injury of which nerve?

Accepted Answer

Ulnar nerve

Answer

Median nerve

Answer

Radial nerve

Answer

Musculocutaneous nerve

Question 7

The ape thumb deformity occurs due to a lesion of the:

Accepted Answer

Median nerve

Answer

Radial nerve

Answer

Ulnar nerve

Answer

Musculocutaneous nerve

Question 8

The cubital fossa is bounded laterally by the:

Accepted Answer

Brachioradialis

Answer

Biceps brachii

Answer

Triceps brachii

Answer

Coracobrachialis

Question 9

Ulnar nerve injury at the wrist involves all of the following except:

Accepted Answer

Opponens pollicis

Answer

Palmar interossei

Answer

Dorsal interossei

Answer

Adductor pollicis

Question 10

Muscles attached to the greater tubercle of the humerus include which of the following?

Accepted Answer

Supraspinatus

Answer

Latissimus dorsi

Answer

Teres major

Answer

Pectoralis major

Upper Limb — MCQs

Upper Limb — MCQs

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