How many functional joints does the shoulder region have?
D) Three
Bone/s conecting the shoulder complex to the axial skeletion
A) Both of these
The manubrium is part of the axial skeleton, whereas the clavicle is part of the shoulder complex.
True or False: The manubrium with the left and right clavicles and scapulae form an incomplete girdle.
True
It is incomplete since a true girdle completely surrounds a structure, and the shoulder girdle does not have a bony connection posteriorly.
Which of the following is not true about the manubrium?
D) On its lateral aspects, immediately adjacent and inferior to the clavicular facets are slightly convex facets for attachment of the first ribs.
On its lateral aspects, immediately adjacent and inferior to the clavicular facets are slightly concave facets for attachment of the first ribs.
Which of the following is not true about the clavicle?
A) It has forward convexity at its humeral end.
The clavicle has forward convexity at its sternal end to clear the brachial plexus and upper extremity vascular bundle and its forward concavity at the humeral end.
Which of the following is not a characteristic of the scapula?
C) It spans between thoracic levels 2 and 8.
It spans between thoracic levels 2 and 7.
True or False: The superior angle of the scapula is difficult to palpate, but it lies essentially parallel to the spine of the scapula.
True
The superior angle of the scapular is difficult to palpate because it is well covered by muscles.
Which of the following is not true about the scapular spine?
C) None of these
It sits over the glenohumeral joint to protect it from overhead forces applied down toward the shoulder.
B) Acromion process
Its name means "crow's beak" because of its appearance.
A) Coracoid process
The coracoid process sits below the clavicle and is medial to the glenoid fossa. It protrudes anteriorly from the scapula and is a site of multiple ligament and muscle attachments.
What is the most lateral aspect of the scapula?
C) Glenoid fossa
Glenoid fossa is also known as glenoid cavity.
Which of the following is not true about the glenoid fossa?
D) It is a deep socket that has two tubercles.
It is a shallow socket that has two tubercles.
The glenoid labrum, a dense fibrous connective tissue rim that surrounds the glenoid fossa, to expand the depth of the glenoid fossa to increase joint congruence and assist in stress reduction by increasing the area of joint surface contact. How many percent does the glenoid labrum add to the depth and curve of the glenoid fossa?
B) 50
True or False: The glenoid labrum attaches securely to the superior glenoid.
False
The glenoid labrum attaches securely to the inferior glenoid. It attaches more loosely to the superior glenoid where the long head of the biceps tendon anchors itself on the most superior aspect of the glenoid.
Which of the following is not a characteristic of the glenoid fossa?
D) It is broader at its superior aspect and narrows slightly towards its inferior border.
The glenoid fossa is narrower at its superior aspect and broadens slightly towards its inferior border to take on a teardrop, or pear-shaped, appearance.
Which of the following is not true about the plane of the scapula?
B) The scapula is rotated on its transverse plane approximately 30° to 45° so the glenoid fossa is tilted anterior to the frontal plane.
The scapula is rotated on its transverse axis approximately 30° to 45° so the glenoid fossa is tilted anterior to the frontal plane.
All of the following are true about the humeral head, except:
D) It is adjacent to the surgical neck, which connects to the shaft of the humerus.
It is adjacent to the anatomical neck, which connects to the shaft of the humerus.
In the frontal plane, the humeral head is angled at ___ to the long axis of the humeral shaft.
D) 135°
This angle is referred to as the angle of inclination.
True or False: The resting position of the humeral head in posterior rotation relative to the distal condyles of the humerus allows the head to be aligned in the scapular plane.
True
This is known as the angle of torsion. The relative position of posterior rotation is called retroversion and is usually 30°.
The greater and lesser tubercles are located on the ________ of the humerus.
B) Neck
The greater and lesser tubercles are located on the neck of the humerus adjacent to the humeral head.
True or False: The greater tubercle sits medial to the lesser tubercle and is a large round protruberance.
False
The greater tubercle sits lateral to the lesser tubercle.
Separating the greater and lesser tubercles is an indentation known as the:
D) Both of these
From its proximal insertion on the supraglenoid tubercle, the long head of the biceps runs through this indentation.
Common site for humeral fractures, especially in the elderly
C) Surgical neck
The surgical neck of the humerus is a circumferential area on the proximal humerus. This region is distal to the bicipital groove.
If the humerus is laterally rotated while the arm is hanging at the side, the greater tubercle of the humerus may be palpated slightly posterior and superior to the acromion process. In full medial rotation, this tubercle is no longer palpable because it disappears under the pectoralis major muscle.
A) Both statements are false.
If the humerus is laterally rotated while the arm is hanging at the side, the greater tubercle of the humerus may be palpated slightly posterior and inferior to the acromion process. In full medial rotation, this tubercle is no longer palpable because it disappears under the deltoid muscle.
How many facets does the greater tubercle of the humerus have?
A) Three
The greater tubercle has three facet, serving as points of attachment for muscles, but these facets cannot be distinguished by palpation.
In full shoulder lateral rotation, the bicipital groove is directly in line with the __________.
B) Acromion process
All of the following are true about the synovial joints of the shoulder complex, except:
D) The clavicle and the scapula join at the coracoclavicular joint.
The clavicle and the scapula join at the acromioclavicular joint.
Scapula motion is the result of the ___ and ___ joints working together to produce scapulothoracic movement.
C) SC; AC
The SC joint moves the scapula in position and the AC joint provides an adjustment to achieve the final desired position.
All of the following are true about coupled movements of the shoulder complex?
C) Horizontal axis motion of protraction and retraction at SC joint and anterior or posterior rotation adjustment in the horizontal plane at the AC joint produce protraction or retraction of the scapula on the thorax.
Vertical axis motion of protraction and retraction at SC joint and anterior or posterior rotation adjustment in the horizontal plane at the AC joint produce protraction or retraction of the scapula on the thorax.
Of the two clavicular joints, the acromioclavicular joint is responsible for the majority of the scapula's movement. Meanwhile, the sternoclavicular joint provides minimal movement and acts more as a fine tuner of scapula motion.
C) Both statements are false.
Of the two clavicular joints, the sternoclavicular joint is responsible for the majority of the scapula's movement. Meanwhile, the acromioclavicular joint provides minimal movement and acts more as a fine tuner of scapula motion.
Which of the following is not true about scapular elevation?
B) The distal end of the clavicle and the coracoid process move superiorly (toward the ear) approximately 60°.
The distal end of the clavicle and the acromion process move superiorly (toward the ear) approximately 60°.
Which of the following is not true about scapular depression?
A) None of these
Downward rotation of the lateral scapula and slight anterior and medial tilting of the superior scapula accompany elevation. Meanwhile, upward rotation of the lateral scapula with slight posterior and lateral tilting of the superior scapula occur with depression.
B) Both statements are true.
True or False: Both the scapula and clavicle play important roles in producing shoulder girdle protraction.
True
During protraction, the lateral end of the clavicle and the scapula move anteriorly around the rib cage, with the medial border of the scapula moving away from the midline.
The motions of scapular protraction and retraction must also include the concurrent motions of:
C) None of these
The motions of scapular protraction and retraction must also include the concurrent motions of protraction and retraction of the clavicle at the SC joint and medial and lateral rotation at the AC joint. These AC and SC joint motions allow the scapula to maintain contact along the upper thoracic ribs during protraction and retraction.
Which of the following does not occur in shoulder girdle upward rotation?
C) None of these
Which motion occurs when the superior border of the scapula tilts forward with its inferior angle moving away from the thorax?
C) Anterior tilting
Tilting is also referred to as tipping or rotation.
From a resting position or anatomical position, the scapula will _______ tilt as the humerus is elevated during shoulder flexion and abduction.
D) Posteriorly
As the arm is elevated in the scapular plane, which combination of scapular motions occurs?
B) Upward rotation, posterior tilting, and lateral tilting
However, it was found that the scapula tilted medially in the lower degrees of elevation.
What is the only joint that acts as a strut to connect the upper extremity directly with the axial skeleton?
A) Sternoclavicular joint
In sternoclavicular joint, the medial end of the clavicle connects with the manubrium of the sternum and the medial first rib.
The sternoclavicular joint is a _________.
B) Sellar
The sternoclavicular joint is a complex sellar (saddle) joint.
How many degrees of motion does the sternoclavicular joint?
C) Three
The sternoclavicular joint has three degrees of motion: elevation and depression, protraction and retraction, and rotation.
Which of the following is true about the clavicle portion of the sternoclavicular joint?
D) Both of these
The manubrium's surface is reciprocally shaped.
True or False: In sternoclavicular joint, the superior aspect of the clavicle is in contact with the manubrium.
False
In sternoclavicular joint, the superior aspect of the clavicle is not in contact with the manubrium.
The sternoclavicular joint has:
B) Both of these
The fibrocartilaginous articular disc lying between the two joint surfaces of the sternoclavicular joint is important because of the following reasons, except:
D) It increases stability by increasing incongruency between the joint surfaces.
It increases stability by increasing congruency between the joint surfaces.
This ligament prevents the upward clavicular displacement at the SC joint.
A) Superior sternoclavicular ligament
The superior sternoclavicular ligament, traverses over the superior aspect of the jugular notch to form the interclavicular ligament. This ligament prevents upward clavicular displacement at the SC joint.
True or False: Although the bony articulations in the sternoclavicular joint appear small, the ligamentous attachments are sufficiently strong.
True
Although the bony articulations in the sternoclavicular joint appear small, the ligamentous attachments are sufficiently strong that when sufficient stresses are applied, the clavicle usually fractures before the joint dislocates.
Which of the following is not true about the costoclavicular ligament?
A) It has two heads that cross each other so the anterior fibers on the first rib lie in a superior and medial direction.
It has two heads that cross each other so the anterior fibers on the first rib lie in a superior and lateral direction while the posterior fibers traverse and angle from the first rib to the clavicle in a superior and medial direction.
The joint capsule and ligaments of the sternoclavicular joint are further reinforced by the proximal tendinous attachments of which muscle?
D) Sternocleidomastoid
Sternoclavicular elevation and depression occur in a:
D) Frontal plane around an anterior-posterior axis
Because of the slight obliquity of the anterior-posterior axis between the sternal end of the clavicle and the articular disc:
B) None of these
Because of the slight obliquity of the axis, shoulder girdle elevation occurs in an upward-backward direction, and depression occurs in a downward-forward direction.
Which muscle/s limit/s the elevation of the SC joint?
D) Subclavius
Elevation of the SC joint is limited by the costoclavicular ligament and the subclavian muscle.
All of the following structures restrict depression at the SC joint, except:
B) Costoclavicular ligament
From the resting position, the SC joint can be depressed 5° to 10° until the clavicle is stopped by the interclavicular ligament, superior capsule, and first rib.
The joint between the articular disc and the sternum is involved mainly in ___________ of the shoulder girdle.
D) Retraction-protraction
Retraction protraction of the shoulder girdle occurs in a plane parallel to the transverse plane about a nearly vertical axis.
Which ligament limit/s shoulder girdle protraction?
D) All except anterior sternoclavicular ligament
The anterior sternoclavicular ligament limits retraction.
If rotation of the clavicle is prevented, elevation of the arm is limited to how many degrees?
D) 110°
The posterior rotation is a passive motion of the clavicle and is caused by the tightening of the ____________ ligaments.
A) Acromioclavicular
The acromioclavicular ligament has two parts - the trapezoid and the conoid - which are attached to the inferior surface of the clavicle and at right angles to each other. These ligaments also function to limit the separation of the clavicle from the scapula.
The clavicle's S-shape provides additional ______ and ______ of the scapula than would be possible if the bone was straight.
A) Elevation and upward rotation
Which of the following combination of arthrokinematic motions occur during elevation?
D) Superior roll of the clavicle with a concomitant inferior slide
Arthrokinematic motion during elevation includes a superior roll of the clavicle with a concomitant inferior slide of the convex clavicle on the concave sternum. Meanwhile, the clavicle rolls inferiorly and slides superiorly on the sternum during depression.
True or False: During protraction and retraction, the moving clavicle's surface is convex.
False
During protraction and retraction, the moving clavicle's surface is concave; therefore, in arthrokinematic terms, as the clavicle rolls anteriorly in protraction, it also slides anteriorly. Conversely, as the clavicle moves in retraction, the clavicle rolls and slides posteriorly.
The acromioclavicular joint is a _________ joint
B) Plane
The acromioclavicular joint is a plane synovial joint with three degrees of freedom involving the medial margin of the acromion and the lateral end of the clavicle.
True or False: In the acromioclavicular joint, the acromial end faces medially and slightly inferiorly.
False
In the acromioclavicular joint, the acromial end faces medially and slightly superiorly while the clavicular end faces laterally and slightly inferiorly to form a wedge-like surface.
The articular surfaces of this joint in the shoulder complex are unusual in that they are lined with fibrocartilage, not articular cartilage as is the case with most synovial joints.
D) Acromioclavicular joint
During full arm elevation, the acromioclavicular joint contributes about _______ of upward rotation of the scapula along an anterior-posterior axis.
C) 20° to 30°
As the scapula moves on the thorax, the primary function at the ______ joint is to allow the scapula to maintain contact with the thorax throughout its movement.
D) AC
The AC joint allows the scapula to maintain contact with the thorax throughout its movement by providing slight adjustments in the scapular motions provided via the sternoclavicular joint.
The motions of this joint keeps the glenoid fossa aligned with the humeral head during glenohumeral elevation.
C) AC joint
Functional joint in the shoulder complex
C) Scapulothoracic joint
Because there are no bony articulations in the scapulothoracic joint, the moving surfaces are called a false joint, a pseudo joint, or a functional joint.
All of the following are functions of the scapulothoracic joint, except:
B) Permits depression of the body in activities such as walking with crutches or performing seated push-ups during transfers
It should be permits elevation of the body in activities such as walking with crutches or performing seated push-ups during transfers.
The sum of ranges of motion at these joints equals the range of motion of the scapula.
A) AC and SC
Because of the intimate attachment of the scapula to the clavicle, the scapula's motion results directly from movement of the joints at either end of the clavicle. Hence, the sum of the ranges of motion at the sternoclavicular and acromioclavicular joints equals the range of motion of the scapula.
Slight ________ AC motion during scapular elevation on the thorax allows the scapula to maintain a near-vertical position throughout elevation.
A) Downward
Without this fine AC motion, the scapula would take an upward and lateral path, moving the scapula's inferior angle laterally on the thorax as the clavicle's distal end elevates higher than its medial aspect.
Upward and downward rotation of the scapulothoracic joint occurs on which axis?
A) Anterior-posterior axis
Upward rotation of the scapulothoracic joint provides ____ of total shoulder or humeral elevation.
D) 60°
The glenohumeral joint is a _________ joint.
A) All of these
The glenohumeral joint, a ball-and-socket, spheroid, or universal joint, has three degrees of freedom, but has little bony stability.
The humeral head faces:
C) Posterior, medial, and superior direction
This is an area of redundancy in the inferior capsule of the glenohumeral joint to allow humeral head mobility during shoulder elevation.
D) Axillary pouch
This ligament in the glenohumeral joint forms a tunnel for the tendon of the long head of the biceps brachii.
B) Coracohumeral ligament
The coracohumeral ligament crosses from the coracoid process of the scapula to the greater and lesser tubercles of the humerus, where it forms as tunnel for the tendon of the long head of the biceps brachii.
Which of the following is incorrect about the glenohumeral ligaments?
D) They attach to the humeral neck and greater tubercle.
Glenohumeral ligaments attach to the humeral neck and lesser tubercle.
There is a weakness in the shoulder capsule, particularly between which glenohumeral ligaments?
C) Superior and middle
This weak capsular region is the foramen of Weitbrecht, a frequent site of anterior dislocations of the joint.
All of the following ligaments of the glenohumeral joint support the dependent arm and limit lateral rotation in the lower ranges of abduction, except:
C) Inferior glenohumeral ligament
This ligament of the glenohumeral joint forms a hammock-like sling with anterior and posterior bands around the lower portion of the humeral head.
B) Inferior glenohumeral ligament
Inferior glenohumeral ligament is part of the axillary pouch.
This ligament in the glenohumeral joint is the main stabilizer of the abducted shoulder.
B) Inferior glenohumeral ligament
The primary function of this ligament is to serve as the primary force against gravity's downward pull on the joint in a resting position.
C) Coracohumeral ligament
This ligament may assist in protection against superior humeral head translation when the rotator cuff fails to provide this protection.
C) Coracohumeral ligament
This ligament limits lateral rotation with the arm resting at the side.
C) Coracohumeral ligament
True or False: Although the bicipital tendon is within the joint capsule, the tendon is covered by reflection of the synovial membrane.
True
Although the bicipital tendon is within the joint capsule, the tendon is covered by reflection of the synovial membrane, so the tendon is not exposed to the synovial fluid of the joint cavity.
The bicipital tendon is considered to be:
A) Intra-articular but extrasynovial
This rotator cuff muscle attaches by a broad tendon to the less tubercle of the humerus.
D) Subscapularis
The tendon of this muscle covers the head of the humerus below 90° of abduction.
B) Subscapularis
The tendon of this rotator cuff muscle is considered by Jobe to be a passive stabilizer to prevent anterior subluxation of the humerus.
C) Subscapularis
These two rotator cuff tendons were found to be the major structures limiting medial rotation in the first half of abduction.
A) Supraspinatus and infraspinatus
The following structures are found in the subacromial space, except:
C) Long head of the triceps tendon
It should be long head of the biceps tendon.
This protects the soft tissue structures from superior blows directed downward and protects the glenohumeral joint from superior dislocations.
B) Coracoacromial arch
This space narrows approximately half of its normal width as the arm is elevated.
A) Subacromial space
If pathologies exist in the soft tissue or bony structures or in the shoulder's biomechanics, this space may become even narrower, threatening soft tissue injury.
During normal shoulder elevation, all of the following structures contribute to the depression of the humeral head, except:
C) None of these
During normal shoulder elevation, the downward line of pull of the rotator cuff along with depression of the humeral head by the supraspinatus and long head of the biceps tendons depress the humeral head as the arm is elevated by the supraspinatus and deltoid.
All of the following are structural causes of diminished subacromial space, except:
A) Hooked or curved acromion
It should be hooked or angled acromion.
How many bursae are found within the shoulder area?
A) 8
Although there are eight bursae within the shoulder area, some of them actually extend from the synovial lining of the capsule or a continuous with each other.
This bursa is located between the supraspinatus tendon and the coracoacromial arch.
C) Subacromial bursa
The subacromial bursa protects the supraspinatus tendon and allows for smooth tendon movement during shoulder motion.
True or False: Inflamed glenohumeral bursae are usually primary conditions.
False
Inflamed glenohumeral bursae are usually not primary conditions but secondary conditions that are brought on by other existing injuries.
When the glenohumeral joint is in full medial rotation, active abduction is limited to approximately how many degrees?
B) 60°
When the glenohumeral joint is in full medial rotation, active abduction is limited to approximately 60°, because the greater tubercle is in alignment with and strikes the acromion process and the acromioclavicular ligament.
Full flexion of the shoulder to 180° is possible because of the motion provided by this joint.
C) Scapulothoracic joint
Flexion motion of the glenohumeral joint is up to 120°.
Which of the following ligaments does not limited shoulder hyperextension?
D) Inferior glenohumeral ligament
Although not technically part of shoulder elevation, additional overhead reach may result from trunk movement with:
B) Both of these
Horizontal abduction and adduction occur around a:
D) Vertical axis in a horizontal plane
Horizontal abduction and adduction occur around a vertical axis in a horizontal plane with the arm elevated to 90°.
All normal limitations of motion on the glenohumeral joint are due to ligamentous and passive muscle tightening. Therefore, the end feels are all firm.
C) Both statements are true.
Even when the greater tubercle of the humerus strikes on the acromion process, the end feel is firm because of the soft tissues lying between the two bony structures.
Arthrokinematic motion of the shoulder joint during flexion and extension consists of the humeral head spinning in the glenoid fossa. Neither roll nor slide occurs in the joint during these motiions.
D) Both statements are true.
However, as the shoulder reaches higher levels offlexion elevation, an anterior slide of the humeral head on the glenoid occurs, and during end phases of hyperextension, a posterior slide of the humeral head occurs.
During abduction, the humeral head rolls superiorly as it slides inferiorly to:
A) Allow the humeral head to stay within its socket with minimal translation
The humeral head slides in direction opposite to the motion to avert impingement of the humeral head against the soft tissue structures below the coracoacromial arch.
Scaption is the position is recommended for examination of glenohumeral elevation because:
D) The capsule is in a loose-packed position.
Scaption is recommended because there is less likelihood of impingement on the coracoacromial structures.
True or False: Most functional shoulder abduction motions in daily and sports activities occur in the frontal plane.
False
Most functional shoulder abduction motions in daily and sports activities occur in the scapular plane, not the frontal plane.
Which of the following is incorrect about the shoulder joint?
C) The close-packed position of the glenohumeral joint occurs in full flexion with full lateral rotation.
The close-packed position of the glenohumeral joint occurs in full abduction with full lateral rotation.
What is the close-packed position of the sternoclavicular joint?
A) Arm fully elevated
What is the close-packed position of the acromioclavicular joint?
D) Arm abducted to 90°
The long head of the biceps tendon is retained in the groove by the:
A) Both of these
In scapulohumeral rhythm, a ratio of 2:1 occurrs after about how many degrees of abduction?
D) 30°
All of the following are scapular stabilizer muscles of the shoulder complex, except:
B) Teres minor
The following are the scapular stabilizer muscles of the shoulder complex:
1. Serratus anterior
2. Trapezius
3. Rhomboid major
4. Rhomboid minor
5. Pectoralis minor
6. Levator scapulae
Primary scapular protractor
C) Serratus anterior
Which of the following is not true about the serratus anterior?
B) The lowest four or five slips of this muscle interdigitate with the internal oblique abdominal muscle.
The lowest four or five slips of this muscle interdigitate with the external oblique abdominal muscle.
Musculus cucullaris
B) Trapezius
Early anatomists named the trapezius "musculus cucullaris" (shaped like a monk' hood).
"Shawl" muscle
C) Trapezius
All parts of the trapezius are recruited during:
D) Full abduction with scapular retraction
In full abduction with scapular retraction, all parts of the trapzius are recruited: retraction of the shoulder girdle by the entire muscle and upward rotation of the scapula by the upper and lower portions of the muscle.
Innervation of the pectoralis minor
B) Medial pectoral nerve
Muscle responsible for the anterior tilt of the scapula
C) Pectoralis minor
Which of the following is incorrect about the OINA of the serratus anterior?
A) Insertion: posterior surface of the vertebral border of scapula
It should be insertion: anterior surface of the vertebral border of scapula.
All of the following are proximal insertions of the trapezius muscle, except?
D) Spinous processes of C5 to T12
It should be spinous processes of C7 to T12.
Nerve supply of the trapezius
C) Both of these
True or False: A comparatively isolated action of the levator scapulae may be obtained if the shrug is made briefly and in a short range.
True
Which of the following is not true about the supraspinatus?
C) It is incapable of performing the total motion of abduction without the assistance of the deltoid.
Supraspinatus is capable of performing the total motion of abduction without the assistance of the deltoid.
The long and short biceps heads attach to the supraglenoid tubercle and to the coracoid process, respectively, whereas the triceps attaches to the infraglenoid tubercle. At the shoulder, the biceps serves as a flexor and an adductor, whereas the triceps is an extensor and abductor.
C) Only the first statement is true.
At the shoulder, the biceps serves as a flexor and an abductor, whereas the triceps is an extensor and adductor.
When the deltoid and the supraspinatus are paralyzed, this muscle is capable of substituting as an arm elevator.
A) Long head of biceps brachii
Which rotator cuff muscle/s insert/s on the middle facet of the greater tubercle of the humerus?
D) Infraspinatus
The supraspinatus inserts on the upper facet, whereas the teres minor inserts on the lower (posterior) facet.
Which rotator cuff muscle inserts on the lesser tubercle of the humerus?
D) Subscapularis
Which muscle inserts on the crest of the lesser tubercle of the humerus?
A) Teres major
Subscapularis inserts on the lesser tubercle of the humerus and on the shaft distal to the tubercle.
Which of the following is not true about the deltoids?
B) None of these
The deltoids comprise how many percent of the mass of the scapulohumeral muscles?
C) 40%
Which of the following is not true about the latissimus dorsi?
D) None of these
The following muscles cover the coracobrachialis, except:
C) Pectoralis minor
It should be pectoralis major.
This muscle is considered a mover of the glenohumeral joint rather than a stabilizer since its line of pull is sufficiently distant from the joint's axis of motion.
B) Coracobrachialis
Which of the following is not an origin of the deltoids?
B) None of these
The anterior deltoid performs flexion and horizontal adduction of the glenohumeral joint. Meanwhile, the posterior deltoid performs extension and horizontal abduction.
D) Both statements are true.
All of the following are proximal insertions of the latissimus dorsi, except:
B) Crest of ilium (anterior portion)
It should be crest of ilium (posterior portion).
All of the following are actions of latissimus dorsi, except:
B) None of these
Which of the following is not an origin of the pectoralis major?
D) Superior and medial clavicle
It should be inferior and medial clavicle.
Which muscle inserts on the crest of the greater tubercle of the humerus?
B) None of these
It should be pectoralis major.
The clavicular head of the pectoralis major flexes the glenohumeral joint. Meanwhile, the sternocostal head extends the glenohumeral joint from neutral position.
C) Only the first statement is true.
The sternocostal head of the pectoralis major extends the glenohumeral joint from fully flexed position.
Which joints of the shoulder complex rely primarily on passive restraints?
B) AC and SC
Which joints of the shoulder complex rely on muscles for stability?
C) ST and GH
The head of the humerus is maintained in the glenoid fossa by the:
B) Negative atmospheric pressure within the capsule
The head of the humerus is maintained in the glenoid fossa by the horizontal coracohumeral ligament, the superior glenohumeral ligament, and the negative atmospheric pressure within the capsule.
During arm elevation, the rotator cuff secures and protects the joint and its surrounding soft tissue structures by:
A) Both of these
During arm elevation, the rotator cuff moves the humeral head into the lower portion of the glenoid where it is able to sit more securely against a larger surface.
When the arm elevates, the rotator cuff pulls the humeral head into the larger inferior area of the glenoid fossa. This action accomplishes:
D) Both of these
Which of the following muscles is not included in the scapulothoracic force couple?
C) Middle trapezius
The scapulothoracic force couple includes the upper and lower trapezius and the serratus anterior combining forces to produce upward rotation of the scapula.
Which of the following muscles is not included in the glenohumeral force couple?
A) Teres major
The glenohumeral force couple consists of the deltoid and the rotator cuff. The deltoid and supraspinatus contract together to produce elevation (abduction or flexion) at the glenohumeral joint, while the infraspinatus, teres minor, and subscapularis work to pull the humeral head down into the lower part of the socket as the deltoid elevates the humerus.
Which of the following muscles is not included in the scapulothoracic force couple producing downward rotation of the scapula on the thorax?
C) Pectoralis major
It should be pectoralis minor.
All of the following are antagonists of the upward rotators of the scapula, except:
D) Teres major
Scapular protractor/s
B) Serratus anterior
Serratus anterior and pectoralis minor are scapular protractors.
All of the following are scapular depressors, except:
A) None of these
All of the following are scapular elevators, except:
B) Lower serratus anterior
All of the following are glenohumeral extensors, except:
B) Teres minor
It should be teres major.
Which of the following is not a glenohumeral adductor?
C) Triceps brachii (short head)
It should be triceps brachii (long head).
Which of the following is not a glenohumeral medial rotator?
D) Infraspinatus
Infraspinatus, together with the teres minor and posterior deltoid, is a lateral rotator.
The glenoid in the resting position has how many degrees of inclination or superior tilt?
A) 5°
The glenoid in the resting position has how many degrees of retroversion or medial rotation?
B) 7°
Most important glenohumeral ligament
C) Inferior
The inferior glenohumeral ligament has an anterior and posterior band with a thin "axillary pouch" in between, so it acts much like a hammock or sling.
Type IV acromion
B) Convex (upturned)
Type I: flat; Type II: curved; Type III: hooked
About 70% of rotator cuff tears are associated with a ________ acromion.
B) Hooked
What is the capsular pattern of the AC joint?
D) Pain at extremes of ROM, especially horizontal adduction and full elevation
What is the capsular pattern of the SC joint?
B) Pain at extremes of ROM, especially horizontal adduction and full elevation
This joint consists of the body of the scapula and the muscles covering the posterior chest wall.
D) Both of these
Scapulothoracic joint is also known as scapulocostal joint.
True or False: The medial border of the scapula is parallel with the spinous processes of the thoracic vertebrae.
False
The medial border of the scapula is not parallel with the spinous processes of the thoracic vertebrae, but is angled about 3° away.
True or False: Because the scapulothoracic joint is not a true joint, it does not have a capsular pattern, a close packed position, nor a resting position.
False
Because the scapulothoracic joint is not a true joint, it does not have a capsular pattern nor a close packed position. The resting position of this joint is the same for the acromioclavicular joint, which is arms resting by side in normal physiologic position.
(+) Shoulder hiking
B) Frozen shoulder
Sensory function and reflexes
C) Cervical spondylosis
Radiography: upward displacement of humeral head
A) Rotator cuff lesions
Shoulder abduction test positive
D) Cervical spondylosis
Resisted isometric movement: pain and weakness on abduction and lateral rotation
D) Rotator cuff lesions
Over age 35
A) External primary impingement (stage I)
Classic night pain
D) Rotator cuff tears (full thickness)
Weakness noted predominantly in abductors and lateral rotators
A) Rotator cuff tears (full thickness)
All of the following are primary causes of shoulder impingement syndrome, except:
A) Capsule tightness especially posterior
Capsule tightness is a secondary cause.
All of the following are secondary causes of shoulder impingement syndrome, except:
C) Inflammation in subacromial space
Inflammation in subacromial space is a primary cause.
Which of the following is not a characteristic of overuse tendinosis?
B) Focus of conservative therapy: anti-inflammatory modalities or drugs
Anti-inflammatory modalities or drugs are indicated for overuse tendinitis.
All of the following are mechanisms of suprascapular nerve injury, except:
B) Compression in suprascapular fossa
It should be compression in suprascapular notch.
Which of the following is not a mechanism of axillary nerve injury?
D) Fracture of anatomical neck of humerus
It should be fracture of surgical neck of humerus.
Which of the following is not a mechanism for long thoracic nerve injury?
B) Compression against external chest wall
It should be compression against internal chest wall (backpack injury).
Which peripheral nerve is most likely to be damaged during Bankart surgery?
C) Musculocutaneous nerve
Other mechanisms of musculocutaneous nerve injury are:
1. Muscle hypertrophy
2. Direct blow
3. Fracture (clavicle and humerus)
4. Anterior dislocation
5. Surgery (Putti-Platt)
Which peripheral nerve is more likely to be injured with shoulder depression and neck rotation to the opposite side?
B) Spinal accessory nerve
All of the following are possible causes of scapular dyskinesia, except:
B) Sternoclavicular arthrosis
It should be acromioclavicular arthrosis.
Which of the following is not true about Sprengel's deformity?
D) It is a developmental condition leading to a low or descended scapula.
Sprengel's deformity is a developmental condition leading to a high or undescended scapula.
All of the following muscles are prone to tightness, except:
B) Lower trapezius
It should be upper trapezius.
All of the following muscles are prone to weakness, except:
C) Pectoralis minor
Pectoralis minor is prone to tightness.
Classification of glenohumeral painful arc that is more common in males than females
A) Superior
Anterior and posterior glenohumeral painful arcs are more common in females than males.
Classification of glenohumeral painful arc which is aggravated by medial rotation and abduction
B) Posterior
Superior glenohumeral painful arc is aggravated by abduction alone, while anterior glenohumeral painful arc is aggravated by abduction and lateral rotation.
Classification of glenohumeral painful arc with AC joint involvement
B) Superior
Anterior and posterior glenohumeral painful arcs have no AC joint involvement.
Classification of glenohumeral painful arc with good prognosis
A) Anterior
Posterior glenohumeral painful arc has very goodprognosis, while superior glenohumeral painful arc has poor prognosis without surgery.
Classification of glenohumeral painful arc with tenderness felt on lesser tuberosity
A) Anterior
In superior glenohumeral painful arc, tenderness is felt on greater tuberosity. In posterior glenohumeral painful arc, tenderness is felt on posterior aspect of greater tuberosity.
Phase of scapulohumeral rhythm in which the scapula has minimal movement
B) Phase 1
In phase 1, the scapula is still in the setting phase.
During phase 2 of scapulohumeral rhythm, which of the following does not occur?
C) Humerus: 30° abduction
It should be humerus: 40° abduction.
Which of the following does not occur during phase 3 of scapulohumeral rhythm?
A) None of these
All of these occur during phase 3.
Which phase of the scapulohumeral rhythm does the clavicle begin to rotate posteriorly?
A) Phase 2
The clavicle rotates minimally during phase 1.
During the final stage of the scapulohumeral rhythm, the humerus finishes its lateral rotation to 90° so that the greater tuberosity avoids the ____________.
C) Acromion process
Reverse scapulohumeral rhythm is common in conditions like the:
B) Frozen shoulder
Reverse scapulohumeral rhythm means that the scapula moves more than the humerus. This occurs in conditions like the frozen shoulder. The patient appears to "hike" the entire shoulder complex rather than produce a smooth coordinated abduction movement.
With anterior shoulder instability, which motion causes excessive scapulothoracic movement?
D) Abduction
With posterior shoulder instability, which motion causes excessive scapulothoracic movement?
D) Horizontal adduction
Which of the following causes tilting of the inferior angle of the scapula?
B) Weak lower trapezius
Tilting of the inferior angle of scapula may result from tight pectoralis minor or weak lower trapezius.
Which of the following leads to inability to shrug the shoulder?
C) Trapezius or spinal accessory nerve lesion
Which of the following leads to difficulty elevating arm above 120°?
C) Serratus anterior or long thoracic nerve lesion
Which of the following causes winging of the upper margin of the scapula on adduction and lateral rotation?
A) None of these
Winging of the upper margin of the scapula on adduction and lateral rotation is caused by muscle imbalance or contractures
Pain in shoulder on abduction
B) Spinal accessory nerve lesion
Inability to flex full extended arm
A) Long thoracic nerve lesion
Increased pain on forward shoulder flexion
C) Suprascapular nerve
Pain increases with cervical rotation to the opposite side
C) Suprascapular nerve lesion
Which shoulder motion is being limited by subcoracoid bursitis?
C) Lateral rotation
Which shoulder motion is being limited by subacromial bursitis?
D) Abduction
Popeye sign indicates the rupture of which muscle?
C) Long head of biceps brachii
Bunching of muscle is attended by complete loss of function of the long head of biceps.
All of the following muscles are responsible for shoulder forward flexion, except:
B) Pectoralis major (sternocostal fibers)
It should be pectoralis major (clavicular head).
All of the following muscles are responsible for shoulder extension, except:
D) Triceps brachii
It should be triceps brachii (long head).
Which of the following muscles are responsible for horizontal adduction of the shoulder?
C) Pectoralis major and anterior deltoid
Which of the following muscles is not responsible for horizontal abduction of the shoulder?
B) Supraspinatus
It should be infraspinatus.
Which muscle can abduct the shoulder provided that the arm is laterally rotated first?
C) Long head of biceps brachii
Which of the following muscles can medially rotate the shoulder provided that the arm is by the side?
D) Subscapularis
All of the following muscles are responsible for scapular depression, except:
A) Rhomboid major
Rhomboid major is responsible for scapular elevation. Other scapular depressors are pectoralis minor and lower trapezius.
All of the following muscles can protract the scapula, except:
A) None of these
Pectoralis minor can also protract the scapula.
Which of the following does not contribute to elbow flexion?
C) None of these
Which activity requires the following ranges of motion:
1. 70° to 100° horizontal adduction
2. 45° to 60° abduction
A) Eating
Which activity requires the following ranges of motion?
1. 30° to 70° horizontal adduction
2. 105° to 120° abduction
3. 90° lateral rotation
B) Combing hair
All of the following ranges of motion are required when reaching the perineum, except:
B) 90° medial rotation
It should be 90°+ medial rotation.
All of the following ranges of motion are required when tucking in shirt, except:
D) None of these
Which of the following ranges of motion is not required when putting the hand behind the head?
A) 10° to 15° horizontal abduction
It should be 10° to 15° horizontal adduction.
Which activity requires the following ranges of motion:
1. 70° to 80° horizontal adduction
2. 70° to 80° forward flexion
3. 45° lateral rotation
B) Putting something on shelf
Which of the following motions is/are required for washing the opposite shoulder?
A) Both of these
Hand-to-Opposite-Scapula: the hand cannot pass the midline of the trunk
C) 3
Hand-to-Opposite-Scapula: the hand reaches the spine of the opposite scapula in full adduction
C) 1
In grade 0, the hand also reaches the spine of the opposite scapula in full adduction but without wrist flexion.
Hand-to-Scapula: the hand reaches the buttock
C) 3
Hand-to-Scapula: the hand reaches the opposite scapula 6 cm to 15 cm beneath it
C) 1
Hand-to-Scapula: the hand reaches the opposite iliac crest
D) 2
Hand-to-Back of Neck: the fingers touch the neck
C) 3
Hand-to-Back of Neck: the fingers reach the posterior median line of the neck with the shoulder in full abduction and lateral rotation; the wrist is not dorsally extended
B) 0
In grade 1, the fingers reach the median line of the neck but do not have full abduction and/or lateral rotation.
Feeling of shoulder slippage with pain
C) Shoulder instability
Normal AROM
B) Shoulder instability
Apprehesion test positive
C) Traumatic anterior dislocation
In traumatic anterior dislocation of the shoulder, the sensation is normal, unless these peripheral nerves are injured.
A) Axillary and musculocutaneous nerves
Impingement often seen in older patients
C) Grade I
Grade I is pure impingement with no instability.
Secondary impingement and instability caused by chronic capsular and labral microtrauma
A) Grade II
Secondary impingement and instability caused by generalized hypermobility or laxity
D) Grade III
Primary instability with no impingement
A) Grade IV
True or False: Primary impingement is more common in older patients, whereas secondary impingement is more common in younger patients.
True
In primary impingement, mechanical impingement occurs because of degenerative changes to the rotator cuff, the acromion process, the coracoid process, and the anterior tissues from stress overload. Meanwhile, secondary impingement is caused by problems with muscle dynamics with an upset in the normal force couple action leading to muscle imbalance and abnormal movement patterns at both the glenohumeral and the scapulothoracic articulation.
Which of the following is true about internal impingement?
B) This type of impingement is found posteriorly rather than anteriorly.
Internal impingement, also known as non-outlet impingement, involves contact of the undersurface of the rotator cuff (primarily supraspinatus and infraspinatus) with the posterosuperior glenoid labrum when the arm is abducted to 90° and laterally rotated fully.
The rotator cuff lies on which aspects of the shoulder joint?
D) Anterior, posterior, and superior
The rotator cuff is deficient inferiorly, and this is a site of potential weakness.
Which of the following is not true about the quadrangular space?
D) It is bounded medially by the long head of the biceps and laterally by the surgical neck of the humerus.
It is bounded medially by the long head of the triceps and laterally by the surgical neck of the humerus.
This nerve runs downward in the posterior triangle of the neck on the levator scapulae muscle.
B) Spinal accessory nerve
The patient with a ruptured supraspinatus tendon is unable to initiate abduction of the arm. However, if the arm is passively assisted for the first 15° of abduction, the deltoid can then take over and complete the movement to a right angle.
A) Both statements are true.
Which nerve passes through the quadrangular space?
D) Axillary
What is the nerve supply of the sternoclavicular joint?
D) Nerve to subclavius
The supraclavicular nerve and the nerve to the subclavius muscle supply the sternoclavicular joint.
The forward movement of the clavicle is produced by which muscle?
C) Serratus anterior
The backward movement of the clavicle is produced by which muscles?
B) Trapezius and rhomboids
All of the following muscles are responsible for elevation of the clavicle, except:
C) None of these
Rhomboids also elevate the clavicle.
Which of the following muscles depress the clavicle?
D) Subclavius
Depression of the clavicle is produced by the pectoralis minor and the subclavius.
Violent forces directed along the long axis of the clavicle usually result in fracture of that bone, but dislocation of the sternoclavicular joint takes place occasionally. This is possible because of the presence of which ligament/s?
A) Costoclavicular ligament
The strong costoclavicular ligament firmly holds the medial end of the clavicle to the 1st costal cartilage.
Anterior dislocation of the sternoclavicular joint results in the medial end of the clavicle projecting forward beneath the skin. The clavicle may also be pulled upward by the scalene muscles.
C) Only the first statement is true.
The clavicle may also be pulled upward by the sternocleidomastoid muscle.
Posterior dislocation of the sternoclavicular joint usually follows direct trauma applied to the front of the joint that drives the clavicle backward. This type is the more serious one because the displaced clavicle may press on the following structures, except:
A) Major blood vessels in the roof of the neck
It should be major blood vessels in the root of the neck.
What is the nerve supply of the acromioclavicular joint?
B) Suprascapular nerve
What is the nerve supply of the glenohumeral joint?
A) Axillary and suprascapular nerves
In a condition known as shoulder separation, which ligament is being torn?
A) Coracoclavicular ligament
In shoulder separation, the acromion is being thrusted beneath the lateral end of the clavicle, tearing the coracoclavicular ligament.
At about ____ of abduction of the arm, the greater tuberosity of the humerus comes into contact with the lateral edge of the acromion.
A) 120°
Further elevation of the arm above the head is accomplished by rotating the scapula.
True or False: The shoulder is the most commonly dislocated large joint.
True
The skin over the point of the shoulder and halfway down the lateral surface of the deltoid muscle is supplied by the supraclavicular nerves. Pain may be referred to this region as a result of inflammatory lesions involving the diaphragmatic pleura or peritoneum.
C) Both statements are true.
Which of the following muscles is not found in the anterior fascial compartment of the upper arm?
B) Anterior deltoid
All of the following structures pass through the anterior fascial compartment of the upper arm, except:
D) Basilic artery
The following structures pass through the anterior compartment:
1. Musculocutaneous nerve
2. Median nerve
3. Ulnar nerve
4. Brachial artery
5. Basilic vein
6. Radial nerve (lower part of the compartment)
Which head of the triceps brachii originate from the upper half of the posterior surface of the humeral shaft?
A) Lateral
The long head originates from the infraglenoid tubercle of the scapula, whereas the medial head originates from the lower half of the posterior surface of the humeral shaft.
It provides the main arterial supply to the arm.
C) Brachial
Brachial artery terminates opposite the neck of the radius by dividing into the radial and ulnar arteries.
This nerve pierces the coracobrachialis muscle.
D) Musculocutaneous
This nerve has no branches in the upper arm, except for a small vasomotor nerve to the brachial artery.
D) Median
This nerve has no branches in the anterior compartment of the upper arm.
C) Ulnar
What is the blood supply of the posterior fascial compartment of the upper arm?
D) Both of these
Which of the following is incorrect about the posterior fascial compartment of the upper arm?
A) Structures passing through the compartment: radial nerve and artery
Radial nerve and ulnar nerve pass through the posterior compartment.
At the elbow, this nerve lies behind the medial epicondyle of the humerus.
D) Ulnar
Which of the following is incorrect about the cubital fossa?
B) The base of the triangle is formed by an imaginary line drawn between the two condyles of the humerus.
The base of the triangle is formed by an imaginary line drawn between the two epicondyles of the humerus.
From the medial to the lateral side, the cubital fossa contains the following structures:
B) (1) Median nerve, (2) bifurcation of brachial artery into ulnar and radial arteries, (3) tendon of biceps muscle, (4) radial nerve and its deep branch
Third joint of the elbow complex
D) Proximal radioulnar
Although the proximal radioulnar joint lies within the elbow capsule, it is technically not part of the elbow joint.
True or False: Most of the contact and osteokinematic elbow motion comes from the humeroulnar rather than from the humeroradial articulation.
True
Although motion occurs and an articulation exists between the humerus and the radius, most of the contact and osteokinematic elbow motion comes from the humeroulnar rather than from the humeroradial articulation.
Which of the following is not true about the medial epicondyle of the humerus?
C) It serves as the proximal attachment site for pronator quadratus, for ulnar collateral ligament, and for most wrist and finger flexors.
Medial epicondyle serves as the proximal attachment site for pronator teres, for ulnar collateral ligament, and for most wrist and finger flexors.
The lateral supracondylar ridge of the humerus is a landmark that is palpable between the ________ posteriorly and the _________ anteriorly.
C) Lateral head of triceps; brachioradialis
Which of the following is not a characteristic of the distal humerus?
C) The capitulum is almost oval in shape.
The capitulum is almost spheroid in shape
All of the following occurs during elbow flexion, except:
A) The radial head slides within the trochlear groove.
The radial head slides within the capitulotrochlear groove when the elbow flexes.
True or False: The radius is the more integral articulating bony partner with the humerus at the elbow, forming the humeroradial joint.
False
The ulna is the more integral articulating bony partner with the humerus at the elbow, forming the humeroulnar joint.
Medial to the olecranon process is a groove between it and the medial epicondyle. Which nerve is being housed by this groove?
C) Ulnar
This groove houses the ulnar nerve, which is palpated as a round cord within the groove.
"Funny bone"
A) Ulnar nerve
Friction across the ulnar nerve within the ulnar groove produces a prickling sensation in the little finger; hence, this location of the ulnar nerve is popularly known as the "funny bone."
Which of the following is not true about the elbow joint?
D) Although the capsule surrounding the joint is reinforced by the collateral ligaments, it is thin and loose, especially anteriorly.
Although the capsule surrounding the joint is reinforced by the collateral ligaments, it is thin and loose, especially posteriorly, with many folds to allow for significant motion.
The olecranon bursa buffers locking of the elbow when it moves into full:
A) Extension
A large, olecranon bursa is located in the olecranon fossa, buffering the locking of the elbow when it moves into full extension.
"Loose" hinge joint
C) Elbow
Because the trochlea is more distal than the capitulum, the line drawn through them is off from horizontal. If the line were horizontal, the elbow's function would be akin to a rigid hinge, similar to that of a door. Since the elbow's axis of motion is a few degrees off of the horizontal, the elbow has variability in excursion; therefore, it is best referred to as a "loose" hinge joint.
The distal end of the humerus lies in ___________ with respect to the humeral shaft. Meanwhile, the proximal ulna lies in __________ in relation to the ulnar shaft.
C) 30° anterior rotation; 30° posterior rotation
This matching relationship provides the 145° range in elbow flexion as well as the stability of the elbow joint in full extension.
Which of the following is not true about elbow flexion?
B) People with little soft tissue may have a hard end feel with bone contact of the radial head into the humeral radial fossa.
People with little soft tissue may have a hard end feel with bone contact of the ulnar coronoid process into the humeral coronoid fossa.
Functional arc of elbow motion
B) 30° to 130°
What is the close-packed position of the humeroulnar joint?
C) Full extension
The close-packed position of humeroradial joint is 90° of flexion with 5° of supination, whereas the close-packed position of radioulnar joint is either full supination or full pronation.
What is the resting position of the humeroradial joint?
D) Full elbow extension with full forearm supination
The resting position of humeroulnar joint is 70° elbow flexion with 10° forearm supination, whereas the resting position of proximal radioulnar joint is 70° elbow flexion with 35° forearm supination.
Full elbow flexion requires the normal length of the following structures, except:
C) Median nerve
It should be ulnar nerve.
Full elbow extension requires the normal length of the following structures, except:
B) Anterior fibers of lateral collateral ligament
It should be anterior fibers of medial collateral ligament.
True or False: In full elbow extension, there is no contact between the radius and humerus.
True
But during elbow flexion, the deep fovea atop the radial head is pulled against the rounded capitulum of the humerus and the radial head slides in the capitulotrochlear groove until full flexion occurs when the head settles snugly into the radial fossa of the humerus.
Which of the following is incorrect about the carrying angle?
A) The biomechanical term for this angulation is cubital varus.
The biomechanical term for this angulation is cubital valgus.
Cubitus varus is usually due to a proximal ulnar fracture sustained during childhood. It is sometimes called a gunstock deformity.
C) Only the second statement is true.
Cubitus varus is usually due to a distal humerus fracture sustained during childhood.
Which of the following is not true about the attachments of the capsule of the elbow joint?
A) The capsule attaches posteriorly to the humerus below the olecranon fossa and to the trochlea.
The capsule attaches posteriorly to the humerus above the olecranon fossa and to the trochlea.
Which of the following is not true about medial collateral ligament of the elbow?
A) It prevents subluxation at the humeroradial articulation.
Medial (ulnar) collateral ligament prevents subluxation at humeroulnar articulation.
Which of the following is not true about the lateral collateral ligament?
A) None of these
Which of the following is not true about the annular ligament?
D) None of these
Which of the following is not true about the oblique cord of the proximal radioulnar joint?
B) Its proximal attachment is on the ventral forearm, particularly at the superior aspect of the radial notch of ulna.
Its proximal attachment is on the ventral forearm, particularly at the inferior aspect of the radial notch of ulna.
Which of the following is not true about the quadrate ligament?
B) Its distal attachment is at the medial surface of the head of radius.
Its distal attachment is at the medial surface of the neck of radius.
Ligament/s which hold/s the ulna to the ulnar notch of the radius
C) Both of these
Which of the following is not true about the ulnar collateral ligament?
A) It stabilizes the elbow against excessive valgus forces to restrict the arm from excessive lateral displacement on the forearm.
It stabilizes the elbow against excessive valgus forces to restrict the forearm from excessive lateral displacement on the arm.
Which of the following is not true about the radial collateral ligament?
C) None of these
Radial collateral ligament is also known as lateral collateral ligament.
How many bursae are there in the elbow joint?
B) 7
Damage to which of the following arteries leads to Volkmann's ischemia?
B) Brachial artery
Since the brachial artery is located in the cubital fossa, it is also susceptible to trauma during elbow dislocations. Damage to the brachial artery during a dislocation can result in a clinical presentation known as Volkmann's ischemia, which results in a loss of blood supply to the forearm muscles.
Olecranon bursitis can result from chronic overuse with the elbow slamming forcefully into extension or from a fall onto the tip of the olecranon producing swelling or bleeding into the bursal space. Olecranon bursitis may also present as part of a clinical picture associated with either concomitant lateral or medial epicondylosis.
B) Only the first statement is true.
Olecranon bursitis may also present as part of a clinical picture associated with either concomitant lateral or medial epicondylopathy.
During forearm pronation and supination, the radius pivots around a stationary ulna. In pronation, the ulna and radius lie parallel to each other, whereas in supination the radius crosses over the ulna.
C) Only the first statement is true.
In supination, the ulna and radius lie parallel to each other, whereas in pronation the radius crosses over the ulna.
In forearm supination, the end feel at the proximal radioulnar joint is firm secondary to the tautness of the stretched ligaments, interosseous membrane, and both pronator muscles. In forearm pronation, the end feel may either be hard if the radius and ulna come in contact with each other or firm because of the stretch to the radioulnar joints' soft tissue capsules and the interosseous membrane.
B) Both statements are true.
The proximal radioulnar joint is classified as a:
D) Trochoid
Trochoid joint is synonymous with pivot joint.
Which ligament forms most of the articulating ring around the head of the radius?
A) Annular ligament
The smaller radial notch of the ulna completes the articular ring formation.
The articular surfaces of the distal radioulnar joint includes the:
D) All of these
Which of the following is not true about the distal radioulnar joint?
C) An articular disc, interposed between the distal ulna and the adjacent carpal bones, follows the ulnar motion.
An articular disc, interposed between the distal ulna and the adjacent carpal bones, follows the radial motion.
All of the following structures reinforce stability at the proximal radioulnar joint, except:
A) Annular ligament
Soft tissue stability at the proximal radioulnar joint is provided by the annular ligament and reinforced by the LCL, the oblique cord, and the quadrate ligament.
Which of the following is incorrect about the interosseous membrane between the radius and ulna?
D) It absorbs shock and transmits force along the kinetic chain to protect the arm bones from injury during excessive force application.
It absorbs shock and transmits force along the kinetic chain to protect the forearm bones from injury during excessive force application.
Which of the following is not true about the quadrate ligament?
A) The stronger posterior portion is the major stabilizer of the proximal radioulnar joint during full supination.
The strongeranterior portion is the major stabilizer of the proximal radioulnar joint during full supination, whereas the weaker posterior portion stabilizes full pronation.
Which of the following is incorrect about the triangular fibrocartilage at the wrist?
A) The disc's superior and inferior surfaces are concave, but the distal surface is comparatively more concave.
The disc's superior and inferior surfaces are concave, but the proximal surface is comparatively more concave to better accommodate the rounded head of the ulna.
Which of the following is not true about the "nursemaid's elbow"?
A) None of these
Nursemaid's elbow is accurately described as "pulled elbow syndrome".
All of the following muscles can flex the elbow, but have weaker leverage as they are primarily active at their distal insertions in the wrist and hand, except:
B) Flexor digitorum profundus
It should be flexor digitorum superficialis.
Which of the following is incorrect about brachialis?
A) It muscle belly is located in the proximal half of the forearm and is largely covered by the biceps.
It muscle belly is located in the distal half of the arm and is largely covered by the biceps.
The brachialis is known as the "workhorse" of the elbow because:
D) All of these
Which of the following is not true about biceps brachii?
B) The muscle fibers belonging to the long head make up the medial portion of the common belly, whereas those of the short head make up the lateral portion.
The muscle fibers belonging to the short head make up the medial portion of the common belly, whereas those of the long head make up the lateral portion.
Distal attachment of brachialis
C) Both
Which of the following is incorrect about the OINA of brachioradialis?
A) Nerve: musculocutaneous nerve
It should be nerve: radial nerve.
Which of the following is incorrect about the OINA of pronator teres?
A) Insertion: medial side of radius about halfway down the forearm
It should be insertion: lateral side of radius about halfway down the forearm.
Which head of the triceps brachii originates from the posterolateral aspect of the humerus inferior to the greater tubercle?
C) Lateral head
The long head originates from the infraglenoid tubercle of the scapula, whereas the medial head originates from the distal portion of the posterior humerus.
Which of the following is incorrect about the OINA of anconeus?
D) Origin: region of medial epicondyle of humerus
It should be origin: region of lateral epicondyle of humerus.
Which of the following is incorrect about the OINA of pronator quadratus?
B) Nerve: ulnar nerve
It should be nerve: median nerve.
This muscle is the longest of the elbow flexors.
C) Brachioradialis
This muscle is the only primary elbow flexors whose belly lies in the forearm.
B) Brachioradialis
Which of the following is incorrect about brachioradialis?
C) None of these
Most muscular portion of the triceps brachii
A) Lateral head
Strongest head of the triceps brachii
C) Lateral head
Which of the following is not true about the triceps brachii?
A) It acts a a powerful stabilizer of the upper extremity during any functional open-chain activity.
It acts a a powerful stabilizer of the upper extremity during any functional closed-chain activity.
Which of the following is not true about anconeus?
B) It initiates most high-load elbow extension motions.
It initiates most low-load elbow extension motions.
The supinator is able to supply adequate force when:
C) All of these
All of the following muscles act as weak supinators, except:
D) Extensor pollicis longus
It should extensor pollicis brevis.
Which of the following is incorrect about supinator?
A) It is covered by anconeus, extensor carpi radialis brevis, and brachioradialis.
It is covered by anconeus, extensor carpi radialis longus, and brachioradialis.
All of the following muscles have poor leverage for pronation and contribute little force, except:
D) None of these
Which of the following is incorrect about pronator teres?
D) It works synergistically with the pronator quadratus to rotate or pivot the ulna around the radius during pronation.
It works synergistically with the pronator quadratus to rotate or pivot the radius around the ulna during pronation.
Which of the following is incorrect about pronator quadratus?
D) Its cross section is almost one-third the size of the pronator teres.
Its cross section is almost two-thirds the size of the pronator teres.
The biceps and brachialis have the largest moment arms, so they provide strength and power for the elbow. On the other hand, the brachioradialis has a short moment arm and provides a large compression force to offer elbow stability.
A) Both statements are true.
Supinator longus
A) Brachioradialis
Brachioradialis is capable of performing a limited range of supination from the fully pronated position.
At 90°, the biceps is almost five times as effective as the supinator in performing supination. When the elbow is extended and supinated, however, the effectiveness of the biceps is only twice that of the supinator.
C) Only the second statement is true.
At 90°, the biceps is almost four times as effective as the supinator in performing supination.
After the anconeus has been recruited, which head of the triceps brachii is recruited next as the force requirements increase?
A) Medial head
As the force requirements increase, the medial head of the triceps is recruited first. The medial head strength is usually sufficient to handle typical demands.
With increasing force demands, what is the order of recruitment of the triceps brachii?
C) (1) Medial; (2) Lateral; (3) Long
Which of the following joints make up the cubital articulations?
A) All of these
The trochlear joint is classified as a:
D) Hinge joint
The ulnohumeral or trochlear joint is found between the trochlea of the humerus and the trochlear notch of ulna.
What is the capsular pattern of the ulnohumeral joint?
C) Flexion > Extension
Ulnohumeral joint is also known as trochlear joint.
The radiohumeral joint is classified as a:
A) Hinge joint
The radiohumeral joint is found between the capitulum of the humerus and the head of the radius.
What is the capsular pattern of the radiohumeral joint?
B) Flexion > Extension
As with the trochlear joint, the capsular pattern is flexion more limited than extension.
Which ligament is the primary restraint to posterolateral elbow instability?
C) Radial collateral ligament
The lateral (radial) collateral ligament is the primary restraint to posterolateral instability (most common) of the elbow.
Any injury that increases the carrying angle put an abnormal stress on the:
B) Ulnar nerve
The medial (ulnar) collateral ligament, along with the flexor carpi ulnaris, forms the cubital tunnel through which the ulnar nerve passes. Any blow to the area or injury that increases the carrying angle puts abnormal stress on ulnar nerve.
Tardy ulnar palsy may be caused by the "double crush" phenomena of a carpal tunnel problem combined with a cervical spine problem. Its symptoms can occur many years after the original injury.
B) Only the second statement is true.
Tardy ulnar palsy may be caused by the "double crush" phenomena of a cubital tunnel problem combined with a cervical spine problem.
This ligament makes up four-fifths of the superior radioulnar joint.
C) Annular ligament
What is the capsular pattern of the superior radioulnar joint?
A) Supination = Pronation
This articulation is made up of the radius and ulna and the interosseous membrane between the two bones.
C) Middle radioulnar joint
The middle radioulnar joint is not a true joint.
When does the interosseous membrane between the radius and ulna become tensed?
A) Midway between pronation and supination
The fibers of this ligament run at right angles to those of the interosseous membrane between the radius and ulna.
C) Oblique cord
This structure assists in preventing displacement of the radius on ulna, especially during movements involving pulling.
A) Oblique cord
Which of the following is incorrect about the carrying angle?
D) It is most evident when the elbow is bent and the forearm is fully supinated.
It is most evident when the elbow is straight and the forearm is fully supinated.
Joint swelling in the elbow is often most evident in the triangular space between the:
A) Radial head, tip of olecranon, and lateral epicondyle
In the presence of swelling, the elbow would be preferrably held at how many degrees of flexion?
C) 70°
With swelling, the joint would be held in its resting position, because it is in the resting position that the joint has maximum volume.
Swelling resulting from olecranon bursitis is more discrete, being more sharply demarcated as a ___________ over the olecranon process.
B) Goose egg
What is the functional position of the elbow?
A) 90° flexion with forearm midway between supination and pronation
At 90° of elbow flexion, the following structures normally form an isosceles triangle.
C) Olecranon process, medial epicondyle, and lateral epicondyle
The isosceles triangle is sometimes called the triangle sign. If there is a fracture, dislocation, or degeneration leading to loss of bone or cartilage, the distance between the apex and the base decreases and the isosceles triangle no longer exists.
When the arm is fully extended, the olecranon process of the ulna and the medial and lateral epicondyles of the humerus form a/an:
B) Horizontal line
When the elbow is flexed, these structures form an isosceles triangle.
Which of the following is not true about elbow extension?
A) Loss of elbow extension is a sensitive indicator of extra-articular pathology.
Loss of elbow extension is a sensitive indicator of intra-articular pathology.
Muscle flexion power around the elbow is greatest in the range of:
C) 90° to 110° with the forearm supinated
All of the following muscles are innervated by the median nerve, except:
C) Hypothenar eminence
It should be thenar eminence.
Other muscles innervated by the median nerve are:
1. Pronator teres
2. Flexor digitorum superficialis
3. Flexor pollicis longus
4. Lateral half of flexor digitorum profundus
5. Pronator quadratus
All of the following muscles are innervated by the anterior interosseous nerve, except:
B) None of these
The anterior interosseous nerve also innervates the flexor pollicis longus, pronator quadratus, and lateral half of flexor digitorum profundus.
Which of the following muscles is not innervated by the ulnar nerve?
D) Abductor pollicis
It should be adductor pollicis.
Other muscles innervated by the ulnar nerve are:
1. Flexor carpi ulnaris
2. Medial half of flexor digitorum profundus
3. Medial two lumbricals
Which of the following muscles is not innervated by the radial nerve?
B) Abductor pollicis brevis
Abductor pollicis brevis is a part of the thenar eminence and is innervated by the median nerve.
Other muscles innervated by the radial nerve are:
1. Anconeus
2. Brachioradialis
3. Extensor carpi radialis longus and brevis
4. Extensor digitorum
5. Extensor pollicis longus and brevis
6. Abductor pollicis longus
7. Extensor carpi ulnaris
8. Extensor indices
9. Extensor digiti minimi
All of the following muscles are innervated by the posterior interosseous nerve, except:
B) Extensor carpi radialis longus
Posterior interosseous nerve is synonymous with the deep branch of the radial nerve.
The inferior articular surface of the radius articulates with which carpal bones?
C) Scaphoid and lunate
On the posterior aspect of the distal end of the radius lies a small tubercle known as the dorsal tubercle. This tubercle is grooved on its medial side by the tendon of the ___________.
B) Extensor pollicis longus
Which of the following is not true about the articulations of ulna?
B) None of these
This structure forms the prominence of the elbow.
C) Olecranon process
In Galeazzi's fracture, there is a bowing forward of the ulnar shaft and an anterior dislocation of the radial head with rupture of the anular ligament. Meanwhile, in Monteggia's fracture, the proximal third of the radius is fractured and the distal end of the ulna is dislocated at the distal radioulnar joint.
A) Both statements are false.
In Monteggia's fracture, there is a bowing forward of the ulnar shaft and an anterior dislocation of the radial head with rupture of the anular ligament. Meanwhile, in Galeazzi's fracture, the proximal third of the radius is fractured and the distal end of the ulna is dislocated at the distal radioulnar joint.
Which ligament/s is/are ruptured in Monteggia's fracture?
D) Annular ligament
In Monteggia's fracture, the shaft of the ulna is fractured by a force applied from behind. There is bowing forward of the ulnar shaft and an anterior dislocation of the radial head with rupture of the annular ligament.
Which joint/s is/are dislocated in Galleazi's fracture?
A) Distal radioulnar joint
In Galeazzi's fracture, the proximal third of the radius is fractured and the distal end of the ulna is dislocated at the distal radioulnar joint.
All of the following may result to a fracture of the olecranon process, except:
C) Pull of the anconeus muscle
Avulsion fractures of part of the olecranon process can be produced by the pull of the triceps muscle.
Which of the following is not true about Colles' fracture?
B) Failure to restore the distal articular surface to its normal position will severely limit the range of extension of the wrist joint.
Failure to restore the distal articular surface to its normal position will severely limit the range of flexion of the wrist joint.
Smith's fracture is a fracture of the distal end of the radius and occurs from a fall on the outstretched hand. It is a reversed Colles' fracture because the distal segment is displaced anteriorly.
D) Only the second statement is true.
Smith's fracture is a fracture of the distal end of the radius and occurs from a fall on the back of the hand.
"First finger"
B) Second digit
The third digit is the second finger; the fourth digit is the third finger; and the fifth digit is the fourth finger.
Longest finger of the hand
B) Second finger
The second finger (third digit) is the longest, whereas the fourth finger (fifth digit) is the smallest.
True or False: The first two digits are used for dexterous or fine manipulations of objects, whereas the last three provide the hand with gross or strength manipulations.
True
How many bones are there in the hands?
A) 58
Each hand has 29 bones.
The primary forearm bone for the elbow joint is the ulna. Meanwhile, the primary forearm bone of the wrist is the radius.
D) Both statements are true.
Which part of the distal ulna provides attachment for the fibrocartilaginous disc?
B) Fovea
The fovea is a depression at the base of the styloid process and provides attachment for the fibrocartilaginous disc.
This part of the distal ulna is a concave articular surface allowing ulnar articulation with the fibrocartilaginous disc.
A) Pole
The ulnar styloid process is a bony projection, easily palpated with the forearm _________.
B) Pronated
The Lister's tubercle at the distal end of the radius has grooves on either side of it that serves as a pulley for the ____________ tendon on the ulnar side and the _____________ tendons on the radial side.
B) Extensor pollicis longus; extensor digitorum and extensor indicis
Lister's tubercle is also known as dorsal tubercle.
True or False: The radial styloid process extends more distally than the corresponding ulnar styloid process.
On the lateral aspect of the distal radius is the articulating surface for the distal radioulnar joint, commonly called the:
D) Both
Which carpal bone has only one articulating surface?
A) Pisiform
From lateral to medial, the proximal row of carpal bones are:
C) Scaphoid, lunate, triquetrum, pisiform
From lateral to medial, the distal row of carpal bones are: trapezium, trapezoid, capitate, and hamate.
The axis of motion for ulnar and radial deviation goes through this carpal bone in a dorsopalmar direction.
A) Capitate
_____________ causes the scaphoid to become prominent, whereas _____________ causes the bone to recede.
C) Ulnar abduction; radial abduction
Carpal bone/s which make/s up the floor of the fovea radialis
A) Scaphoid
The scaphoid and trapezium make up the floor of the "anatomic snuff box" or fovea radialis.
Based on its appearance, this carpal bone seems to extend across both rows of carpal bones.
D) Scaphoid
The scaphoid seems to extend across both rows of carpal bones, giving the impression that the proximal row curves around the capitate.
Greater multangular
B) Trapezium
Meanwhile, trapezoid is formerly known as the lesser multangular.
This carpal bone is in line with and distal to the Lister's tubercle.
A) Lunate
Lister's tubercle is also known as the dorsal tubercle.
The lunate becomes prominent as the wrist is passively __________ and recedes as the wrist is passively ___________.
A) Flexed; extended
The most frequently dislocated bone in the wrist
A) Lunate
The most frequently dislocated bone in the wrist
A) Lunate
B) Scaphoid
C) Triquetrum
Which of the following is not true about the pisiform?
D) It serves as the point of attachment for the extensor carpi ulnaris tendon.
It serves as the point of attachment for the flexor carpi ulnaris tendon.
Formerly called the triangular
D) Triquetrum
Most difficult carpal bone to palpate
C) Trapezoid
The trapezoid lies distal to the scaphoid, medial to the trapezium, and lateral to the capitate.
This carpal bone is located by palpating its hook.
A) Hamate
The hook of hamate lies at a ____ angle into the palm from the pisiform.
D) 45°
The triquetrum is under the pisiform. It is best palpated on the volar wrist with the wrist in radial abduction.
C) Only the first statement is true.
The triquetrum is best palpated on the dorsal wrist with the wrist in radial abduction.
Which of the following is incorrect about the metacarpals?
D) A tubercle at the medial base of the fifth metacarpal serves as the distal attachment site for the flexor carpi ulnaris.
A tubercle at the medial base of the fifth metacarpal serves as the distal attachment site for the extensor carpi ulnaris.
The wrist joint is classified as a:
B) Ellipsoidal joint
The hinge joint is also known as the radiocarpal joint.
The apex of the fibrocartilaginous disc in the wrist attaches to which carpal bone/s?
D) Neither
A triangular fibrocartilginous disc attaches to the distal end of the radius and the styloid process of the ulna proximally while the apex of the disc attaches to the triquetrum distally.
Which of the following is not true about the triangular fibrocartilaginous disc in the wrist?
D) None of these
Which of the following is incorrect about the articulations of the midcarpal joint?
B) The pisiform articulates with the hamate.
The triquetrum articulates with the hamate.
How many bones are distal to the carpals?
D) 19
There are a total of 19 bones distal to the carpals that make up the hand: 5 metacarpals, 5 proximal phalanges, 4 middle phalanges, and 5 distal phalanges.
Which CMC joint is the most flexible?
A) 5th
The 1st CMC joint is the most flexible with 25° to 30° of motion.
Which is the least mobile CMC joint?
B) 3rd
Because the 3rd CMC joint is the least mobile, it is the central pillar of the hand around which the rest of the hand rotates.
The CMC joint of the thumb is formed by the trapezoid and the base of the first metacarpal. The surfaces of both of these bones are both convex and concave, forming a saddle joint.
C) Only the second statement is true.
The CMC joint of the thumb is formed by the trapezium and the base of the first metacarpal.
Which of the following is incorrect about the motions of the 1st CMC?
B) Opposition is the rotation of the trapezium on the first metacarpal to place the pad of the thumb opposite the pads of the fingers.
Opposition is the rotation of the first metacarpal on the trapezium to place the pad of the thumb opposite the pads of the fingers.
The MCP joints are classified as:
D) Condyloid
The MCP joints are of the condyloid type with two degrees of freedom. Motions of flexion, extension, abduction, and adduction occur at these joints.
Which of the following is not true about the IP joints?
D) None of these
True or False: Finger sprains more often occur at the DIP joint than at the PIP joint.
False
Finger sprains more often occur at the PIP joint than at the DIP joint.
Extrinsic ligaments in the wrist connect the radius, ulna, or metacarpals to the carpals. Meanwhile, intrinsic ligaments run between carpals only.
B) Both statements are true.
Extrinsic ligament /s of the wrist located proximally
C) Radiocarpal
Carpometacarpal is also an extrinsic ligament but is located distally.
Which of the following is not true about the ligaments in the wrist?
A) None of these
Which of the following structures pass through the carpal tunnel?
A) 4 FDP tendons, 4 FDS tendons, 1 FPL tendon, median nerve
Which of the following structures pass through the Guyon tunnel?
B) Ulnar artery and nerve
Which of the following is correct about the transverse carpal ligament?
B) Ulnarly, it attaches to the hook of hamate and pisiform bones.
The transverse carpal ligament is 1 to 2 mm thick and 2 to 3 cm wide, attaching to the hook of the hamate and pisiform bones ulnarly and coursing to the radial side, where it attaches to the trapezium and the scaphoid.
Which of the following is not true about the collateral ligaments of the fingers?
D) The collateral ligaments attach from the bases of the metacarpals to the heads of the phalanges.
The collateral ligaments attach from the heads of the metacarpals to the bases of the phalanges.
After ____ of elbow flexion, the wrist extensors also become elbow flexors.
C) 15°
After 15° of elbow flexion, their line of pull moves anterior to the axis, so the wrist extensors also become elbow flexors.
This wrist extensor is often used to flex the elbow if the biceps and brachialis are paralyzed.
D) Extensor carpi radialis longus
The higher attachment (lateral supracondylar ridge of humerus) of the extensor carpi radialis longus provides good lever arm distance from the elbow axis when the elbow is flexed to 90°. This muscle is often used to flex the elbow if the brachialis and biceps are paralyzed.
Which of the following are the primary muscles that extend the wrist?
A) ECRL, ECRB, and ECU
This muscle participates in extension of the wrist only when the fingers are simultaneously extended.
C) Extensor digitorum
Which of the following muscle/s insert/s on the pisiform bone?
D) Flexor carpi ulnaris
Which muscle/s insert/s into the palmar aponeurosis?
D) Palmaris longus
All of the following are primary muscles involved in wrist flexion, except:
B) None of these
Other primary muscles involved in wrist flexion are:
1. Flexor carpi radialis
2. Flexor carpi ulnaris
3. Flexor digitorum profundus
4. Flexor pollicis longus
If the fist is tightly closed and wrist flexion is simultaneously resisted, one or more tendons of the flexor digitorum superficialis become prominent in the space between the ______________.
B) Palmaris longus and flexor carpi ulnaris
All of the following muscle are extrinsic muscles of the fingers, except:
C) Abductor pollicis brevis
Abductor pollicis brevis is an intrinsic muscle.
All of the following muscles are extrinsic muscles of the fingers, except:
C) Neither
Flexor digitorum superficialis and flexor digitorum profundus are both extrinsic muscles found on the ventral surface of the hand.
All of the following muscles are part of the thenar eminence, except:
D) Adductor pollicis
The thenar eminence is composed of opponens pollicis, abductor pollicis brevis,and flexor pollicis brevis.
The following are the mid-palm muscles:
A) 4 lumbricals, 3 palmar interossei, 4 dorsal interossei
Which of the following is not true about the extrinsic muscles of the fingers?
A) Their main function is to provide strength and fine motor control in hand function.
Their main function is to provide strength and gross motor control in hand function.
Which of the following is incorrect about the extensor retinaculum at the wrist?
B) The osseofibrous tunnels through which these tendons pass are numbered 1 through 6 from the medial to lateral wrist and serve to anatomically divide the extensor tendons into functional groups.
The osseofibrous tunnels through which these tendons pass are numbered 1 through 6 from the lateral to medial wrist and serve to anatomically divide the extensor tendons into functional groups.
As the finger extensor tendons travel under the retinaculum, they are surrounded with their own synovial sheath that ends in the region of which joint?
B) Carpometacarpal
Tunnel 1 of the extensor retinaculum includes the tendons of the:
C) Abductor pollicis longus and extensor pollicis brevis
Tunnel 2 of the extensor retinaculum contains the:
C) Extensor carpi radialis longus and extensor carpi radialis brevis
Tunnel 3 of the extensor retinaculum contains:
D) Extensor pollicis longus only
Tunnel 4 of the extensor retinaculum encloses the tendons of the:
B) Extensor digitorum and extensor indicis
How many tendons pass through the tunnels of the extensor retinaculum?
D) 9
Tunnel 1 = APL and EPB (2)
Tunnel 2 = ECRL and ECRB (2)
Tunnel 3 = EPL (1)
Tunnel 4 = ED and EI (2)
Tunnel 5 = EDM (1)
Tunnel 6 = ECU (1)
This is the only muscle on the posterior forearm that extends to all four fingers.
D) None of these
The extensor digitorum is the only muscle that extends all four fingers.
The extensor digiti minimi extends the following joint/s:
D) Both
The extensor digiti minimi is a long narrow muscle located on the posterior forearm and functions to extend all the joints of the little finger.
The extensor indicis is the main extensor of the index finger at the:
A) Metacarpophalangeal joint
The extensor indicis is a fairly small and narrow muscle located on the posterior forearm and acts as the main extensor of the index finger at the metacarpophalangeal joint.
Which of the following muscles is/are extrinsic flexor/s on the anterior forearm for digits 2 through 5?
A) Both
Unlike the ED, there are two extrinsic flexors on the anterior forearm for digits 2 through 5: the FDS and the FDP.
Which of the following is not a characteristic of the flexor digitorum superficialis?
B) None of these
The flexor digitorum superficialis muscle has a large muscle belly proximally that divides into a superficial and a deep muscle belly more distally in the forearm; its two superficial tendons attach to digits 3 and 4 whereas the two deep tendons attach to digits 2 and 5.
What is the insertion of the flexor digitorum superficialis?
D) Middle phalanges
What is the insertion of the flexor digitorum profundus?
C) Distal phalanges
The flexor digitorum profundus is located on the ulnar aspect of the anterior forearm and has one muscle belly that divides into four tendons; each tendon lies under its respective superficialis tendon in the hand and digits until they become more superficial when they emerge through the split of their digit's flexor digitorum superficialis to attach at the distal phalanges of the fingers.
All of the following are extrinsic muscles of the thumb, except:
B) Abductor pollicis brevis
The extrinsic muscles of the thumb include the flexor pollicis longus, extensor pollicis longus and brevis, and abductor pollicis longus.
Which of the following is not an intrinsic muscle of the thumb?
D) Extensor pollicis brevis
Extensor pollicis brevis is an extrinsic muscle of the thumb. The intrinsic muscles of the thumb are the adductor pollicis, flexor pollicis brevis, abductor pollicis brevis, and opponens pollicis.
Flexor/s of the IP joint at the thumb?
D) Flexor pollicis longus
The flexor pollicis longus is the primary thumb flexor and is the only flexor of the IP joint.
This/these muscle/s can be isolated when the MCP and IP joints are held in extension and the individual flexes the DIP joint.
A) Flexor digitorum profundus
Flexor digitorum superficialis can be isolated by flexing only the PIP joint.
Primary thumb extensor/s
B) Both
The extensor pollicis longus inserts on the distal phalanx of the thumb. Meanwhile, the extensor pollicis brevis inserts on the head of the proximal phalanx.
C) Only the first statement is true.
The extensor pollicis brevis inserts on the base of the proximal phalanx.
The intrinsic muscles of the fingers are relatively small and are grouped by their position within the hand. Which of the following is not true regarding such groupings?
D) The superficial muscle group is located in the palm of the hand.
The deep muscle group is located in the palm of the hand.
Most superficial thenar muscle
B) Abductor pollicis brevis
Deepest hypothenar muscle
D) Opponens digiti minimi
The deep muscle group lies between the thenar and hypothenar eminences and is situated in the palm of the hand. The muscles in this area include the interossei, lumbricals, and adductor pollicis.
A) Both statements are true.
The deep muscle group is also known as the midpalm group.
Muscles that have no bony attachment
B) Lumbricals
The lumbricals are the only muscles that have no bony attachment. Their proximal and distal insertions are on the tendons of other muscles.
The proximal insertion of the lumbricals are on the tendons of the:
A) Flexor digitorum profundus
The distal insertion of the lumbricals are on the tendons of the:
C) Extensor digitorum
The digital tendons of the extrinsic extensor muscles and almost all of the intrinsic muscles terminate in the extensor retinaculum. Exceptions are the following, except:
D) Abductor pollicis brevis
Exceptions to this are the palmaris brevis, the opponens pollicis, and the opponens, abductor, and flexor digiti minimi.
Which of the following is not true about the extensor expansion?
A) None of these
The extensor expansion is also known as the extensor hood mechanism, apparatus, retinaculum, dorsal hood, or hood.
The lateral bands of the extensor hood mechanism course on either side to the ______ joint.
B) PIP
The extensor expansion is also known as the extensor hood mechanism, apparatus, retinaculum, dorsal hood, or hood.
For each finger, the motor input into the lateral bands of the dorsal hood is provided by which muscles?
A) Long finger extensors, two interossei, and a lumbrical
For each finger, the motor input into the lateral bands, which extend the PIP and DIP joints, is provided by at least four muscles: the long extensor, two interossei, and a lumbrical.
The extensor mechanism of the thumb includes the extensor pollicis longus along with the intrinsic tendinous insertions of the following muscles, except:
C) Opponens pollicis
Which of the following is not true about the mallet finger?
D) None of these
Which of the following is incorrect about the flexor pulleys?
B) None of these
The midcarpal joint is responsible for ______ of the range of radial deviation and for ______ of the range of ulnar deviation.
A) 1/2; 1/3
Normal end feel for wrist radial deviation
B) Hard
The normal end feel for radial deviation is usually hard from contact of the scaphoid on the styloid process of the radius.
Normal end-feel of the wrist ulnar deviation
B) Firm
Ulnar deviation provides more motion and has a firm end feel caused by tension on the radial collateral ligament.
When the wrist goes through flexion, Kapandji states that there are ___ of motion at the radiocarpal joint and ___ at the midcarpal joint.
A) 50°; 35°
When the wrist goes through extension, Kapandji states that there are ___ of motion at the radiocarpal joint and ___ at the midcarpal joint.
B) 35°; 50°
True or False: The total wrist flexion and extension occurs because of equal contributions from the radiocarpal and midcarpal joints.
True
Axis of motion for wrist flexion and extension goes through this carpal bone.
A) Capitate
True or False: Full wrist extension requires slight spreading of the distal radius and ulna.
True
In the midcarpal joint, with a dorsal roll, the glide occurs palmarly. Likewise, with a palmar roll, the glide occurs dorsally.
A) Both statements are true.
The same is true for the radiocarpal joint.
The axis for wrist flexion-extension changes in positions of flexion and extension because of the complex movements of which carpal bones?
A) Scaphoid and lunate
What is the close-packed position of the wrist?
B) Full extension
Normal end feel of MCP flexion
A) Either
The end feel of MCP flexion may be hard with contact of the phalanx on the metacarpal or firm from capsular limitation.
What is the close-packed position of the MCP joint?
D) Full flexion
In 90° of MCP flexion, the collateral ligaments are taut and abduction or adduction is limited to a few degrees.
The MCP joint of the thumb is classified as a:
D) Hinge joint
The MCP joints of digits 2 through 5 are classified as condyloid.
The proximal aspects of MCP and IP joints are concave and the distal aspects are convex. Therefore, during flexion and extension of these joints, the arthrokinematic roll and slide are in the same direction.
A) Only the second statement is true.
The proximal aspects of MCP and IP joints are convex and the distal aspects are concave.
Resting position of MCP and IP joints
C) 20° flexion
Close-packed position of the thumb's MCP joint
D) None of these
The close-packed position of the thumb's MCP and IP joints is full extension.
Close-packed position of MCP and IP joints of digits 2 through 5
D) Full flexion
Which of the following is not true about the power grip?
B) It involves holding an object between fully flexed fingers and the palm while the thumb usually applies counterpressure to maintain and stabilize the object within the hand.
Power grip involves holding an object between partially flexed fingers and the palm while the thumb usually applies counterpressure to maintain and stabilize the object within the hand.
Only power grip in which the thumb is not required to participate
C) Hook grip
In power grips, the thumb is in
B) Opposition
In the power grips, the thumb is in adduction or opposition, and it reinforces the pressure of the fingers to stabilize the object in the hand.
In precision grip, the thumb is in:
B) Both
In precision grips, the thumb is abducted and is usually positioned to oppose the pulp of the fingers.
Which of the following is incorrect about tenodesis?
D) Extending the wrist shortens the flexor tendons (FDS) to produce finger flexion.
Extending the wrist shortens the flexor tendons (FDP) to produce finger flexion.
Palmar prehension is also known as:
A) Both
Most commonly used precision grip for picking up and holding small objects
B) Palmar prehension
Palmar prehension is also known as three-jaw chuck or three-prong chuck.
Individuals who have lost their ability to oppose the thumb but are capable of adducting it may use this grip for grasping and holding small objects.
A) Lateral prehension
Lateral prehension makes use of pressure of the thumb against the radial side of the index finger, which is held in a semi-flexed position.
Prehension pattern of choice for patients with upper motor neuron lesions
B) Lateral prehension
Lateral prehension makes use of pressure of the thumb against the radial side of the index finger, which is held in a semi-flexed position. This is the prehension pattern of choice for patients with upper motor neuron lesions for whom contact on the palmar surface of the fingers increases spasticity of the finger flexors. Such patients may be able to release an object held with lateral prehension, whereas an object that touches the palm of the hand may be very difficult to release because of the spasticity.
Non-prehensile power grip
B) Hook
If the wrist flexes during finger flexion, the grip becomes markedly weakened because:
A) Both of these
Carrying suitcase
D) Hook grip
Holding a beverage container
B) Cylindrical grip
Power grip used to hold objects that are large enough that the thumb does not touch the fingers
C) Cylindrical grip
Holding a ball
D) Spherical grip
The interossei muscles work more in this power grip.
D) Spherical grip
In spherical grip, the fingers are spread apart more than in the cylindrical grip, so interossei muscles work more in this grip.
Also known as the digital palmar prehension pattern
B) Fist grip
Also known as the digital palmar prehension pattern, the palm and fingers flex around the object and the thumb wraps around from the other direction to enclose the object.
Grasping a broom handle
C) Fist grip
Thumb held in extension, away from the hand
A) Hook grip
Also called as the key grip
A) Lateral pinch grip
Least precise of the precision grips
A) Lateral pinch grip
Grasping papers
D) Lateral pinch grip
Grasping a pencil
A) Three-prong chuck
Three-prong chuck is also known as the three-jaw chuck or palmar prehension.
Also known as pad-to-pad prehension grip
A) Three-prong chuck
In this precision grip, the pads of distal #2-3 digits contact the pad of the distal thumb for the purpose of picking up or grasping objects.
In tip-to-tip grip which finger is most often used to oppose the thumb?
D) 1st finger
The first finger is synonymous with 2nd digit or index finger.
Picking up a strand of hair
C) Tip-to-tip grip
What is the optimal wrist position during grip activities?
B) 20° to 35° of extension with slight ulnar deviation
This is known as the functional position of the wrist.
After perforating the superficialis tendon, the flexor digitorum profundus attaches to the base of the distal phalanx. This muscle only flexes the distal interphalangeal joint.
B) Only the first statement is true.
Flexor digitorum profundus flexes the distal as well as the proximal IP joint. However, this is the only muscle capable of flexing the distal IP joint.
The leverage of a lumbrical muscle for __________ is far better than its leverage for ___________.
C) Extension of the IP joints; flexion of the MCP joint
Which of the following muscles can flex both the wrist and fingers?
C) Both
Which of the following muscles cannot extend both the wrist and fingers?
D) Neither
All of the following muscles can abduct the wrist, except:
B) None of these
The abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus can abduct or radially deviate the wrist.
Which of the following muscles cannot adduct the wrist?
C) None of these
All of the following muscles can adduct the finger, except:
A) Opponens pollicis
It should be opponens digiti minimi.
All of the following muscles extend the thumb, except:
B) None of these
All of the following muscles can adduct the thumb, except:
D) Neither
Adductor pollicis and flexor pollicis brevis can also adduct the thumb.
It is the position in which the interossei and lumbricals assume their shortest length.
C) Intrinsic-plus
The hand assumes this position with contracture of the intrinsic muscles as is often found in rheumatoid arthritis.
A) Intrinsic-plus
(+) Paralysis of interossei and lumbricals
D) Intrinsic-minus
Intrinsic-minus is also known as "claw hand".
The intrinsic-plus hand position is used to minimize adhesion between the:
C) Intrinsic hand muscles and long extensor tendons
The hand is moves from MCP and IP extension to MCP flexion and IP extension and back to the start position.
The intrinsic-minus hand position is used to minimize adhesion between the:
D) Flexor digitorum superficialis and flexor digitorum profundus
The fingers begin in full extension at the MCP and IP joints and, while maintaining MCP extension or hyperextension, move the IPs into full flexion before returning to the start position.
First palmar interosseous muscle
C) Neither
Some anatomists identify the deep portion of the flexor pollicis brevis, or of a division of the adductor pollicis, as the first palmar interosseous muscle. In that case, the index finger is served by the second, the ring finger by the third, and the little finger by the fourth palmar interosseous.
The thumb is used in:
A) All precision grips and all but one of power grips
The thumb is responsible for ___ of the hand's function.
D) 50%
Which of the following is incorrect about the boutonniere deformity?
A) None of these
Which of the following is not true about swan neck deformity?
B) It occurs primarily with arthritis; with subsequent weakness of the extrinsic muscles, the PIP joints deform into hyperextension.
It occurs primarily with arthritis; with subsequent weakness of the intrinsic muscles, the PIP joints deform into hyperextension.
The extensive mobility that the thumb possesses as compared with the other fingers is made possible through all of the following factors, except:
C) The movements that occurs at the PIP and DIP joints of the thumb add substantially to the versatility of thumb movements.
The movements that occurs at the MCP and PIP joints of the thumb add substantially to the versatility of thumb movements. The thumb has only one IP joint.
Opposition-reposition of the thumb occurs in a plane ________ to the palm of the hand.
A) Perpendicular
Similar to abduction-adduction, opposition-reposition of the thumb occurs in a plane perpendicular to the palm of the hand. Meanwhile, flexion-extension of the thumb occurs in a plane parallel to the palm of the hand.
Which nerve supplies the flexor pollicis brevis?
C) Both
The median nerve supplies the superficial portion of this muscle, whereas the ulnar nerve supplies the deep portion.
This muscle may have ulnar innervation.
D) Abductor pollicis brevis
(+) Wrist drop
D) Radial nerve injury
The wrist cannot actively extend.
In the wrist-drop position, the digits are partially extended. This is due to passive tendon tension, not to active contraction.
B) Both statements are true.
With radial nerve injury, the strength of the grip is good when:
D) The wrist is passively extended.
With radial nerve injury, the grasp becomes awkward and weak, but if the wrist is supported in extension by means of a splint, the strength of the grip is good because the flexor muscles are intact.
(+) Claw hand
C) Ulnar nerve injury
In ulnar nerve paralysis, the habitual position of the hand is known as the "claw hand" or "ulnar claw", based on its characteristic appearance that occurs when the intrinsic muscles are paralyzed.
What digits are commonly affected in claw hand?
A) 4th and 5th digits
The 4th and 5th digits are the ones most commonly affected because the flexor digitorum profundus, the lumbricals, and the interossei belonging to these fingers are paralyzed and the hypothenar group is also not able to function.
In the presence of ulnar nerve injury, this muscle keeps the MCP joints of the 4th and 5th digits in hyperextension and the IP joint in partial flexion.
C) Extensor digitorum
True or False: If the ulnar nerve is interrupted in the proximal forearm, the deformity is less than when the disruption occurs in the hand.
True
Claw-hand deformation occurs because of the unopposed pull of the FDP on the distal fingers. When the ulnar nerve is damaged in the proximal forearm, the FDP is affected, so there is no unopposed flexor force on the distal phalanges to create a claw hand. Such condition is known as the "ulnar paradox" because of the lesser deformity.
(+) hand of Benediction
D) Median nerve injury
As the individual attempts to close the hand into a fist, the inability to flex the 2nd and 3rd digits causes them to remain extended, giving the appearance of an individual giving a Benediction.
If the median nerve is injured proximal to the wrist, which of the following will become apparent?
D) Ape hand
Only intrinsic muscles are affected with this more proximal nerve injury. Therefore, the thumb is unable to oppose the other fingers, but the FDS and FDP remain unaffected so flexion of the second and third digits occur when the individuals makes a fist.
Which carpal bone begins to ossify during the first year?
D) Capitate
All the carpals are ossified by ________.
C) 12th year
Most commonly fractured carpal bone
B) Scaphoid
Shortest metacarpal
D) 1st
Most mobile metacarpal
B) 1st
The first metacarpal of the thumb lies in the same plane as the others but occupies a more anterior position. It is also rotated medially through a right angle so that its extensor surface is directed laterally and not backward.
B) Only the second statement is true.
The first metacarpal of the thumb does not lie in the same plane as the others but occupies a more anterior position.
Which of the following is not true about scaphoid fracture?
A) The fracture line usually goes through the narrowest part of the bone, which, because of its location, is not bathed in synovial fluid.
The fracture line usually goes through the narrowest part of the bone, which, because of its location, is bathed in synovial fluid.
With dislocation of the lunate bone, what nerve/s is/are commonly involved?
A) Median nerve
What is the mechanism of injury for lunate dislocation?
D) Wrist hyperextension
Dislocation of the lunate bone occasionally occurs in young adults who fall on the outstretched hand in a way that causes hyperextension of the wrist joint.
Which of the following is not true about the "boxer's fracture"?
D) It is a horizontal fracture of the neck of the fifth and sometimes the fourth metacarpal bones.
It is an oblique fracture of the neck of the fifth and sometimes the fourth metacarpal bones.
Fracture of the base of the metacarpal of the thumb
B) Bennett's fracture
Bennett's fracture is oblique and enters the carpometacarpal joint of the thumb, causing joint instability.
Which of the following is not true about Volkmann's ischemic contracture?
C) The extensor muscles are larger than the flexor muscles, and they are therefore the ones mainly affected.
The flexor muscles are larger than the extensor muscles, and they are therefore the ones mainly affected.
The fibers of the interosseous membrane between the radius and ulna are taut when the forearm is in:
B) Midpronation
The flexor retinaculum is attached medially to the pisiform and the hook of the hamate and laterally to the tubercle of the scaphoid and the trapezium. The attachment to the trapezium consists of superficial and deep parts and forms a synovial-lined tunnel for passage of the tendon of the flexor pollicis longus.
B) Only the first statement is true.
The attachment to the trapezium consists of superficial and deep parts and forms a synovial-lined tunnel for passage of the tendon of the flexor carpi radialis.
The extensor retinaculum is attached medially to the __________ and ____________.
B) Pisiform; hook of hamate
The extensor retinaculum attaches laterally to the:
D) Neither
The flexor retinaculum attaches laterally to the tubercle of scaphoid and the trapezium. Meanwhile, the extensor retinaculum attaches laterally to the distal end of the radius.
The median nerve lies in a restricted space between the tendons of the _________ and the _________ muscles.
A) Flexor digitorum superficialis; flexor carpi radialis
Which of the following muscles does not belong to the superficial group of the anterior fascial compartment of the forearm?
B) Pronator quadratus
The superficial group consists of the pronator teres, the flexor carpi radialis, the flexor carpi ulnaris, and the palmaris longus.
The intermediate group consists of flexor digitorum superficialis.
The deep group consists of flexor pollicis longus, flexor digitorum profundus, and pronator quadratus.
Blood supply to the anterior fascial compartment of the forearm
C) Both
All of the muscles found in the anterior fascial compartment of the forearm are supplied by the median nerve, except:
D) Flexor digitorum profundus
The medial part of the flexor digitorum profundus is supplied by the ulnar nerve.
True or False: The ulnar artery is the larger of the two terminal branches of the brachial artery.
True
The ulnar artery begins in the cubital fossa at the level of the neck of the radius. It descends through the anterior compartment of the forearm and enters the palm in front of the flexor retinaculum in company with the ulnar nerve.
The ulnar artery lies just lateral to which carpal bone?
D) Pisiform
In front of the flexor retinaculum, the ulnar artery lies just lateral to the pisiform bone and is covered only by skin and fascia (site for taking ulnar pulse).
The median nerve leaves the cubital fossa by passing between the two heads of this muscle.
B) Pronator teres
The anterior interosseous nerve arises from the median nerve as it emerges from between the two heads of the pronator teres. It passes downward on the anterior surface of the interosseous membrane, between the flexor pollicis longus and pronator quadratus.
D) Only the first statement is true.
It passes downward on the anterior surface of the interosseous membrane, between the flexor pollicis longus and flexor digitorum profundus.
The articular branches of this nerve supply the wrist and distal radioulnar joints.
A) None of these
The articular branches of the anterior interosseous nerve supply the wrist and distal radioulnar joints. They also supply the joints of the hand.
The median nerve enters the palm by passing in front of the flexor retinaculum. Meanwhile, the ulnar nerve enters the palm by passing behind the flexor retinaculum.
A) Both statements are false.
The median nerve enters the palm by passing behind the flexor retinaculum. Meanwhile, the ulnar nerve enters the palm by passing in front of the flexor retinaculum.
The articular branches of this nerve supply the elbow joint.
D) Both
What is the blood supply of the lateral fascial compartment of the forearm?
A) Radial and brachial arteries
All of the following muscles are found in the lateral fascial compartment of the forearm, except:
C) Flexor carpi radialis
Flexor carpi radialis is found in the anterior fascial compartment of the forearm.
The lateral fascial compartment of the forearm may be regarded as part of the ________ fascial compartment.
C) Posterior
What is the nerve supply to the lateral fascial compartment of the forearm?
B) Radial nerve
At the level of the ___________, the radial nerve divides into superficial and deep branches.
B) Lateral epicondyle
The radial nerve supplies all of the following muscles, except:
D) None of these
A small branch of the radial nerve supplies the lateral part of the brachialis muscle.
The deep branch of the radial nerve winds around the neck of the radius, within the ________ muscle, and enters the posterior compartment of the forearm.
A) Supinator
The superficial branch of the radial nerve is the direct continuation of the nerve after its main stem has given off its deep branch behind the lateral epicondyle of humerus. It runs down under cover of the brachioradialis muscle on the lateral side of the radial artery.
A) Only the second statement is true.
The superficial branch of the radial nerve is the direct continuation of the nerve after its main stem has given off its deep branch in front the lateral epicondyle of humerus.
Which of the following muscles does not belong to the deep group of the posterior fascial compartment of the forearm?
D) Extensor digiti minimi
The superficial group includes the extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi,extensor carpi ulnaris, and anconeus.
The deep group includes the supinator, abductor pollicis longus, extensor pollicis longus brevis, extensor pollicis longus, and extensor indicis.
What is the nerve supply of the posterior fascial compartment of the forearm?
C) Deep branch of radial nerve
Roughening of the dorsal tubercle of the radius by the fracture line can cause excessive friction on the tendon of this muscle, eventually leading to its rupture.
A) Extensor pollicis longus
The anatomic snuffbox is a triangular skin depression on the lateral side of the wrist that is bounded medially by the tendon of the ______________ and laterally by the tendons of the _____________.
A) EPL; APB and
A) EPB; APL and EPL
B) EPL; APB and EPB
C) EPB; APB and EPL
D) A) EPL; APL and EPB
D) A) EPL; APL and EPB
Pulsations of this/these artery/arteries can be palpated in the anatomic snuffbox.
A) Radial artery
This muscle forms the most lateral boundary of the fovea radialis.
A) APL
Tennis elbow is caused by a partial tearing or degeneration of the origin of the deep extensor muscles from the lateral epicondyle of the humerus. It is characterized by pain and tenderness over the lateral epicondyle of the humerus, with pain radiating down the lateral side of the forearm.
C) Only the second statement is true.
Tennis elbow is caused by a partial tearing or degeneration of the origin of the superficial extensor muscles from the lateral epicondyle of the humerus.
All of the following structures pass superficial to the flexor retinaculum, except:
A) Flexor carpi ulnaris tendon
The flexor carpi ulnaris tendon does not cross the flexor retinaculum.
Other structures that pass superificial to the flexor retinaculum are the ulnar artery and the palmar cutaneous branch of median nerve.
The following structures pass superficial to the flexor retinaculum from medial to lateral:
C) Ulnar nerve, ulnar artery, palmar cutaneous branch of ulnar nerve, palmaris longus tendon, palmar cutaneous branch of median nerve
The following structures pass beneath the flexor retinaculum, except:
B) None of these
The following structures pass beneath the flexor retinaculum from lateral to medial
D) FCR tendon, FPL tendon, median nerve, FDS/FDP tendons
The FDS tendons lie anterior to the FDP tendons. Both groups of tendons share a common synovial sheath.
The tendon of this muscle goes through a split in the flexor retinaculum.
C) FCR
The flexor carpi radialis tendon goes through a split in the flexor retinaculum. This tendon is surrounded by a synovial sheath.
The following structures pass beneath the extensor retinaculum, except:
B) None of these
Other structures the pass beneath the extensor retinaculum are the extensor carpi ulnaris tendon, extensor indicis tendon, extensor pollicis longus tendon, extensor carpi radialis longus and brevis tendons, and extensor pollicis brevis tendon.
The following tendons share a common synovial sheath, except:
B) Abductor pollicis longus and extensor pollicis brevis
Abductor pollicis longus and extensor pollicis brevis have separate synovial sheaths but share a common compartment.
Which of the following is not true about the palmar aponeurosis?
D) Its medial and lateral borders are continuous with the thinner deep fascia covering the thenar and hypothenar muscles.
Its medial and lateral borders are continuous with the thinner deep fascia covering the hypothenar and thenar muscles.
The four separate tendons of the flexor digitorum superficialis muscle are arranged in anterior and posterior rows, those to the middle and ring fingers lying in front of those to the index and little finger. At the lower border of the flexor retinaculum, the four tendons diverge and become arranged on the same plane.
B) Both statements are true.
The palmaris brevis is a small msucle that arises from the:
A) Both
The palmaris brevis is a small muscle that arises from the flexor retinaculum and palmar aponeurosis and is inserted into the skin of the palm.
The palmaris brevis corrugates the skin at the base of the:
B) Hypothenar eminence
The function of the palmaris brevis is to corrugate the skin at the base of the hypothenar eminence and so improve the grip of the palm in holding a rounded object.
The tendons of the flexor digitorum profundus muscle are on the same plane. They also lie in front of the superficialis tendons.
C) Only the first statement is true.
They also lie behind the superficialis tendons.
Which of the following is not true about the carpal tunnel syndrome?
D) This syndrome is dramatically relieved by decompressing the tunnel by making a horizontal incision through the flexor retinaculum.
This syndrome is dramatically relieved by decompressing the tunnel by making a longitudinal incision through the flexor retinaculum.
True or False: In carpal tunnel syndrome, no paresthesia occurs over the thenar eminence.
True
In carpal tunnel syndrome, no paresthesia occurs over the thenar eminence because this area of skin is supplied by the palmar cutaneous branch of the median nerve, which passes superficially to the flexor retinaculum.
True or False: The synovial sheath of the FPL communicates with the common synovial sheath of the FDS and FDP tendons at the level of the wrist.
True
The synovial sheath of the FPL (sometimes referred to as the radial bursa) communicates with the common synovial sheath of the FDS and FDP tendons (sometimes referred to as the ulnar bursa) at the level of the wrist.
This fascial space in the forearm lies between the flexor digitorum profundus anteriorly and the pronator quadratus and the interosseous membrane posteriorly.
C) Space of Parona
Which of the following is not true about the trigger finger?
A) It is caused by the presence of a localized swelling of one of the long flexor tendons that catches on a narrowing of the fibrous flexor sheath posterior to the MCP joint.
It is caused by the presence of a localized swelling of one of the long flexor tendons that catches on a narrowing of the fibrous flexor sheath anterior to the MCP joint.
This muscle enables the thumb to form one claw in the pincer-like action used for picking up objects.
D) Opponens pollicis
Which of the following is true about the mallet finger?
B) Both of these
All of the following describe the position of rest, except:
A) The plane of thumb lies parallel to the plane of other fingernails.
The plane of thumb lies perpendicular to the plane of other fingernails.
All of the following describe the position of function, except:
C) The plane of thumbnail lies perpendicular with that of index finger, and pulp of thumb and index finger are in contact.
The plane of thumbnail lies parallel with that of index finger, and pulp of thumb and index finger are in contact.
Opposition of the thumb is accomplished by lateral rotation of the 1st metacarpal and the attached phalanges on the trapezium. The plane of the thumbnail comes to lie parallel with the plane of the nail of the opposed finger.
C) Only the second statement is true.
Opposition of the thumb is accomplished by medial rotation of the 1st metacarpal and the attached phalanges on the trapezium.
If the hand requires immobilization for the treatment of disease of any part of the upper limb, it should be immobilized in the ____________.
C) Position of function
Form of syndactyly that is associated with a central cleft dividing the hand into two parts
D) Lobster hand
Lobster hand is a heredofamilial disorder, for which plastic surgery is indicated where possible.
A floating thumb results if the _________ is/are absent.
A) Metacarpal
A floating thumb results if the metacarpal is absent but the phalanges are present.
How many intrinsic muscles are there in the hand and wrist?
B) 19
How many extrinsic muscles are there in the wrist and hand?
B) 20
Although the radius moves over the ulna, the ulna does not remain stationary. The ulna moves forward and medially during pronation and backward and laterally during supination.
B) Only the first statement is true.
The ulna moves forward and medially during supination and backward and laterally during pronation.
What is the resting position of the distal radioulnar joint?
C) 10° supination
What is the close-packed position of the distal radioulnar joint?
D) 5° supination
May followed bumped elbow
B) Ulnar neuritis
Pain on supination and wrist and finger flexion
D) Medial epicondylitis
Elbow flexion test positive
D) Ulnar neuritis
The distal radius is not straight but is angle toward the ulna by how many degrees?
B) 15° to 20°
The __________ margin of the distal radius projects more distally to provide a "buttress effect."
B) Posterior
With the triangular cartilaginous disc in place, the radius bears ___ of the load and the ulna bears ___.
B) 60%; 40%
If the triangular cartilaginous disc is removed, the radius transmits ___ of the axial load and the ulna transmits ___.
C) 95%; 5%
Therefore, the disc acts as a cushion for the wrist joint and as a major stabilizer of the distal radioulnar joint.
What is the resting position of the wrist joint?
C) Neutral with slight ulnar deviation
The wrist joint is also known as the radiocarpal joint
What is the close-packed position of the wrist joint?
D) Extension with radial deviation
The wrist joint is also known as the radiocarpal joint.
What is the capsular pattern of the radiocarpal joint?
D) Flexion = extension
The radiocarpal joint is also known as the wrist joint.
This ligament is most likely to be injured with a pronated fall on outstretched hand.
B) Radioscapholunate ligament
The radioscapholunate ligament is most likely to be injured with a pronated FOOSH injury (wrist extension, ulnar deviation, and intercarpal supination).
This ligament is most likely to be injured with wrist extension, radial deviation, and intercarpal supination.
D) Lunotriquetral ligament
What is the resting position of the intercarpal joints?
B) Either
What is the close-packed position of the intercarpal joints?
B) Extension
The pisotriquetral joint is considered separately because the pisiform sits on the triquetrum. The pisiform also does not take direct part in other intercarpal movements.
D) Both statements are true.
Which of the following is not true about the midcarpal joints?
A) On the lateral side, the scaphoid and lunate articulate with the trapezoid and trapezium, forming a compound sellar joint.
On the lateral side, the scaphoid articulates with the trapezoid and trapezium, forming a compound sellar joint.
As with the intercarpal joints, the midcarpal joints are bound together by dorsal and palmar ligaments. However, there are no interosseous ligaments between the proximal and distal rows of bones.
A) Both statements are true.
Therefore, greater movement exists at the midcarpal joints than between the individual bones of the two rows of the intercarpal joints.
What is the resting position of the midcarpal joints?
C) Slight flexion with ulnar deviation
What is the close-packed position of the midcarpal joints?
A) Extension with ulnar deviation
The proximal transverse arch that forms the carpal tunnel is formed by the proximal row of carpal bones. In this relatively rigid arch, the lunate acts as a central keystone structure.
C) Both statements are false.
The proximal transverse arch that forms the carpal tunnel is formed by the distal row of carpal bones. In this relatively rigid arch, the capitate acts as a central keystone structure.
The CMC joint of the thumb is sellar. Meanwhile, the CMC joints of the 2nd to 5th digits are condyloid.
A) Only the first statement is true.
The CMC joints of the 2nd to 5th digits are plane.
What is the resting position of the CMC joint of the thumb?
A) Both
What is the resting position of the CMC joints of the 2nd through 5th digits?
D) Midway between flexion and extension
What is the close-packed position of the 1st CMC joint?
C) Full opposition
What is the close-packed position of the 2nd through 5th CMC joints?
A) Full flexion
What is the capsular pattern of the 1st CMC joint?
B) Abduction followed by extension
Which of the following is not true about the MCP joints?
A) The capsular pattern of the MCP joints is more limitation of extension than flexion.
The distal transverse arch passes through the midcarpal joints. It has greater mobility than the proximal transverse arch allowing the hand to form or fit around different objects.
C) Only the second statement is true.
The distal transverse arch passes through the metacarpophalangeal joints.
True or False: The longitudinal arch follows the more rigid portion of the hand running from the carpals to the metacarpophalangeal joints.
False
The longitudinal arch follows the more rigid portion of the hand running from the carpals to the carpometacarpal joints.
If the MCP joints and the PIP joints of the fingers are flexed, they converge toward the ________.
B) Tubercle of scaphoid
This is sometimes referred to as a cascade sign. If the fingers do not converge, it usually indicates trauma to the digits that has altered their normal alignment.
What is the resting position of the interphalangeal joints?
B) Slight flexion
In the wrist and hand, effusion and synovial thickening are most evident on the _________ and __________ aspects.
D) Dorsal; radial
Bouchard nodes appear on the dorsal surface of the distal interphalangeal joints. Heberden nodes appear on the dorsal surface of the proximal interphalangeal joints.
D) Both statements are false.
Heberden nodes appear on the dorsal surface of the distal interphalangeal joints. Bouchard nodes appear on the dorsal surface of the proximal interphalangeal joints. Both are associated with osteoarthritis.
Sympathetic changes after nerve injury: mottled or cyanotic
D) Vasomotor
Sympathetic changes after nerve injury: (-) gooseflesh response
B) Both
Sympathetic changes after nerve injury: warm skin temperature
B) Early
All of the following may cause spoon-shaped nails, except:
C) Vitamin C deficiency
It should be iron deficiency. Other causes of spoon-shaped nails are local injury, developmental abnormality, and chemical irritants.
All of the following conditions may be associated with clubbed nails, except:
A) None of these
Which of the following is not a characteristic of the ape hand?
A) None of these
Wasting of which of the following muscles occurs in Bishop's hand?
C) Hypothenar eminence, all interossei, two medial lumbricals
In Bishop's hand or Benediction hand, wasting of the hypothenar eminence, the interossei, and the two medial lumbricals occurs because of ulnar nerve palsy.
Which of the following is not a characteristic of the Boutonniere deformity?
B) Results from rupture of lateral bands of extensor hood
Boutonniere deformity results from rupture of central tendinous slip of the extensor hood.
What is the primary deformity in Boutonniere deformity?
A) PIP joint flexion
Which of the following is incorrect about claw fingers?
B) This deformity is most often caused by ulnar nerve palsy.
This deformity is most often caused by a combined median ulnar nerve palsy.
Which of the following is not true about Dupuytren contracture?
C) None of these
In Dupuytren contracture, there is a fixed flexion deformity of the ___________ joints.
A) MCP and PIP
Which of the following is correct about extensor minus deformity?
D) None of these
Extensor plus deformity is caused by adhesions or shortening of the extensor communis tendon proximal to the MCP joint. It results in the inability of the patient to simultaneously flex the MCP and PIP joints, although they may be flexed individually.
Which of the following does not describe myelopathy hand?
A) This deformity is a dysfunction of the hand caused by cervical spinal cord pathology in conjunction with cervical spondylolysis.
This deformity is a dysfunction of the hand caused by cervical spinal cord pathology in conjunction with cervical spondylosis.
What is the primary deformity in swan neck deformity?
D) PIP joint extension
In swan neck deformity, there is flexion of the MCP and DIP joints, but the real deformity of the extension of the PIP joint.
Which of the following causes swan neck deformity?
A) Neither
Swan neck deformity may result from contracture of the intrinsic muscles or tearing of the volar plate and is often seen in patients with rheumatoid arthritis or following trauma.
The thickening of the flexor tendon sheath associated with trigger finger is called:
C) Notta's nodule
Trigger finger is also known as digital tenovaginitis stenosans.
Which of the following is not true about trigger finger?
A) A low-grade inflammation of the distal fold of the flexor tendon leads to swelling and constriction in the digital flexor tendon.
A low-grade inflammation of the proximal fold of the flexor tendon leads to swelling and constriction in the digital flexor tendon.
Trigger thumb is more common in:
B) Children
Which of the following does not describe ulnar drift?
D) It is commonly seen in patients with osteoarthritis.
Ulnar drift is commonly seen in patients with rheumatoid arthritis.
Which of the following describe the zigzag deformity of the thumb?
C) Both of these
Zigzag deformity is associated with rheumatoid arthritis.
Transverse lines or ridges marking repeated disturbances of nail growth
B) Beau lines
Beau lines may result from systemic diseases, toxic or nutritional deficiency states of many type, and trauma from manicuring.
Complete loss of nails
A) Defluvium unguium
Defluvium unguium is also known as onychomadesis (shedding of all the nails).
Nail plate thin, semitransparent bluish-white with a tendency to curve upward at the distal edge
D) Eggshell nails
Eggshell nails are associated with syphilis.
Nails very soft, split easily
A) Hapalonychia
Hapalonychia may result following contact with strong alkali, endocrine disturbances, malnutrition, syphilis, and chronic arthritis.
"Watch-glass nails" associated with drumstick fingers
B) Hippocratic nails
Hippocratic nails may be associated with chronic respiratory and circulatory diseases, especially pulmonary tuberculosis, or hepatic cirrhosis.
Nails are concave on the outer surface
A) Koilonychia
Koilonychia ("spoon nails") is associated with acromegaly, trauma, dermatoses, syphilis, nutritional deficiencies, and hypothyroidism.
White spots or striations or rarely the whole nail may turn white
B) Leukonychia
Leukonychia is associated with local trauma, hepatic cirrhosis, nutritional deficiencies, and many systemic diseases.
Transverse white bands on nails
D) Mees' lines
Mees' lines are associated with Hodgkin's granuloma, arsenic and thallium toxicity, high fevers, and local nutritional derangement.
Infections (usually paronychial) caused by yeast forms (Candida albicans)
D) Monoliasis of nails
Monoliasis of nails is occupational and is common in food-handlers, dentists, dishwashers, and gardeners.
Atrophy of failure of development of nails
B) Onychatrophia
Onychatrophia is associated with trauma, infection, dysendocrinism, gonadal aplasia, and many systemic disorders.
Nail plate is greatly thickened
A) Onychauxis
Onychauxis is associated with mild persistent trauma, systemic diseases, such as peripheral stasis, peripheral neuritis, syphilis, leprosy, and hemiplegia.
Inflammation of the nail matrix causing deformity of the nail plate
C) Onychia
Onychia is associated with trauma, infection, and many systemic diseases.
Any deformity of the nail plate, nail bed, or nail matrix
C) Onychodystrophy
Onychodystrophy is associated with trauma and chemical agents.
Extreme degree of hypertrophy, sometimes with horny projections arising from the nail surface
B) Onychogryposis
Onychogryposis ("claw nails") may be congenital or related to many chronic systemic diseases.
Loosening of the nail plate beginning at the distal or free edge
A) Onycholysis
Onycholysis is associated with trauma, injury by chemical agents, and many systemic diseases.
Longitudinal ridging and splitting of nails
A) Onychorrhexis
Onychorrhexis is associated with dermatoses, nail infections, many systemic diseases, senility, injury by chemican agents, and hyperthyroidism.
Extreme thickening of all the nails
D) Pachyonychia
In pachyonychia, the nails are more solid and more regular than in the onychogryposis. It is usually congenital and is associated with hyperkeratosis of the palms and soles.
Thinning of the nail fold and spreading of the cuticle over the nail plate
A) Pterygium unguis
Pterygium unguis is associated with vasospastic conditions, such as Raynaud phenomenon and occasionally with hypothyroidism.
"Opera glove" anesthesia is seen in hysteria, leprosy, and diabetes. It is a condition in which there is numbness from the forearm to the fingers.
B) Only the first statement is true.
It is a condition in which there is numbness from the elbow to the fingers.
The fixed segment of the hand consists of the following bones, except:
D) 4th metacarpal
The fixed segment consists of the distal row of carpals (trapezium, trapezoid, capitate, and hamate) and the second and third metacarpals. Movement between these bones is less than that between the bones of the mobile segment.
The mobile segment of the hand is made up of the following bones, except:
A) Third metacarpal
The mobile segment is made up of the five phalanges and the first, fourth, and fifth metacarpals.
The functional position of the wrist is extension to between 20° to 35° with ulnar deviation of 10° to 15°. Meanwhile, the position of wrist immobilization is further extension than is seen in the functional position with the MCP joints more extended and the IP joints flexed.
A) Only the first statement is true.
Meanwhile, the position of wrist immobilization is further extension than is seen in the functional position with the MCP joints more flexed and the IP joints extended. The functional position is sometimes called the position of rest.
The lateral prehension is also known as:
C) All of these
The loss of index finger function accounts for about ___ of hand function.
D) 20%
A patient is unable to fully extend, adduct, and internally rotate his shoulder due to a thoracodorsal nerve injury. Where can you palpate the insertion of the weak muscle?
D) Floor of bicipital groove
The pectoralis major inserts on the lateral lip of the bicipital groove, whereas the teres major inserts on the medial lip.
This muscle has an extensive origin from the whole lower shaft of the humerus and inserted by a tendon into the tuberosity of ulna below the coronoid process.
A) Brachialis
The sole concern of this muscle is elbow flexion.
B) Brachialis
What is the insertion of the brachialis?
B) Ulnar tuberosity
The brachialis insert on the tuberosity on ulna just below the coronoid process.
Which of the following is true about brachialis?
D) Its effectivity as an elbow flexor is unaffected by the position of the forearm.
The brachialis acts on this/these joint/s.
A) Humeroulnar joint
Which of the following is not true about swan neck deformity?
B) With weakness of extrinsic muscles, the PIP joint deforms into hyperextension.
With weakness of intrinsic muscles, the PIP joint deforms into hyperextension.
The only joint attachment of the upper extremity to the trunk is classified as:
B) Sellar
Sternoclavicular joint is classified as sellar or saddle.
Rockwood classification: acromioclavicular and coracoclavicular ligaments are ruptured.
D) 3
Rockwood classification: coracoclavicular ligament is sprained, while the acromioclavicular ligament remains intact
D) None of these
In grade 1, the acromioclavicular ligament is sprained, while the coracoclavicular ligament remains intact.
Rockwood classification: posterior displacement of clavicle
B) 4
Rockwood classification: 5
B) AC and CC ligaments torn with superior displacement of clavicle
Principal muscle/s involved in strong fist closure
B) Flexor digitorum superficialis
With progressive flexion of the wrist, the length-tension relationship of this muscle as a finger flexor diminishes.
A) Flexor digitorum profundus
Largest carpal bone situated in the proximal row
C) Scaphoid
Capitate is the largest carpal bone, but it is located in the distal row.
Carpal bone which forms the floor of the anatomic snuffbox
B) Navicular
The scaphoid (navicular) and trapezium (greater multangular) forms the floor of the anatomic snuffbox.
Which of the following structures form the anterior wall of the axillary triangle?
D) Pectoralis major and minor; subclavius
Which of the following structures form the posterior wall of the axillary triangle?
C) Subscapularis, latissimus dorsi, and teres major
Which of the following structures form the medial wall of the axillary triangle?
B) 4th and 5th ribs; serratus anterior
Which of the following structures form the lateral wall of the axillary triangle?
C) Coracobrachialis and biceps brachii
Which of the following structures does not form the apex of the axillary triangle?
B) 2nd rib
It should be 1st rib.
Which of the following is not true about the base of the axillary triangle?
D) Both of these
The anterior axillary fold is formed by the pectoralis major, whereas the posterior axillary fold is formed by the latissimus dorsi and teres major.
A PT attempts to palpate the lunate by moving his finger immediately distal to the Lister's tubercle. Which wrist motion will allow the therapist to facilitate the palpation of this carpal bone?
B) Flexion
The radial head is kept in its place by this structure.
A) Annular ligament
The annular ligament has firm, fibrous connections to the ulna, attaching it on the either side of the radial notch, anchoring firmly around the radial head and neck.
The A1 pulley, which is the most commonly affected in patients with trigger finger, is located at the:
D) MCP
The anconeus is responsible for:
C) All of these
Injury to this nerve produces this type of scapula winging, wherein the medial border of the scapula becomes closer to the midline and the inferior angle becomes medially rotated.
D) Long thoracic nerve
The long thoracic nerve is also known as the external respiratory nerve of Bell or posterior thoracic nerve.
Which of the following statements is incorrect?
C) None of these
According to Neer's classification, which of the following is not a characteristic of stage 1 rotator cuff injury?
D) None of these
Stage 1 is characterized by reversible inflammation, edema, and hemorrhage of bursa, subacromial space, and rotator cuff.
According to Neer's classification, which of the following is not a characteristic of stage 2 rotator cuff injury?
C) Reversible rotator cuff fibrosis and tendinitis
It should be irreversible rotator cuff fibrosis and tendinitis.
According to Neer's classification, which of the following is not a characteristic of stage 3 rotator cuff injury?
C) None of these
According to Neer's classification, what stage of rotator cuff injury involves rotator cuff arthropathy and progressive disability?
D) 4
Stage of rotator cuff injury which is common in individuals younger than 25 years old
D) 1
Stage 1 rotator cuff injury is usually managed conservatively.
Stage of rotator cuff injury requiring subacromial decompression
D) 2
Stage 2 is common in individuals aged 25 to 40 years.
Stage of rotator cuff injury which is common in individuals who are older than 40 years
A) 3
Stage of rotator cuff injury requiring rotator cuff repair
A) 3
Stage of rotator cuff injury requiring total shoulder replacement
B) 4
Stage 4 is common in individuals who are older than 60 years.
Which structure forms the inferior boundary of the quadrangular space?
C) Teres major
Which of the following forms the superior boundary of the quadrangular space?
D) Both
Anteriorly, the subscapularis forms the superior boundary. Posteriorly, the teres minor forms the superior boundary.
Which of the following forms the medial boundary of the quadrangular space?
C) Long head of triceps
Which of the following forms the lateral boundary of the quadrangular space?
C) Surgical neck of humerus
Which of the following passes through the quadrangular space?
A) Both
Strongest supinator of the forearm
D) Biceps brachii
Primary lateral rotator of the shoulder
A) Infraspinatus
All of the following are insertions of flexor carpi ulnaris, except:
B) Head of 5th metacarpal
It should be base of 5th metacarpal.
Which of the following statements is true about the elbow ligaments?
A) The fibers of the radial collateral ligament fuse with the fibers of the annular ligament.
The anterior fibers of the ulnar collateral ligament are stronger than the posterior fibers.
The oblique ligament attaches to the radial notch of ulna below the bicipital tuberosity.
The annular ligament prevents proximal radioulnar joint dislocation.
What structure in the elbow is affected in Panner's disease?
A) Capitulum
Panner's disease is an osteochondrosis of the capitellum or capitulum. It is primarily seen in boys aged 5 to 10 years.
The stability of the shoulder primarily depends on:
C) Muscles and ligaments
A patient with adhesive capsulitis of the glenohumeral joint will demonstrate limitation of motion when performing:
C) All of these
Adhesive capsulitis affects the whole capsule around the glenohumeral joint. Once the capsule is affected, all planes of motion of a particular joint will be limited.
Anterior dislocation of the shoulder is usually potentiated by the weakness of this muscle.
D) Subscapularis
Anterior shoulder dislocation usually occurs with repetitive shoulder abduction and external rotation. This mechanism of injury will be potentiated if there is weakness of the shoulder internal rotators.
With the forearm in fully pronated position, flexion of the elbow is carried out mostly by the:
C) Brachialis
Mechanism of anterior shoulder dislocation
C) Abduction and external rotation
Which of the following is true about mallet finger?
C) Baseball finger
Mallet or baseball finger presents with flexed DIP joint due to rupture of terminal extensor tendon.
The following joints are usually dislocated posteriorly, except:
D) None of the above
Superior: acromioclavicular
Anterior: glenohumeral
Posterior (posterolateral): humeroulnar
Anterior: lunate
Posterior: acetabulofemoral
Anterior: tibiofemoral
Lateral: patellofemoral
Posterior: talocrural
Mobile wad of Henry is composed of the following muscles, except:
A) Brachialis
It should be brachioradialis.
Most commonly involved muscle in lateral epicondylitis
D) Extensor carpi radialis brevis
Lateral epicondylitis is also known as tennis elbow.
Boxer's fracture
D) Neck of 5th metacarpal
The following are management strategies for golfer's elbow, except:
D) None of these
Little League's elbow is caused by:
A) Excessive valgus stress
Avascular necrosis of the distal lunate is known as:
C) Burn's disease
A patient complains of right shoulder pain since falling onto the right shoulder 3 weeks ago. There was no dislocation and x-rays were negative. AROM is 35° of flexion and abduction with scapular elevation noted. PROM is nearly full with mild pain and muscle guarding at end of range. Resisted abduction is weak with pain noted in the anterior and lateral deltoid region. There is no atrophy. Based on the above findings, the physical therapist should most likely suspect:
A) Rotator cuff tear
There is no limitation during PROM and this indicates the there is no problem with the joint. However, limitation during AROM indicates problem in either muscle or nerve. But since there is no atrophy, which is the hallmark of peripheral nerve injury, the best choice is rotator cuff tear.
A patient has been referred to PT for acute shoulder pain after shoveling snow in the driveway for 2 hours. Positive findings include pain and weakness with flexion of an extended upper extremity, as well as scapular winging with greater than 90° of abduction. The patient's problem is most likely the result of:
C) Compression of long thoracic nerve
Medial winging occurs due to weakness of the serratus anterior, which is innervated by the long thoracic nerve.
Olecranon impingement syndrome
C) Boxer's elbow
In nursemaid's elbow, the radial head was subluxed from the annular ligament because the position of the child's forearm is in:
I. Flexion
II. Extension
III. Supination
IV. Pronation
C) II and IV
A 9-year old baseball pitcher was referred to you for physical therapy, and your clinical findings revealed that the child has lateral elbow pain, a flexion contracture of 15°, and a slight elbow effusion. The medical charts also included a radiograph evaluation that showed focal lesions and loose bodies to the child's capitellum. What could be the primary diagnosis?
D) Osteochondritis of capitulum
Based on the demographics presented such as age, gender, and focal affectation of the capitellum, this is more likely to be osteochondritis of the capitellum. Capitellum is synonymous with capitulum.
Contracture of the palmar fascia commonly affects which digit?
D) 4th
Dupuytren's contracture commonly affects the 4th and 5th digits.
The patient was referred for an x-ray after a FOOSH injury. However, she was not diagnosed with any condition because nothing was seen in the x-ray, but pain and swelling still persist. Fracture of which bone commonly manifests with these findings?
D) Scaphoid
A repeat x-ray may be suggested 10-14 days after injury to see signs of healing or avascular necrosis.
Damage to FDP, resulting to inability to flex the distal phalanx
C) Jersey finger
Jersey finger is also known as basketball finger, whereas mallet finger is also known as baseball finger.
An examination of a patient reveals drooping of the shoulder, rotatory winging of the scapula, inability to shrug the shoulder, and complaints of aching in the shoulder. Based on these findings, what is the most likely cause of the patient's symptoms?
B) A lesion of the spinal accessory nerve
Spinal accessory nerve innervates the trapezius.
Acute olecranon bursitis
B) Student's elbow
Draftsman's elbow and miner's elbow are chronic olecranon bursitis.
Rupture of anteroinferior labrum
D) Bankart lesion
Most restrictive phase of frozen shoulder
B) III
Most painful phase of frozen shoulder
A) II
Which of the following conditions is the most common cause of anterior shoulder pain?
B) Subacromial impingement
What is the hallmark of Eulenberg deformity?
D) Limitation of shoulder abduction
Eulenberg deformity is also known as Sprengel's deformity.
All of the following tendons are affected in intersection syndrome, except:
D) EPL
The affected tendons in intersection syndrome are APL, EPB, ECRL, and ECRB.
A physical therapist is examining a patient who is complaining of pain in the left shoulder region. The examination of the shoulder elicits pain in the last 30° of shoulder abduction range of motion. This finding is most congruent with which diagnosis?
C) Acromioclavicular sprain
What is the mechanism of injury for tennis elbow?
A) Repetitive wrist extension
Repetitive wrist extension occurs in backhand swing.
Mechanical locking of A1 pulley is called:
B) All of these
The following findings are associated with posterior shoulder dislocation, except:
B) All of these
These findings are associated with anterior shoulder dislocation.
Which of the following limit/s inferior translation of the humerus when arms are at the side?
B) Superior glenohumeral ligament
The middle glenohumeral ligament provides anterior stability from 0°-45° of abduction and limits anterior and lateral translation of humeral head. Meanwhile, the anterior fibers of the inferior glenohumeral ligament limit anterior humeral head translation during abduction and lateral rotation whereas the posterior fibers limit posterior humeral head translation during abduction and medial rotation.
All of the following ligaments support the dependent arm, except:
D) None of these
In order to perform a grade III PJM on a patient with adhesive capsulitis, the physical therapist must first position the glenohumeral joint to its resting position. What is the resting position of the glenohumeral joint?
D) 30° horizontal adduction and 40° to 55° of abduction
What type of acromion is commonly associated with rotator cuff tears?
B) Type III
Type III is hooked acromion.
The presence of step deformity in the shoulder indicates the this ligament is torn.
A) Coracoclavicular ligament
The coracoclavicular ligament is the primary support of the acromioclavicular joint. It has two portions: the conoid (medial) and trapezoid (lateral), and they control the vertical motion of the clavicle.
This ligament primarily limits inferior translation and helps limit lateral rotation below 60° abduction.
C) Coracohumeral ligament
This ligament forms a roof over the bicipital groove to hold the long head of the biceps tendon within the groove.
C) Transverse humeral ligament
A biker falls on his left shoulder. The x-ray shows chipping of the lesser tubercle of the humerus. Which of the following muscles would most likely be damaged?
B) Subscapularis
The subscapularis inserts on the lesser tubercle of humerus, whereas the supraspinatus, the infraspinatus, and the teres minor insert on the greater tubercle.
In an anatomical resting position, the scapula lies in between what thoracic levels?
D) T2-T7
In anatomical resting position, the medial vertebral border of the scapula lies approximately 5-6 cm or 2-3 finger widths from the thoracic spinous processes.
This muscle is active during initiation of humeral abduction.
B) Supraspinatus
In normal abduction, the supraspinatus initiates the motion. However, in persons with supraspinatus paralysis or debilitating injury, the deltoid is able to abduct the humerus throughout the range of motion if the other functioning rotator cuff muscles are able to counteract the deltoid's superior translatory force.
Triceps activity is enhanced by:
B) Elbow extension with shoulder flexion
Which of the following statements apply to scapulohumeral mechanism?
D) The scapula rotates further to elevate the arm above the head.
At about 120° of arm abduction, the greater tuberosity of the humerus comes into contact with the lateral edge of the acromion process.
For every 3° of arm abduction, 2° occurs in the shoulder joint and 1° occurs by rotation of scapula.
SICK scapula, except:
A) Inferolateral border prominence
It should be inferomedial border prominence.
The functional position of the ulna includes the following, except:
A) Radial deviation to 5°
A patient sustains a gunshot wound in the infraclavicular region and later complains weakness in the arm. Upon examination, the only weakness that can be detected is elbow flexion and forearm supination. There is noted strip of hypesthesia along the radial border of the forearm. What nerve is most likely injured?
D) Musculocutaneous nerve
Musculospiral nerve is another name for radial nerve.
This nerve is necessary for power grips.
C) Ulnar nerve
This nerve is necessary for precision grips.
D) Median nerve
Rockwood classification: piano key sign
A) 3
In a midclavicular fracture, this structure protects the underlying vessels from being injured.
C) Subclavius
What is the site of the most frequent fracture of the upper end of the humeral shaft?
D) Surgical neck
Pisiform articulates with the:
D) Triquetrum
Pisiform only articulates with triquetrum.
The brachial artery enters the upper arm on the medial side of the humerus and is accompanied throughout its course by this nerve.
D) Median nerve
The axillary nerve can occasionally be injured where it passes through a muscle. Which muscle would this be?
B) Coracobrachialis
The following statements are true of the clavicle, except:
A) None of these
Which of the following muscles is not supplied by the median nerve?
D) Abductor pollicis longus
Abductor pollicis longus is innervated by the radial nerve.
Without posterior rotation component of the clavicle upon elevating the arm, should abduction will be limited to:
D) 110°
At <90° of shoulder elevation, the clavicle elevates as well. At 90° of shoulder elevation, the clavicle rotates posteriorly.
A therapist evaluates a patient with bicipital tendinitis. These clinical findings are expected, except:
C) There is referred pain in the C5-C6 dermatomes.
There should be no referred pain if a tendon is affected.
Which carpal bone serves as the bed of the pisiform?
C) Triquetrum
Pisiform lies on top of triquetrum.
To test this muscle, the proximal IP joint of the hand is stabilized.
D) Flexor digitorum profundus
The joints of the pectoral girdle include the following, except:
B) Coracoacromial
A patient reports pain lateral to the coracoid process. When palpating the shoulder to assess the possible cause of pain, starting at the coracoid process and moving laterally, the physical therapist should expect to find the following sequence of structures.
A) Lesser tuberosity, long head of biceps tendon, greater tuberosity
Stage 2 of CRPS
B) Mottled, cyanotic skin
Three months ago, a patient experienced a traumatic injury to the hand that resulted in surgical tendon repair and fracture stabilization. The therapist is planning a treatment program to address the tightness of the lumbricals. What exercises would be best to increase the range of motion of the hand?
C) The MCP joints are extended and the IP joints are flexed.
Lumbrical action is extension of the IP joint and simultaneous flexion of the MCP joint of 2nd through 5th digits. Therefore, the opposite motion of MCP extension and IP flexion would stretch the lumbricals.
Muscles of the digits that have their proximal attachments in the forearm or humerus are classified as:
C) Extrinsic muscles
The following statements describe clavicular motion, except:
A) The clavicle rotates at the sternoclavicular joint approximately 30° around its long axis.
The clavicle rotates at the sternoclavicular joint approximately 40° around its long axis.
Grade 1 anterior instability
B) 25%-50%
The brachialis is located deep to the:
C) Biceps brachii
Which of the following is not true about the palmar aponeurosis?
D) It can be present even if the palmaris brevis is absent.
The palmar aponeurosis can be present even if the palmaris longus is absent.
Stage of rotator cuff injury requiring shoulder hemiarthroplasty
C) 4
Following dislocation of the shoulder, a patient complains of weakness of the arm. Examination reveals weakness but not complete paralysis of the deltoid, as well as wrist and finger extensors. Where would the lesion most likely be located?
D) Posterior bord of brachial plexus
Tenosynovitis of the 1st dorsal compartment of the wrist is called:
C) Hoffman's disease
De Quervain's tenosynovitis is also known as Hoffman's disease or stenosis tenosynovitis. Stenosing tenovaginitis is another name for trigger finger.
A fracture of this bone typically involves the neck and may result in avascular necrosis
D) Navicular
Navicular is another name for scaphoid. Avascular necrosis of this bone is known as Preisser's disease.
Which of the following muscles does not attach to the humerus?
B) Pectoralis minor
The pectoralis minor inserts into the coracoid process, as well as 3rd, 4th, and 5th ribs.
All of the following are true about pectoralis minor, except:
D) It inserts into the inferior and medial border of the coracoid process of scapula.
It inserts into the superior and medial border of the coracoid process of scapula.
A razor slash at the anterior surface of the wrist will likely damage the:
A) Median nerve
Median nerve would be the most superficial nerve in the anterior portion of the wrist.
With the forearm in neutral position, flexion of the elbow is most likely carried out by the:
C) Brachioradialis
Which of the following is not true about the ulnar nerve?
D) The deep branch supplies the hypothenar muscles, the medial two lumbricals, the abductor pollicis, and all the interossei.
The deep branch supplies the hypothenar muscles, the medial two lumbricals, the adductor pollicis, and all the interossei.
Which of the following is not true about the median nerve?
C) As it passes the cubital fossa, it gives off a superficial branch known as the anterior interosseous nerve.
As the median nerve passes the cubital fossa, it gives off a deep branch known as the anterior interosseous nerve.
A forearm muscle that belongs to the extensor group but flexes the elbow is the:
B) Brachioradialis
Most mobile carpal bone
A) Navicular
Navicular is another name for scaphoid.
A physical therapist observes a patient from behind during bilateral shoulder abduction and notes that the patient's right scapula is more abducted than the left scapula at the end range of movement. Which of the following conditions is most likely the cause of altered scapula position on the right?
D) Restricted motion of glenohumeral joint
Tightness of the rhomboids major and minor would promote downward rotation of the scapula. Weakness of the serratus anterior, as well as the upper and lower trapezius, would limit upward rotation of the scapula. The most likely reason for the increase in scapular motion is restriction of the glenohumeral joint. To fully abduct the shoulder, the scapula and the glenohumeral joint both have to contribute to the motion. If the glenohumeral joint is restricted, the scapula has to increase its motion to accomplish the task.
Nearly two months ago, a patient noticed left shoulder pain after walking the dog. This pain has progressively worsened. The patient is now unable to move the left upper extremity overhead while performing ADLs. An orthopedic surgeon diagnosed the problem as adhesive capsulitis. The most effective direction for glenohumeral mobilization for this patient would be:
A) Posteroinferior translatory glides
Inferior glides will improve flexion and abduction (overhead motion). Posterior glides have been shown to be the most effective in increase external rotation. This is an exception to the convex-concave rule.
Inability to raise arm above 90° of shoulder flexion
B) Long thoracic nerve
Carrying angle is present when the:
B) Forearm is in supination
Carrying angle is present when the elbow is extended and the forearm is supinated.
Which of the following is true about brachial artery?
D) Both of these
The following are true about the shoulder joint, except:
A) The movement primarily occurs between the clavicle and scapula.
The movement primarily occurs between the humerus and scapula.
Medial boundary of the quadrangular space
C) Long head of triceps brachii muscle
The conoid and trapezoid ligaments connect the:
C) Coracoid and clavicle
The conoid and trapezoid ligaments are collective known as the coracoclavicular ligament.
Which of the following is not true about the anatomical snuffbox?
A) It is bounded laterally by the abductor pollicis brevis and extensor pollicis brevis tendons.
The anatomic snuffbox, also known as fovea radialis, is bounded laterally by the abductor pollicis longus and extensor pollicis brevis tendons.
A hack wound extending to the bone on the posteromedial aspect of the upper limb above the elbow joint will likely damage the:
B) Ulnar nerve
The following are associated with anterior shoulder dislocation, except:
D) Bennett lesion
Bennett lesion is associated with posterior shoulder dislocation.
The following statements apply to the bicipital groove, except:
D) It is more easily palpable if the shoulder is internally rotated.
Bicipital or intertubercular groove is more easily palpable if the shoulder is externally rotated.
The deltoids are innervated by the:
C) None of these
The deltoids are innervated by the axillary nerve (C5, C6).
This muscle forms the medial floor of the cubital fossa.
B) Brachialis
A patient with flaccid hemiplegia exhibits pain in the shoulder region secondary to inferior glenohumeral subluxation. Using electrical stimulation as orthotic substitution, where would it be best to place the electrodes?
D) Supraspinatus
EMG studies confirm that the supraspinatus prevents downward migration of the humeral head. Shoulder alignment problems (e.g. downwardly rotated scapula, relative abduction and internal rotation of humerus) also influence subluxation.
Closed-packed position: wrist extension with radial deviation
C) Both
Which ligament limits shoulder flexion and extension at the glenohumeral joint?
D) None of these
The coracohumeral ligament limits shoulder flexion and extension at the glenohumeral joint.
A physical therapist observes an infant exhibiting a high guard position when sitting. Which muscle would be the most essential for the infant to maintain this position?
A) Rhomboids
The rhomboids adduct and downwardly rotate the scapula. Their ability to adduct the scapula provides assistance to the trunk extensors when maintaining upright posture.
Which of the following is not expected of a patient with posterior shoulder dislocation?
B) None of these
Chief pronator muscle
B) Pronator quadratus
The pronator quadratus is single-jointed and its sole action is forearm pronation.
The axis form by the humeral shaft and ulna among men is normally:
A) 5°-10°
<5° cubital angle is called cubitus varus, whereas >15° cubital angle is called cubitus valgus.
A baseball pitcher was seen by a PT following surgical repair of a SLAP lesion of his pitching arm. In follow-up care, the therapist needs to pay attention to the pitching motion. The phase of the throwing motion that puts the greatest stress on the anterior labrum and capsule is:
C) Cocking
During the cocking phase, the arm is taken into end-range of humeral external rotation. At that point, the anterior aspects of the capsule and labrum are acting as constraints to prevent excessive anterior glide of the humerus.
Which of the following is not true about extensor digitorum communis?
D) None of these
Ulnar nerve paralysis will manifest with the following, except:
D) The thenar group does not function.
With ulnar nerve paralysis, the hypothenar group does not function. The thenar group is innervated by the median nerve.
What is the best initial intervention to improve functional mobility in an individual with stable humeral neck fracture?
C) Pendulum exercises
This individual will typically be immobilized in a sling for a period of 6 weeks. After 1 week, the sling should be removed to have the patient perform pendulum exercises to prevent shoulder stiffness.
Which of the following is not true about the acromioclavicular joint?
A) The range of motion of the scapula is equal to the sum of the glenohumeral and sternoclavicular ranges of motion.
The range of motion of the scapula is equal to the sum of the acromioclavicular and sternoclavicular ranges of motion.
No man's island
A) Flexor zone 2
Flexor zone 2 is the insertion of the flexor digitorum superficialis.
Pull/s the scapula upward, medially, and posteriorly
C) All of these
The elbow flexors would be at best advantage at:
D) 90° elbow flexion
The lunate recedes during which wrist motion?
D) Extension
A patient presents with a cubital angle of <5°. This deformity is known as:
A) Gunstock deformity
A cubital angle of <5° is called cubitus varus or Gunstock deformity.
This carpal bone acts as the primary restraint to wrist hyperextension.
C) Scaphoid
Scaphoid is also known as navicular.
The axis for wrist flexion-extension changes in positions of flexion and extension because of the complex movements of this carpal bone during these motions.
C) Scaphoid
Scaphoid is also known as navicular.
2nd most commonly dislocated carpal bone
D) Triquetrum
Lunate is the most commonly dislocated carpal bone.
2nd carpal bone to ossify
B) Hamate
The carpal bones ossify in this order:
Come: Capitate
Home: Hamate
To: Triquetrum
Luneta: Lunate
Lateral attachment/s of the extensor retinaculum
B) Distal end of radius
The extensor retinaculum is attached medially to the pisiform and the hook of hamate and laterally to the distal end of the radius. The upper and lower borders of the retinaculum are continuous with the deep fascia of the forearm and hand, respectively.
The scaphoid and trapezium are the lateral attachments of the flexor retinaculum.
Artery that passes through the anatomic snuffbox
B) Radial artery
The floor of the cubital fossa is formed by the brachioradialis and pronator teres. The median nerve is its most medial content and the superficial branch of the radial nerve is its most lateral content.
B) Both statements are false.
The floor of the cubital fossa is formed by the supinator and brachialis. The median nerve is its most medial content and the deep branch of the radial nerve is its most lateral content.
Which of the following is true about the roof of the cubital fossa?
C) Both of these
While playing volleyball, a varus force was applied to your elbow leading to a torn ligament. As a PT student, you know the following statements are true about the torn ligament, except:
A) One of its attachment is from medial epicondyle to supinator crest.
One of the attachments of the lateral (radial) collateral ligament is from lateral epicondyle to supinator crest.
The following are true about annular ligament, except:
B) It limits spinning of the radial head.
The quadrate ligament limits spinning of the radial head.
Which of the following is not true about the subclavius muscle?
A) It inserts on the inferior surface of the medial third of the clavicle.
The subclavius inserts on the inferior surface of the middle third of the clavicle.
The arcade of Frohse may compress the:
D) Posterior interosseous nerve
Posterior interosseous nerve is a pure motor branch of the radial nerve. It can be compressed by the following:
Monteggia fracture
Arcade of Frohse
Radial head resection
Vascular leash of Henry
Elbow dislocation
Supinator spasm
Synergists of finger flexors
D) Wrist extensors
All of the following are primary wrist extensors, except:
B) Extensor digitorum
Extensor digitorum, extensor indicis, extensor digiti minimi, and extensor pollicis longus are secondary wrist extensors.
Which of the following sequences most accurately depicts the most common to the least common part of scaphoid to be involved upon its fracture?
Scaphoid fracture commonly occurs following FOOSH injury.
The following may lead to musculocutaneous nerve injury, except:
C) None of these
The musculocutaneous tunnel syndrome is purely sensory.
The following nerves will be affected in Erb-Duchenne palsy, except:
C) Subscapular nerve
It should be suprascapular nerve.
In Erb-Duchenne palsy, the following conditions apply, except:
A) Injuries result from excessive displacement of the head and depression of the shoulder to the opposite side.
Erb-Duchenne palsy result from excessive displacement of the head to the opposite side and depression of the shoulder to the same side.
The tendon can be isolated by holding the subject's finger in extension and flexing the finger in question at the IP joint. If the finger can be flexed at the specified joint, the tendon is intact.
B) Flexor digitorum superficialis
Sensation to the middle finger is supplied by neurologic level:
The stability of the wrist joint primarily depends on:
B) Ligaments
The palmar radiocarpal ligament is stronger than the dorsal radiocarpal ligament.
Which of the following is not true about the brachioradialis?
A) None of these
Primary elbow flexor, especially during rapid movement
C) Brachioradialis
The following statements describe the carrying angle, except:
A) As the ulna swings round the trochlea from flexion to extension, the trochlea is gradually forced lateralwards.
As the ulna swings round the trochlea from flexion to extension, the ulna is gradually forced lateralwards.
The following are true about the palmar prehension pattern, except:
A) In a glass jar, the entire palmar surface of the hand grasps around it, and the thumb closes in over the glass.
This describes a cylindrical grasp.
The only prehension pattern that can be observed in a patient with median nerve injury.
A) Lateral pinch
Lateral pinch is possible because of the intact adductor pollicis.
A1 pulley that is usually affected in patients with trigger finger is located at the:
C) Head of metacarpal
A1 pulley: head of metacarpal
A2 pulley: middle of proximal phalanx
A3 pulley: distal proximal phalanx
A4 pulley: middle of middle phalanx
A5 pulley: proximal distal phalanx
What is the second largest carpal bone?
C) Scaphoid
Scaphoid is also known as navicular. The largest carpal bone is the capitate.
What is the second smallest carpal bone?
D) Trapezoid
Trapezoid is also known as lesser multangular. The smallest carpal bone is pisiform.
What is the required range of motion for ulnar deviation of the wrist to become fully functional?
D) 30°
Wrist flexion: 40°
Wrist extension: 40°
Wrist radial deviation: 10°
The following statements are true about the forearm pronators:
I. The pronator teres is supplied by the ulnar nerve.
II. When the forearm is pronated slowly without resistance with the elbow in extension, the pronator quadratus acts.
III. The pronator teres is the strongest of the pronators.
IV. Palmaris longus, flexor carpi radialis, and extensor carpi radialis longus assists in pronating the forearm.
V. The shortening distance of the pronator quadratus is large.
B) II, III, IV
The pronator teres is supplied by the median nerve.
The shortening distance of the pronator quadratus is short.
Which of the following is true about wrist motions?
B) Upon wrist flexion, most of the motion comes from the radiocarpal joint with minimal contribution from the midcarpal joint.
Upon wrist extension, most of the motion comes from the midcarpal joint with minimal contribution from the radiocarpal joint.
Strongest hand prehension position is provided by:
A) Cylindrical prehension
Cylindrical prehension uses almost all the muscles of hands and fingers.
Second most commonly fractured carpal bone
C) Lunate
Second most commonly involved tendon in tennis elbow
D) Extensor digitorum communis
Extensor carpi radialis brevis is the most commonly involved in tennis elbow due to its origin at the lateral epicondyle of humerus.
A 27-year old baseball player is hit on his forearm by a high-speed ball during the World Series. The muscles that form the floor of the cubital fossa appear to be torn. Which of the following muscles have lost their functions?
D) Brachialis and supinator
The brachialis forms the medial part of the floor, whereas the supinator forms the lateral part.
Which of the following is not true about the cubital angle?
D) None of these
A 24-year old carpenter suffered a crush injury of his entire little finger. Which of the following muscles is most likely to be spared?
C) Dorsal interosseous
The dorsal interossei abduct the fingers. The little finger has no attachment for the dorsal interosseous muscle because it has its own abductor, the abductor digiti minimi. Therefore, the dorsal interosseous muscle not affected. The other muscles are attached to the little finger; thus, they are injured.
The palmar aponeurosis is a triangular, fibrous layer overlying the tendons in the palm and is continuous with the following structures, except:
C) None of these
The palmar aponeurosis is continuous with the palmaris longus tendon, the thenar and hypothenar fasciae, the flexor retinaculum, and the palmar carpal ligament.
The palmar aponeurosis protects the following structures, except:
A) Deep palmar arterial arch
It should be superficial palmar arterial arch.
This muscle is palpated by positioning the elbow and forearm in relaxed flexion and pronation, respectively, and palpating deep to the brachioradialis, ECRL, ECRB on the lateral aspect of the proximal radius. Where does this muscle insert?
D) Lateral surface of the proximal radius just below the head
The muscle being pertained to is the supinator.
This bony landmark in the elbow serves as the proximal attachment site for a primary forearm pronator, a major stabilizing ligament, and for most wrist and finger flexors.
C) Medial epicondyle of humerus
The medial epicondyle serves as an attachment for the pronator teres, the medial (ulnar) collateral ligament, and for most wrist and finger flexors.
A seated individual with C7 SCI who wants to perform activities that involve cutting food, performing a push-up, or opening a door compensate for the elbow extension function of the triceps brachii by:
C) Performing concentric and eccentric contractions of the biceps brachii and brachialis muscles
An individual with C7 SCI has lost innervations to his/her anconeus and wrist extensors.
The muscle belly of the extensor carpi radialis longus can be located by palpating the origin of the brachioradialis and moving proximally. Another way is palpating at the supracondylar ridge of the humerus and moving posteriorly.
B) Both statements are false.
The muscle belly of the extensor carpi radialis longus can be located by palpating the origin of the brachioradialis and moving distally. Another way is palpating at the supracondylar ridge of the humerus and moving anteriorly.
The biceps brachii and the brachialis are best suited to generate large amounts of elbow force, whereas the brachioradialis is most active under certain conditions. The pronator teres is a rather weak flexor.
B) Both statements are true.
The biceps brachii and the brachialis are the primary elbow flexors, whereas the pronator teres is only secondary.
A patient was referred to physical therapy following removal of a long arm cast extending to the forearm. She lacks full passive elbow extension. What may be causing this problem?
B) Passive insufficiency of the pronator teres
The pronator teres is a polyarticular muscle crossing anterior to the elbow joint.
The following are not part of the triangular fibrocartilage complex of the wrist, except:
D) Dorsal radioulnar ligament
The triangular fibrocartilage complex of the wrist consists of the dorsal radioulnar ligament, the volar radioulnar ligament, the ulnar collateral ligament, the ulnar articular cartilage, the ulnocarpal meniscus, and the sheath of ECU.
In abduction of the 2nd MCP joint, it moves in a __________ roll and ___________ glide.
A) Lateral; lateral
Arthrokinematic motion in abduction and adduction of the MCP joints have roll and slide occurring in the same direction. During flexion and extension of the MCP and IP joints, the arthrokinematic roll and slide also occur in the same direction since the proximal aspects of these joints are convex and the distal aspects are concave.
The keystone of the distal transverse arch is the middle finger. Meanwhile, the keystone of the longitudinal arch is the capitate.
B) Only the first statement is true.
The keystone of the proximal transverse arch is the capitate, whereas the keystone of the longitudinal arch are the 2nd and 3rd fingers.
The following are not true about the small intrinsic muscles of the hand, except:
A) The interossei rotate the finger to fit the surface of the object and strengthen the grip.
The palmaris brevis corrugates the skin to improve the grip of the palm.
The lumbricals do not participate in the grip.
The interossei are found to have high levels of activity in pinching, grasping, and power grip.
It is the area where the primary repair of the flexor tendons is contraindicated.
B) Zone 2
Zones of Flexor Tendon Injury
Zone
Boundary
1
Distal to insertion of FDS
2
Distal palmar crease
3
Distal to the distal edge of transverse carpal ligament
4
Carpal tunnel
5
Distal portion of forearm
Used for powerful grasp of objects
A) Fist grip
The hook grip is used to support or carry an object.
The lateral pinch grip is used to grip small objects that are placed between the thumb and the index finger.
The tip-to-tip grip is used to pick up and manipulate small objects.
These pulleys prevent bowstringing of the long flexor tendons during flexor activity and are attached on the shafts of the phalanges and cross to form distal attachments on the volar plates of PIP and DIP joints.
A) Cruciate pulleys
Both annular and cruciate pulleys prevent bowstringing of the long flexor tendons during flexor activity. However, the annular pulleys are attached to the shaft of the proximal and distal phalanges and to the sides of the volar plates of the MCP, PIP, and DIP joints at the junction with the extensor hood and the retinaculum.
The coracohumeral originates on the coracoid process of scapula and inserts into the ______________ of humerus.
D) Both
Intramuscular contusions take longer to resolve and have greater inflammatory response than intermuscular contusions. In addition, these injuries have higher incidence of compartment syndrome and myositis ossificans.
C) Both statements are true
Contusions occurring between the muscles tend to disperse more easily along the fascial plains and result in earlier return to function.
The glenoid labrum contributes about ____ of the glenohumeral stability with the joint loaded.
C) 20%
The anterior forces when the arm is abducted to 90° are mainly counteracted by the:
D) Inferior glenohumeral ligament
At angles closer to the body, the middle glenohumeral ligament plays a larger role.
The area most likely to be involved in a traumatic dislocation of the shoulder is:
D) Inferior glenohumeral ligament
Most shoulder dislocations occur in an anterior plane when the arm is abducted, thereby indicating that the area most likely to be involved in a traumatic dislocation is the inferior glenohumeral ligament.
What is the mechanism of injury for posterior shoulder dislocation?
D) FADDIR
The position of the humerus that places the glenohumeral joint at greatest risk for posterior dislocation are flexion, adduction, and internal rotation.
AC joint sprain usually occurs from a:
C) Both
Pain over the joint and increased joint mobility are frequently noted.
Which of the following is not true about acromioclavicular joint sprain?
B) None of these
Grade of AC joint sprain defined as pain at the joint; however, the ligaments are intact, and there is no subluxation of the joint
D) Grade 1
Grade of AC joint sprain which involves entrapment of the distal clavicle in the surrounding muscles
C) Grade 6
Grade 6 AC joint sprain involves anteroinferior displacement of the clavicle.
Typically, grades 1 to 3 AC joint sprains are treated conservatively, whereas grades 4 to 6 require reconstruction. Reconstruction can also be considered in individuals with persistent pain from a grade 2 injury.
C) Only the first statement is true.
Reconstruction can also be considered in individuals with persistent pain from a grade 3 injury.
In a grade 1 AC joint sprain, weight loading of the joint is avoided for about:
C) 6 weeks
Rupture of the bicipital tendon most commonly affects the distal portion of the long head. Symptoms range from discomfort and weakness to a painful snap.
A) Only the second statement is true.
Rupture of the bicipital tendon most commonly affects the proximal portion of the long head.
Which of the following bursae separate/s the rotator cuff from the acromial arch?
C) All of these
The subacromial bursa can become inflamed in the younger athlete by direct trauma or in the older individual with overuse and cuff problems.
According to Kibler, scapular dyskinesis is defined as the loss of control in the motion of scapula with respect to:
C) External rotation and retraction
Imaging modality that is highly specific for full-thickness rotator cuff tears
C) MRI with T2-weighted images
Imaging modality of choice if a labral tear is suspected
D) MRI arthrogram
Clinically, adhesive capsulitis should be suspected with progressive loss of range and diffuse pain despite conservative treatment measures. Middle-aged men and diabetic patients appear to be at a higher risk for spontaneous idiopathic adhesive capsulitis.
D) Only the first statement is true.
Middle-aged women and diabetic patients appear to be at a higher risk for spontaneous idiopathic adhesive capsulitis.
Plexus injuries typically occur as a result of compression-type injuries. Sports-related injuries to the plexus are typically neuropraxic and have a good prognosis.
B) Only the second statement is true.
Plexus injuries typically occur as a result of traction-type injuries.
This nerve courses in front of the subscapularis muscle and passes along the lower part of the capsule along with the posterior circumflex vessels.
D) Axillary nerve
Axillary nerve is at greatest risk with dislocations of the shoulder and fracture of the surgical neck of the humerus.
This nerve is sensitive to entrapment at the notch and along the spine of the scapula.
C) Suprascapular nerve
The suprascapular nerve may be entrapped in the suprascapular notch or spinoglenoid notch.
This nerve can be injured by either a direct blow to the neck of thorax or by repetitive and prolonged pressure at the base of the neck.
C) Long thoracic nerve
This can be seen with backpacks or briefcases being carried on one shoulder.
The following are possible sites of impingement in thoracic outlet syndrome, except:
D) Supraclavicular space
Entrapment may be noted at the scalene muscles, along the 1st rib in the subclavicular space, or in the infraclavicular space along the coracoid and pectoralis minor.
The following are part of exercise prescription for thoracic outlet syndrome, except:
C) None of these
True or False: Isometrics are not allowed in rotator cuff repairs in the early phases of rehabilitation.
True
Isometrics can be introduced usually at the 6-week post-operative period.
The ulnohumeral joint is the primary articulation in the elbow. It is a single-axis, hinged joint allowing for 150° of flexion.
A) Both statements are true.
Meanwhile, the radiohumeral and proximal radioulnar articulations allow for axial rotation and can be considered pivot-type joints.
Most patient with tennis elbow present with localized tenderness over the common forearm extensor tendon insertion at the lateral epicondyle, often extending into the extensor mass. Less commonly, there is discomfort over the radiohumeral joint and quadrate ligament.
B) Only the first statement is true.
Less commonly, there is discomfort over the radiohumeral joint and annular ligament.
All of the following are possible sources of lateral elbow pain, except:
B) Anterior interosseous nerve compression
It should be posterior interosseous nerve compression.
To reduce the occurrence of lateral epicondylitis among tennis players, the following corrective strategies may be employed, except:
A) Wearing a counterforce arm brace
It should be wearing a counterforce forearm brace. Other corrective strategies include using a two-handed backhand and using the largest, comfortable grip.
Surgery is generally reserved for chronic lateral epicondylitis that are unresponsive to conservative management and are associated with significant limitations in functional performance. The approach most commonly involves debridement of the degenerative granulation tissue adjacent to the extensor carpi radialis longus insertion and partial release of the common extensor aponeurosis.
B) Only the first statement is true.
The approach most commonly involves debridement of the degenerative granulation tissue adjacent to the extensor carpi radialis brevis insertion and partial release of the common extensor aponeurosis.
In medial epicondylitis, the symptoms are typically reproduced with:
B) Both of these
In lateral epicondylitis, the symptoms can be reproduced with:
D) Resisted wrist and middle finger extension
The symptoms of lateral epicondylitis can be reproduced with resisted wrist and middle finger extension, as well as passive wrist flexion with elbow extension.
The differential diagonosis for medial elbow pain includes the following, except:
B) Posterior interosseous nerve entrapment
It should be anterior interosseous nerve entrapment (pronator teres syndrome).
Which of the following is not true about olecranon bursitis?
A) Aspiration may be indicated in a severly swollen sterile bursa, and in acute conditions, surgical excision may be necessary.
In chronic conditions, surgical excision may be necessary.
Pain associated with triceps tendinitis can be reproduced with:
B) Resisted elbow extension
Pain associated with triceps tendinitis can be reproduced with resisted elbow extension, as well as passive elbow flexion with shoulder forward flexion.
This nerve is well protected in the upper arm behind the medial head of the triceps and, except for associated trauma in the presence of humeral shaft fractures, is relatively spared of injury in the upper arm.
D) Ulnar nerve
As the ulnar nerve emerges into the cubital tunnel, it becomes more superficial and susceptible to trauma and repetitive overuse. In cubital tunnel syndrome, the ulnar nerve is particularly vulnerable as it passes through the fibrous arch connecting the two head of extensor carpi ulnaris.
B) Only the first statement is true.
In cubital tunnel syndrome, the ulnar nerve is particularly vulnerable as it passes through the fibrous arch connecting the two head of flexor carpi ulnaris.
Which of the following muscles is spared in cubital tunnel syndrome?
B) Medial half of flexor digitorum profundus
Even though the branches of the ulnar nerve to the flexor carpi ulnaris and medial half of flexor digitorum profundus originate below the cubital tunnel, these muscles are often spared in cubital tunnel syndrome, as the nerve fascicles to the intrinsic hand muscles tend to be most affected.
Ligament of Struthers is a fibrous band that attaches to an anomalous supracondylar spur. This represents a potential, albeit, rare site of ulnar nerve compression.
B) Only the first statement is true.
Ligament of Struthers represents a potential, albeit, rare site of median nerve compression.
Lesions of the median nerve at this level may be associated with pain at the medial elbow, distal sensory symptoms, and weakness below the level of the lesion, including the pronator teres.
D) Ligament of Struthers
Weakness of the pronator teres often distinguishes compression at the ligament of Struthers from pronator teres syndrome.
The anterior interosseous nerve, a pure motor branch of the median nerve, emerges below the two heads of pronator teres. Compression of this nerve against the accessory muscle involving the flexor pollicis longus and flexor digitorum superficialis has been reported.
A) Both statements are true.
The accessory muscle is known as the Gantzer muscle.
The subacromial space is defined by the following, except:
D) Acromion, subacromial bursa, and coracohumeral ligament above
It should be acromion, subacromial bursa, and coracoacromial ligament above.
The "wringing out" phenomenon seen in rotator cuff tendinopathy refers to the creation of a hypovascular region in this tendon when the arm is held in abduction.
B) Supraspinatus
The finger flexor tendons of the hand are enclosed by a synovial sheath that extends from the:
A) Metacarpal bones to DIP joints
In trigger finger, there is inflammation and thickening of the tenosynovium or pulleys, leading to tendon nodule formation. These changes compromise the smooth gliding motion of the tenosynovium above the pulleys and the involved digit may even become locked in a flexed position.
A) Only the first statement is true.
These changes compromise the smooth gliding motion of the tenosynovium under the pulleys and the involved digit may even become locked in a flexed position.
The trigger finger is caused by:
B) All of these
Pain associated with trigger finger may be aggravated by ____________ of the involved digit.
B) Both of these
What hand motions precipitate de Quervain's tenosynovitis?
B) Thumb flexion and wrist ulnar deviation
Orthotic device/s for Hoffman's disease
D) Both of these
Both orthoses aim to further limit the motion and rest the APL and EPB tendons.
Which of the following is not true about the hand-arm vibration syndrome?
B) Grip strength may be reduced due to weakness of finger flexors or extrinsic hand muscles.
Grip strength may be reduced due to weakness of finger flexors or intrinsic hand muscles.
Entrapment of the median nerve can occur at the following points, except:
D) Thickened or fibrous portion of FDP
It should be thickened or fibrous portion of FDS. Lacertus fibrosus is a thickened aponeurosis from the biceps tendon to the flexor forearm mass.
Which of the following muscles become weak in pronator teres syndrome, but are unaffected in carpal tunnel syndrome?
D) Both
In addition, the distribution of sensory abnormality will include the thenar eminence in pronator teres syndrome. This area is spared in carpal tunnel syndrome.
Entrapment of the median nerve at the ligament of Struthers and at the lacertus fibrosus can be accentuated by:
A) Resisted full elbow flexion or resisted supination
Entrapment of the median nerve at the pronator teres can be resisted by:
A) Resisted forearm pronation
The pronator teres is only a weak elbow flexor.
Entrapment of the median nerve at the fibrous portion of the flexor digitorum superficialis can be accentuated by:
B) Resisted middle finger flexion
The second most common entrapment syndrome in the upper limb is:
B) Cubital tunnel syndrome
The most common entrapment syndrome in the upper limb is the carpal tunnel syndrome.
This ligament bridges across the two head of flexor carpi ulnaris.
D) Ligament of Osborne
The arcuate ligament of Osborne is a possible entrapment site for the ulnar nerve.
Elbow motion causes the arcuate ligament to become taut, the flexor carpi ulnaris to tighten, and the ulnar collateral ligament of the elbow to buckle and encroach into the cubital tunnel. 45% narrowing of the cubital tunnel volume occurs during elbow flexion.
B) Only the first statement is true.
55% narrowing of the cubital tunnel volume occurs during elbow flexion.
The combined movements of shoulder abduction, elbow flexion, and wrist extension result in the greatest increase in ______________ pressure.
A) Cubital tunnel
This is known as the elbow flexion test.
Categories of thoracic outlet syndrome include the following, except:
C) Coracoclavicular syndrome
It should be costoclavicular sydrome.
In the neck, the subclavian artery travels along the upper trunk of the brachial plexus between the anterior and middle scalenes. The subclavian vein typically passes anteriorly to the anterior scalene, but in some cases, may also travel along with the subclavian artery.
D) Only the second statement is true.
In the neck, the subclavian artery travels along the lower trunk of the brachial plexus between the anterior and middle scalenes.
All of the following may cause thoracic outlet syndrome, except:
A) None of these
In mild cases of carpal tunnel syndrome, there may be an absence of electromyographic and nerve conduction changes. As symptoms progress, sensory distal latency is usually the first abnormal EMG finding.
B) Both statements are true.
Which of the following is not true about the carpal tunnel?
C) The arch is covered by a thick fibrocartilaginous band called the extensor retinaculum.
The arch is covered by a thick fibrocartilaginous band called the flexor retinaculum or transverse carpal ligament.
Normal pressure within the carpal tunnel is 7 to 8 mm Hg with the wrist in neutral. Increased pressure of 30 mm Hg can result in symptoms of carpal tunnel syndrome and 90 mm Hg can be observe with wrist flexion and extension.
C) Both statements are true.
If abnormally increased pressure in the carpal tunnel continues, segmental demyelination of the median nerve occurs. The motor fibers are the first to be affected owing to their extensive myelination and high metabolic demands.
A) Only the first statement is true.
The sensory fibers are the first to be affected owing to their extensive myelination and high metabolic demands. Prolonged pressure causes injury to the motor fibers, and weakness ensues.
The prevalence of the carpal tunnel syndrome increases with the following, except:
B) Hyperthyroidism
It should be hypothyroidism. The prevalence of CTS also increases with pregnancy, inflammatory arthritis, acromegaly, and intake of corticosteroids and estrogens.
Most common association of carpal tunnel syndrome
B) Diabetes
___ radiculopathies are often confused with carpal tunnel syndrome because the sensory symptoms involve the radial aspect of the hand.
D) C6
All of the following are possible interventions for trigger finger, except:
B) A2 pulley release
It should be A1 pulley release.
All of the following are signs and symptoms of digital tenovaginitis stenosans, except:
B) Locking of digits in extension
It should be locking of digits in flexion. Digital tenovaginitis stenosans is another name for trigger finger.
All of the following are possible interventions for washerwoman's disease, except:
B) None of these
Washerwoman's disease is another name for de Quervain's tenosynovitis.
Which of the following characterize Dupuytren's contracture?
B) Superficial palmar nodules
Dupuytren's contracture is characterized by superficial palmar nodules and painless flexion contractures. It is managed with collagenase injection or surgical release.
All of the following can be observed in carpal tunnel syndrome, except:
A) None of these
Carpal tunnel syndrome can be managed with splint, activity modification, cortisone injection, and surgical release.
Which of the following is not a manifestation of the cubital tunnel syndrome?
A) Positive Tinel's sign at the wrist
It should be positive Tinel's sign at the elbow.
Which of the following is not an intervention for cubital tunnel syndrome?
D) None of these
Which of the following characterize basilar thumb degenerative joint disease?
C) Both
Interventions for basilar thumb degenerative joint disease include splint, activity modification, NSAIDs, cortisone injection, and surgical reconstruction.
Corticosteroid injections into the carpal tunnel are recommended if splinting and other conservative measures fail to reduce the symptoms. These injections are performed in a sterile fashion with needle placement ulnar to the:
A) Palmaris longus
In performing corticosteroid injections into the carpal tunnel, the needle is directed:
C) Dorsally, distally, and radially at a 45° angle
The areas of ulnar nerve compression about the elbow include the following, except:
D) Superficial flexor aponeurosis
It should be deep flexor aponeurosis.
Compression of the ulnar nerve at Guyon's canal may be secondary to:
D) Both of these
Thrombus of the ulnar artery is known as the hypothenar hammer syndrome.
Entrapment of the ulnar nerve at the Guyon's canal spares the:
A) Wrist muscles
Entrapment of the ulnar nerve at the Guyon's canal spares the wrist muscles and the dorsal hand cutaneous sensation.
There are three major categories of surgical treatment considered for ulnar neuropathy at the elbow. The first category involves:
C) Decompression of the ulnar nerve usually combined with medial epincondylectomy
Meanwhile, the second and third categories involve subcutaneous and submuscular transposition of the ulnar nerve, respectively. These transpositions place the ulnar nerve anterior to the medial epicondyle, protecting it from direct trauma and from stretching.
Basilar thumb osteoarthritis is the most common symptomatic arthropathy of the hand. Ligamentous laxity plus axial loading of the MCP joint of the thumb are thought to be major contributors to the development of this condition.
C) Only the first statement is true.
Ligamentous laxity plus axial loading of the CMC joint of the thumb are thought to be major contributors to the development of this condition. The most important ligament of the CMC joint of the thumb is the so-called beak ligament or deep anterior oblique ligament.
Grade of basilar thumb osteoarthritis with normal joint space
C) 1
Grade
Characteristic/s
1
Normal joint space
2
Decreased joint space
3
Decreased joint space; osteophytes; sclerosis
A5
Decreased joint space; osteophytes; sclerosis; involvement of scaphotrapezial joint
The greater the distance between the thumb and the fingertip, the less pressure there is on the CMC joint. Therefore, enlarging the grip of tools or objects is a possible activity modification for patients with basilar thumb osteoarthritis.
D) Both statements are true.
One of the surgical options for the basilar thumb degenerative joint disease is the complete or partial excision of the trapezium. The base of the first metacarpal is then reattached to the carpus using a tendon slip from the flexor carpi radialis, the abductor pollicis brevis, or the extensor pollicis brevis.
D) Only the first statement is true.
he base of the first metacarpal is then reattached to the carpus using a tendon slip from the flexor carpi radialis, the abductor pollicis longus, or the extensor pollicis brevis.
Anchovy procedure
C) Basilar thumb osteoarthritis
In refractory cases of basilar thumb DJD, the trapezium is wholly or partially excised. The remaining tendon slip is used as a cushion to fill in the gap left by the trapezium. This is known as the ligamentous reconstruction tendon interposition or the "anchovy" procedure.
A patient with a basilar thumb DJD who requires a large amount of grip strength and durability is recommended to undergo:
B) Arthrodesis
The tendon reconstruction requires 6 months of recovery and often results in 60% to 70% of normal grip and pinch strength.
Pain associated with de Quervain's tenosynovitis is elicited with:
C) Both of these
The annular and cruciate pulleys:
B) Both of these
Which of the following is not true about the trigger finger?
D) None of these
Which of the following is not a characteristic of the DIP joint?
A) Its volar surface is covered by a thick volar plate, which has small amount of laxity allowing 50° to 60° of hyperextension.
The volar surface of the DIP joint is covered by a thick volar plate, which has small amount of laxity allowing 40° to 50° of hyperextension.
Which of the following is not true about mallet finger?
D) At times, the still intact extensor tendon may draw the avulsed fragment proximally as far as the base of the middle phalanx.
At times, the still intact extensor tendon may draw the avulsed fragment proximally as far as the midshaft of the middle phalanx.
X-rays of a jersey finger are usually unremarkable and rarely show an avulsion fragment off the proximal volar rim of the distal phalanx. Unlike the common extensor tendon, there is little to stop the proximal migration of such an avulsion fragment and of the free end of the superificialis tendon from migrating proximally even into the palm.
A) Only the first statement is true.
Unlike the common extensor tendon, there is little to stop the proximal migration of such an avulsion fragment and of the free end of the profundus tendon from migrating proximally even into the palm.
This joint is more likely to develop stiffness after trauma or surgery than the other digital joints.
B) PIP
This is because of the multiple tendinous and ligamentous structures that cross the PIP joint and the tight stout volar plate.
Which of the following is not true about Kienbock's disease?
D) At later stages, the bone scan shows further decrease in uptake at the lunate, indicating bony healing of the fractures of collapse.
At later stages, the bone scan shows increased uptake at the lunate, indicating bony healing of the fractures of collapse.
Dupuytren's contracture mode of inheritance
C) Autosomal dominant
Dupuytren's contracture is a benign hypertrophy of the palmar fascia, which progresses radially to ulnarly. This condition affects whites of northern European descent, and its prevalence increases with age.
A) Only the second statement is true.
Dupuytren's contracture is a benign hypertrophy of the palmar fascia, which progresses ulnarly to radially.
In Dupuytren's contracture, three stages in the nodule and cord formation have been described. Which of the following statements below is incorrect?
B) None of these
Tabletop test
D) Dupuytren's contracture
In this test, the individual places the palm on a flat surface and attempts to extend the involved finger actively. A positive test is noted if the MCP joint cannot be placed flat against the surface.
Which of the following is incorrect about CRPS?
D) None of these
To make the clinical diagnosis of CRPS, the following criteria must be met except:
A) Must display at least one sign at time of evaluation in one or more of the four categories (sensory, vasomotor, sudomotor, and motor)
It should be must display at least one sign at time of evaluation in two or more of the four categories (sensory, vasomotor, sudomotor, and motor).
Which of the following is incorrect about writer's cramp?
C) The extensors are more commonly involved than the extensors.
The flexors are more commonly involved than the extensors. Among the flexors, the FDS, FDP, FPL, and the lumbricals may be involved. The EPL, EI, and EDC may be involved among the extensors.
The capsule of the GH joint is lax ____________ to permit full elevation of the arm.
A) Inferiorly
The glenoid fossa of the scapula faces laterally, superiorly, and anterior at rest. When the arm is in dependent position, the fossa faces posteriorly and inferiorly.
C) Both statements are true.
Approximately 50% of the fibers of the ______________ muscle originate from the superior glenoid labrum.
C) Long head of biceps brachii
The remaining fibers of the long head of the biceps brachii originate from the superior glenoid tubercle.
The labrum enhances glenohumeral joint stability by increasing the humeral head contact areas to ___ vertically and ___ transversely.
D) 75%; 56%
Contact between the humeral head and glenoid fossa is significantly reduced when the humerus is positioned in:
C) Abduction and elevation
Contact between the humeral head and glenoid fossa is significantly reduced when the humerus is positioned in:
1. Adduction, flexion, and internal rotation
2. Adducted at the side, with the scapula rotated downward
3. Abduction and elevation
The scapula is a flat blade of bone that is oriented to contribute to stability; it lies along the thoracic cage at:
B) All of these
This orientation of the scapula results in arm elevation occurring in a plane that is 30° to 45° anterior to the frontal plane. When elevation of the arm occurs in this plane, the motion is referred to as scapular plane abduction or scaption.
It has been recommended that many strengthening exercises for the shoulder joint complex be performed in the scapular plane because:
A) Both of these
Which of the following muscles does not attach to the scapula?
B) None of these
In all, 16 muscles gain attachment to the scapula. Six of these muscles support and move the scapula, while nine of the others are concerned with GH motion.
As the tendon of the long head of biceps brachii passes over the humeral head from its origin, it makes a right-angle turn to lie in the posterior aspect of the humerus. This abrupt turn may permit abnormal wearing of the tendon at this point.
A) Only the second statement is true.
As the tendon of the long head of biceps brachii passes over the humeral head from its origin, it makes a right-angle turn to lie in the anterior aspect of the humerus.
This structure acts as a restraint to the biceps tendon within the intertubercular groove.
B) Coracohumeral ligament
The transverse humeral ligament, which runs perpendicular over the biceps tendon, was once thought to function as a restraint to the biceps tendon within the intertubercular groove. However, this appears to be the role of the coracohumeral ligament.
This is the region below the greater and lesser tuberosities, where the upper margin of the humerus joints the shaft of the humerus.
A) Surgical neck
Structure/s which lie/s in close proximity to the medial aspect of the surgical neck of the humerus
C) Both
These structures form a Z-pattern on the anterior aspect of the shoulder joint.
C) Glenohumeral and coracohumeral ligaments
This ligament acts as a primary restraint against both anterior and posterior dislocations of the humeral head.
B) Inferior glenohumeral ligament
What is the most important stabilizing structure of the shoulder in the overhead athlete?
D) Inferior glenohumeral ligament
At 0° abduction, the following structures act as primary restraints against anterior translation of the humeral head, except:
A) Supraspinatus muscle
It should be subscapularis muscle.
At 45° abduction, the subscapularis muscle, the middle GH ligament, and the glenoid labrum prevent anterior translation. At more than 90° abduction, the anterior fibers of the inferior GH ligament primarily prevents anterior translation.
Which of the following is incorrect about the coracohumeral ligament?
C) It arises from the lateral end of the coracoid process and runs laterally, where it is split into two bands by the presence of the coracobrachialis tendon.
The coracohumeral ligament arises from the lateral end of the coracoid process and runs laterally, where it is split into two bands by the presence of the biceps tendon.
This structure is often described as the roof of the shoulder.
B) Coracoacromial ligament
The coracoacromial ligament is a very thick structure that runs from the coracoid process to the anteroinferior aspect of the acromion, with some of its fibers extending to the AC joint.
The structures located in the subacromial space, from inferior to superior are:
B) (1) Humeral head, (2) LHB tendon, (3) superior aspect of joint capsule, (4) supraspinatus and upper margins of subscapularis and infraspinatus, (5) subdeltoid-subacromial bursae, (6) inferior surface of coracoacromial arch
The suprahumeral space is narrowest between:
C) 60°-120° of scaption
The brachial artery is bordered by the:
B) All of these
The tendons of these muscles appear to be particularly vulnerable to areas of relative avascularity, referred to as critical zones.
A) Biceps brachii and supraspinatus
The third stage of Kienbock's disease is known as:
C) Collapse
Stage 1: Sclerosis
Stage 2: Fragmentation
Stage 3: Collapse
Stage 4: Arthritis
The glenohumeral joint is most unstable in this position.
D) Flexion, abduction, external rotation
The most common direction of shoulder dislocation is towards anterior and its mechanism of injury is abduction and external rotation.
The lumbrical muscle:
D) Has a better leverage as a DIP extensor compared to its leverage as an MCP flexor
This ligament protects against lateral rotation with the arm adducted. It also protects against inferior translation of the dependent arm and superior translation of a shoulder with weak rotator cuff.
D) Coracohumeral ligament
The main function of this muscle is to stabilize the scapula.
D) Serratus anterior
When the serratus anterior is paralyzed or weak and forward reaching is attempted, a typical "winging" of the medial border of the scapula is seen as the scapula fails to protract or slide forward on the rib cage or to remain in contact with it.
A person's grip is weaker if his/her wrist is in a flexed position because of:
A) Passive insufficiency of finger extensors and active insufficiency of finger flexors
When muscles become elongated over two or more joints simultaneously, they may reach the state of passive insufficiency. Active insufficiency also occurs in multijoint muscles when the muscle is at its shortest length and its ability to produce physiologic force is minimal.
In the cubital fossa, the _______________ is separated from the underlying brachial artery by the bicipital aponeurosis.
D) Median cubital vein
This muscle is responsible for the characteristic roundness of the shoulder.
D) Deltoid
The teres minor as a rotator cuff muscle:
A) Prevents subluxation of the shoulder when carrying a load in the hand while standing erect
Rotator cuff muscles elevate the humeral head when preventing subluxation.
It classically involves an isolated fracture of the junction of the distal third and middle third of the radius with associated subluxation or dislocation of the distal radio-ulnar joint.
A) Galleazi
Closed rupture of the extensor tendon usually from forceful hyperflexion is known as:
B) All of these
What is the test position of a fair or better lower trapezius muscle?
A) Prone with arms over the head
The following ranges of motion may be attributed to glenohumeral joint when the scapula is stabilized, except:
C) When the glenohumeral joint is externally rotated to 90°, active abduction is limited to 90° by active insufficiency by the triceps brachii.
When the glenohumeral joint is externally rotated to 90°, active abduction is limited to 90° by active insufficiency by the biceps brachii.
The key joint in hand movements is the:
B) Radiocarpal joint
Position of the wrist definitely affects the leverage of the hand muscles.
Not an important crutch walking muscle
D) Middle trapezius
It should be lower trapezius.
Shoulder subluxation is prevented by the following, except:
D) Inferior capsular ligament
It should be superior capsular ligament.
Which of the following statements is true about the radial artery?
C) All of these
Which of the following is incorrect about the radial artery?
B) It is the larger of the terminal branches of the brachial artery.
The radial artery is the smaller of the terminal branches of the brachial artery.
All of the following are functions of the scapulothoracic joint, except:
D) Maintains favorable length-tension relationship for the biceps brachiii to function above 90° of glenohumeral elevation
The scapulothoracic joint maintains favorable length-tension relationship for the deltoids to function above 90° of glenohumeral elevation.
Which of the following is not true about the radius?
B) The radial shaft crossing over the ulna is further aided by the shaft of the ulna that is bowed a little lateralwards.
The radial shaft crossing over the ulna is further aided by the shaft of the radius that is bowed a little lateralwards.
Which of the following statements is not true about the shoulder?
C) Torque is maintained as the muscles shorten.
Torque will decrease as the muscles shorten.
What is the most important crutch-walking muscle?
D) Latissimus dorsi
In a closed-chain motion, the distal attachment (crest of ilium) of latissimus dorsi can aid in lifting the pelvis, so that the foot clears the ground.
In circling movement performed by the shoulder girdle, this structure serves as the pivot.
C) Sternoclavicular joint
The sternoclavicular joint is a complex saddle joint with three degrees of freedom: elevation, depression, protraction, retraction, and rotation.
Which of the functional differences between the hand and foot joints is/are true?
A) All of these
The following statements are true about the radial nerve, except:
A) As it crosses the elbow joint, it supplies the muscles arising from the lateral supracondylar ridge: the brachioradialis and the extensor carpi radialis brevis.
As the radial nerve crosses the elbow joint, it supplies the muscles arising from the lateral supracondylar ridge: the brachioradialis and the extensor carpi radialis longus.
Special test for scalenus anticus?
D) Adson's
Roos test is the special test for hyperabduction syndrome, whereas military brace test is the special test for costoclavicular syndrome.
Least common type of acromion
B) Flat
Meanwhile, curved is the most common type of acromion.
Most common digit affected in jersey finger
B) 4th
What is the most significant symptom seen in Volkmann ischemic contracture?
D) Severe pain upon stretching
Volkmann ischemic contracture results from injury to the brachial artery.
Most common muscle affected in golfer's elbow?
D) Pronator teres
The second most commonly affected muscle in golfer's elbow (medial epicondylitis) is flexor carpi radialis; the third most commonly affected is flexor carpi ulnaris; and the fourth most commonly affected is flexor digitorum superficialis.
Operative procedure for total shoulder replacement using anterior approach involves the release of this from its insertion prior to anterior capsulotomy.
A) Subscapularis
Progression of rehabilitation following rotator cuff repair is slower considering the following factors, except:
A) Use of tendon to bone repair
(+) square shoulder
D) Axillary nerve injury
The axillary nerve innervates the deltoids, which are responsible for the characteristic roundness of the shoulder.
A physical therapy treatment plan for a patient rehabilitating from an anterior shoulder dislocation includes progressive resistance exercises. Which muscle groups should be emphasized during rehabilitation?
A) Adductors and internal rotators
The mechanism of injury for anterior shoulder dislocation is excessive abduction and external rotation. To prevent such injury to occur, adductors and internal rotators must be strengthened.
A patient with chronic shoulder instability is scheduled to have an open Bankart procedure. As part of the surgery, the subscapularis is removed and then reattached to the anterior capsule. In order to protect the subscapularis post-operatively, which of the following shoulder motions should initially be most limited?
D) Lateral rotation
One of the consistent precautions for post-operative conditioning is overstretching. Since the subscapularis is a medial rotator, lateral rotation should be limited.
The following muscles prevent dislocation of the shoulder joint in the position of full abduction, except:
C) None of these
The coracoclavicular joint is an articulation between:
C) Conoid tubercle and coracoid process
The coracoclavicular joint is a normal variant of the pectoral girdle, where the conoid tubercle of the clavicle appears enlarged or elongated, with flattened inferior surface where it approximates the coracoid process of the scapula.
The ability to hold the arms extended above the head is impaired in weakness of the shoulder girdle from any cause. The following statements are true when testing for shoulder and arm strength, except:
B) A painful atrophic shoulder joint will not limit movement and seriously interfere in the diagnosis of a neurogenic lesion.
A painful atrophic shoulder joint will limit movement and seriously interfere in the diagnosis of a neurogenic lesion.
The proximal IP joint of the hand is stabilized in order to test this/these muscle/s.
A) Flexor digitorum profundus
The flexor digitorum profundus is attached to the distal phalanx.
In tennis elbow, what portions of the common extensor tendons are typically affected?
A) Anterolateral and midportion
The posterior portion of the common extensor tendons is spared in tennis elbow.
Which of the following is not true about the triquetrum?
D) It is formed within the flexor carpi ulnaris tendon.
The attachments of the flexor carpi ulnaris are the pisiform, the hook of hamate, and the base of the 5th metacarpal.
The most important joint in the upper extremity for spatial placement is the:
B) Glenohumeral
Glenohumeral joint has the ability to elevate the entire upper extremity.
The integrity of the transverse arch of the hand is maintained by the:
A) Carpal bones and ligaments
The palm of the hand has a concave appearance even when the hand is fully open due to the arches produced by the carpal bones and ligaments.
The flexor digitorum profundus flexes the:
C) Both
Meanwhile, the flexor digitorum superficialis only flexes the PIP joint.
Metacarpophalangeal and interphalangeal joint extension is primarily the action of the:
D) Extensor digitorum communis
The extensor carpi ulnaris and the extensor carpi radialis extends the wrist.
The following statements allow soft tissue palpation of certain structures, except:
D) The medial collateral ligament, a basic stabilizer of the humeroulnar articulation which rises from the medial epicondyle and extends to the medial margin of the ulna's trochlear notch, may be palpated directly.
The medial collateral ligament, a basic stabilizer of the humeroulnar articulation which rises from the medial epicondyle and extends to the coronoid process and olecranon process of ulna, may be palpated directly.
Perilunate dislocation
A) The radiolunate articulation remains intact.
In perilunate dislocation, the capitate dislocates dorsally.
Midcarpal dislocation
B) Both of these
All of the following are seen in lunate dislocation, except:
C) The capitate moves distally.
The capitate moves proximally.
The following statements apply to the radial nerve, except:
C) Abduction and adduction of fingers are weakened.
Abduction adduction of fingers are not weakened, as the innervation to the interossei remains intact.
The following statements apply to the rotator cuff, except:
D) The shoulder must be actively extended to rotate it into a palpable position.
Boutonniere deformity results from:
C) All of these
The axilla is a quadrilateral pyramidal structure through which vessels and nerves pass to the upper extremity. The following statements apply to the axilla, except:
A) The anterior and posterior wall can be palpated when the arm is abducted and extended.
The following statements are true of the anatomic snuffbox, except:
A) The terminal branches of the deep radial nerve are palpable where they cross the extensor pollicis longus tendon.
The terminal branches of the superficial radial nerve are palpable where they cross the extensor pollicis longus tendon.
This crease lies at the base of the fingers and marks the location of the proximal pulley.
A) Proximal palmar crease
The proximal transverse palmar crease is below the distal crease and somewhat parallel to it, running from one end of the hand to the other. "Thenar" means ball of the thumb. The thenar crease runs vertically around the base of the thumb.
The following is true of the brachioradialis, except:
C) It is a strong flexor of the elbow only with light loads or during slow flexion.
The brachioradialis will pronate the forearm from a supinated position to midposition in face of heavy resistance, especially when the elbow is flexed.
The apex of the axilla decreases in size most markedly when the arm is fully:
A) Abducted
The apex of the axilla decreases in size most markedly when the arm is fully abducted, leaving the contents of the axilla at risk for compression.
The tendons of these muscles pass through the axilla.
D) Short head of biceps brachii and coracobrachialis
The tendons of the biceps brachii (short head) and coracobrachialis pass through the axilla, where they attach to the coracoid process of the scapula.
The clavipectoral triangle is an opening in the anterior wall of the axilla, which is bounded by the pectoralis minor, deltoid, clavicle. The cephalic vein enters the axilla via this triangle, while the medial and lateral pectoral nerves leave.
B) Only the second statement is true.
The clavipectoral triangle is an opening in the anterior wall of the axilla, which is bounded by the pectoralis major, deltoid, clavicle.
Which nerve is commonly damaged during axillary clearance?
B) Long thoracic nerve
Axillary clearance refers to the removal of the lymph nodes to prevent the breast cancer from spreading. During this procedure, the long thoracic nerve may be damaged, resulting to winged scapula.
Which of the following is incorrect about the cubital fossa?
A) Its floor is formed by the supinator proximally and the brachialis distally.
Its floor is formed by the brachialis proximally and the supinator distally.
The brachial artery bifurcates into radial and ulnar arteries at the base of the cubital fossa. The brachial pulse can be felt in the cubital fossa by palpating lateral to the biceps tendon.
A) Both statements are false.
The brachial artery bifurcates into radial and ulnar arteries at the apexof the cubital fossa. The brachial pulse can be felt in the cubital fossa by palpating medial to the biceps tendon.
A 60-year old woman attends a phlebotomy service for a full blood count. The phlebotomist inserts a needle into a superficial vein within the roof of the cubital fossa. What is the name of this vein?
C) Median cubital vein
The median cubital vein connects the basilic and cephalic veins.
Gartland classification for supracondylar fractures: completely off-ended
D) Type III
Type I is undisplaced; type II is displaced but with an intact posterior cortex; and type IV is multidirectional instability with circumferential periosteal disruption.
Which of the following is not true about the borders of the cubital tunnnel?
D) The roof is formed by the ligament of Struthers.
The roof is formed by the arcuate ligament ofOsborne (cubital tunnel retinaculum), a band of fascia which runs between the ulnar and humeral heads of the flexor carpi ulnaris.
During _______________, the shape of the ulnar tunnel changes from oval to elliptical and the pressure increases.
B) Elbow flexion
Ulnar tunnel is also known as cubital tunnel.
A patient visits his primary care physician with paresthesia in the little finger. Tapping over the cubital tunnel exacerbates the symptoms. Which of the following movements is most likely to be affected in this condition?
D) Finger adduction
The patient has cubital tunnel syndrome, where the ulnar nerve is compressed within the cubital tunnel. The motor function of the ulnar nerve can be affected, weakening some of the intrinsic hand muscles, particularly the lumbricals, the interossei, the hypothenar eminence, and the adductor pollicis.
The second extensor compartment of the wrist is separated from the third compartment by this structure.
C) Lister's tubercle
Which of the following is incorrect about the borders of the ulnar canal?
D) Its roof is formed by the dorsal carpal ligament.
The roof of the ulnar (Guyon's) canal is formed by the palmar carpal ligament.
This is where the ulnar nerve bifurcates into superficial (sensory) and deep (motor) branches.
C) Guyon's canal
Guyon's canal is also known as ulnar canal.
A patient is undergoing ulnar canal decompression. Which structure forms the roof of the ulnar canal?
B) Palmar carpal ligament
The flexor retinaculum, together with the hypothenar muscles, forms the floor of the ulnar (Guyon's) canal.
Which border of the Guyon's canal is formed by the pisiform?
B) Medial
Meanwhile, the hook of hamate forms the lateral border of the Guyon's (ulnar) canal.
Once the median nerve passes through the carpal tunnel, it divides into two branches: the recurrent branch and the palmar digital nerves. The recurrent branch supplies the hypothenar muscle group, whereas the palmar digital nerves supply the palmar skin and dorsal nail beds of the lateral three and a half digits, as well as the two lateral lumbricals.
B) Only the first statement is true.
The recurrent branch supplies the thenar muscle group, whereas the palmar digital nerves supply the palmar skin and dorsal nail beds of the lateral three and a half digits, as well as the two lateral lumbricals.
Which of the following structures in not found within the anatomic snuffbox?
D) Basilic vein
It should be cephalic vein.
This carpal bone is at particular risk of avascular necrosis after a fracture because of its so-called retrograde blood supply which enters at its distal end.
A) Scaphoid
This means that a fracture to the middle (waist) of the scaphoid may interrupt the blood supply to the proximal part of the scaphoid bone rendering it avascular.
What is the concave depression on the costal surface of the scapula?
C) Subscapular fossa
Both infraspinous and supraspinous fossas are convex, with the latter more convex than the former.
The following muscle attach to the shaft of the clavicle, except:
B) Pectoralis minor
It should be pectoralis major. Other muscles which attach to the shaft of the clavicle are subclavius and sternocleidomastoid.
After a fracture, the lateral end of the clavicle is displaced medially by the _____________ and the medial end is displaced superiorly by the _______________.
B) Pectoralis major; sternocleidomastoid
A 22-year old man sustains a displaced clavicular fracture after falling off his bike. He undergoes open reduction and internal fixation of the fracture. Which of the following nerves is at risk of iatrogenic damage during this procedure?
C) Supraclavicular nerve
Damage to the supraclavicular nerve results to a numb patch over upper chest and shoulder.
The greater tuberosity serves as an attachment site for three rotator cuff muscles - the supraspinatus, infraspinatus, and teres minor. These muscles attach to the superior, middle, and inferior facets of the greater tuberosity respectively.
D) Both statements are true.
A mid-shaft fracture of the humerus will most likely damage this nerve.
A) Radial nerve
A mid-shaft fracture of the humerus will damage the radial nerve and profunda brachii artery as these structures are tightly bound to the spiral groove.
A fracture involving this part of the humerus will result in wrist drop deformity.
A) Mid-shaft
A fracture of the humerus involving its mid-shaft will damage the radial nerve. Meanwhile, a fracture of the humerus involving its surgical neck will damage the axillary nerve.
The ulnar tuberosity is a roughening immediately proximal to the coronoid process. It is where the brachialis muscle attaches.
B) Only the second statement is true.
The ulnar tuberosity is a roughening immediately distal to the coronoid process.
Which part of the ulna is commonly fractured?
A) Shaft
Which of the following is not true about boxer's fracture?
C) None of these
Which of the following is not true about Bennett's fracture?
A) It may damage the 1st MCP joint leading to instability and subluxation of this joint.
Bennett's fracture may damage the 1st CMC joint leading to instability and subluxation of this joint.
This is the most superficial of all the back muscles.
C) Trapezius
This nerve may be damaged during cervical lymph node biopsy or cannulation of the internal jugular vein.
D) Spinal accessory nerve
Damage to this nerve causes muscle wasting, partial paralysis of SCM, and asymmetric neckline.
T
In some individuals, the long head of the triceps brachii is innervated by the _____________.
D) Axillary nerve
A patient is seen with (+) Popeye's sign. Which pathology is most likely to produce this clinical sign?
B) Bicipital tendon rupture
In Popeye's sign, there is marked deformity at the muscle belly of the biceps brachii.
An amateur shotput thrower is seen in ED with shoulder pain and weakness. Torn anterior deltoid fibers are seen on ultrasound imaging. Which of the following movements would be most affected?
D) Flexion
The anterior fibers of the deltoid flex and medially rotate the shoulder.
This forearm muscle originates from the medial epicondyle of the humerus and inserts into the flexor retinaculum of the wrist.
C) Palmaris longus
This is a square-shaped muscle found deed to the tendons of FDP and FPL.
A) Pronator quadratus
Paradoxical muscle of the forearm
C) Brachioradialis
The origin and innervation of the brachioradialis are characteristic of an extensor muscle, but it is actually an elbow flexor.
The anconeus:
C) Both of these
What is the largest thenar muscle?
D) Opponens pollicis
Opponens pollicis is the largest thenar muscle and it lies underneath the abductor pollicis brevis and flexor pollicis brevis.
What is the most distal thenar muscle?
B) Flexor pollicis brevis
What is the most superficial hypothenar muscle?
B) Abductor digiti minimi
This hypothenar muscle originates from the pisiform and the tendon of the flexor carpi ulnaris.
C) Abductor digiti minimi
These intrinsic hand muscles connect the flexor tendons and the extensor tendons.
A) Lumbricals
Each lumbrical originates from a tendon of the flexor digitorum profundus. They pass dorsally and laterally around each finger, and inserts into the extensor hood.
The radial artery passes between the two heads of this intrinsic hand muscle.
A) Adductor pollicis
This nerve is responsible for the cutaneous innervation of the regimental badge area.
C) Axillary nerve
The regimental badge area refers to the inferior portion of the deltoid.
The 'M' shape in the brachial plexus is formed by which of the following nerves?
C) Musculocutaneous, ulnar, median
A 25-year old man sustains a stab wound to the axilla. It was found that the lateral cord of his brachial plexus has been completely severed. If left unrepaired, which of the following peripheral nerves would be most affected?
C) Median
The median nerve is formed by the medial and lateral cords. The ulnar nerve is derived from the medial cord, while the radial and axillary nerves are derived from the posterior cord.
Which vessel accompanies the axillary nerve as it passes through the quadrangular space?
B) Posterior circumflex artery
A patient undergoes a shoulder arthroplasty. Post-operatively, the patient reports numbness in the distribution of the axillary nerve. Which branch of the axillary nerve is most likely to have been affected?
B) Posterior terminal branch
After the posterior terminal branch of the axillary nerve has innervated the teres minor, it continues as the upper lateral cutaneous nerve of the arm. It innervates the skin over the inferior portion of the deltoid, known as the regimental badge area.
The musculocutaneous nerve passes down the flexor compartment of the upper arm, in a plane between these muscles.
C) Biceps brachii and brachialis
In the upper arm, what is the course of the median nerve relative to the brachial artery?
B) Lateral - anterior - medial
The median nerve is initially lateral to the brachial artery. Halfway down the arm, it crosses over the brachial artery to lie medial to it.
Which of the following muscles is not spared when the radial nerve is damaged as it passes through the spiral groove?
B) Medial head of triceps brachii
When the radial nerve is damaged as it passes through the spiral groove, the triceps brachii may be weakened, but not paralyzed. This is because the branches to the long and lateral heads of the triceps brachii arise proximal to the spiral groove.
When the radial nerve is damaged as it passes through the spiral groove, which cutaneous branch of this nerve is most likely to be involved?
C) Superficial branch
Damage to the superficial branch of the radial nerve would result to sensory loss to the dorsal surface of the lateral three and a half digits and the associated area on the dorsum of the hand.
Which of the following injuries is most likely to result in wrist drop deformity?
A) Humeral shaft fracture
The radial nerve is tightly bound to the spiral groove of the humerus, and can be damaged in a humeral shaft fracture. The other options are less likely to injure the radial nerve, and are not proximal enough to cause a complete wrist drop.
The lower lateral cutaneous nerve of the arm, a sensory branch of the radial nerve, supplies the lateral aspect of the arm, inferior to the insertion of what muscle?
C) Deltoid
When the ulnar nerve is damaged as is passes through the Guyon's canal, which cutaneous branch is most likely to be spared?
D) Dorsal branch
Damage of the ulnar nerve at the Guyon's canal would result in sensory loss over the palmar side of the medial one and a half fingers only.
Which branch of the ulnar nerve supplies the volar surface of the medial one and a half fingers?
C) Superficial
The superficial branch of the ulnar nerve supplies the volar surface of the medial one and a half fingers. The palmar cutaneous branch supplies the skin of the medial palm, not the fingers.
Where does the ulnar nerve lie in relation to the ulnar artery at the wrist?
B) Medial
The thoracoacromial artery supplies the acromioclavicular joint. From which artery does it arise?
B) Axillary artery
All of the following ligaments are considered to be thickenings of the sternoclavicular joint capsule, except:
A) Costoclavicular ligament
The sternoclavicular ligament reinforce the capsule anteriorly and posteriorly, while the interclavicular ligament reinforces the capsule superiorly.
The coracohumeral ligament runs from the coracoid process of the scapula to which part of the humerus?
C) Greater tuberosity
The coracohumeral ligament supports the superior part of the glenohumeral joint capsule.
What is the least common direction of glenohumeral dislocation?
A) Inferior
Anterior dislocations are the most prevalent (95%), although posterior (4%) and inferior (1%) dislocations can sometimes occur. Superior displacement of the humeral head is prevented by the coraco-acromial arch.
Which major ligament of the shoulder is not a thickening of the joint capsule?
D) Coracoacromial ligament
The coracoacromial ligament forms the coraco-acromial arch, which overlies the shoulder joint and prevents superior displacement of the humeral head.
The intratendinous bursa of the elbow joint is located within the tendon of this muscle.
D) Triceps brachii
The subtendinous bursa is found between the olecranon and the tendon of the triceps brachii, while the subcutaneous bursa is found between the olecranon and the overylying connective tissue.
A supracondylar fracture usually occurs due to a fall onto an outstretched, extended hand in a child (95%), but more rarely can occur by a direct impact on a flexed elbow. It is typically an oblique fracture, spanning between the two epicondyles in the relatively weak epicondylar region formed by the olecranon fossa and coronoid fossa which lie opposite to each other in the distal humerus.
B) Only the first statement is true.
It is typically a transverse fracture, spanning between the two epicondyles in the relatively weak epicondylar region formed by the olecranon fossa and coronoid fossa which lie opposite to each other in the distal humerus.
The proximal radioulnar joint is located immediately distal to the elbow joint, and is enclosed within the same articular capsule. It is formed by an articulation between the head of the radius and the radial notch of ulna.
C) Both statements are true.
The ulnar collateral ligament of the wrist runs from the ulnar styloid process to the pisiform and hamate. This ligament acts to prevent excessive radial deviation (abduction) of the wrist.
A) Only the second statement is true.
The ulnar collateral ligament of the wrist runs from the ulnar styloid process to the pisiform and triquetrum. Meanwhile, the radial collateral ligament runs from the radial styloid process to the scaphoid and trapezium and it acts to prevent excessive ulnar deviation (adduction) of the wrist.
A woman is undergoing an axillary clearance. During the operation, the axillary artery is identified within the axillary sheath. Which of the structures listed below is also found within the axillary sheath?
A) Lateral cord of brachial plexus
The axillary sheath is a fibrous layer that covers the axillary artery and the three cords of the brachial plexus.
Which muscle tendon can be used as a surface landmark for palpation of the radial pulse?
B) Flexor carpi radialis
The radial pulse can be palpated in the distal forearm, immediately lateral to the prominent tendon of the flexor carpi radialis.
The axillary artery can be classified by its positive relative to which muscle?
A) Pectoralis minor
The axillary artery can be divided into three parts based on its position relative to the pectoralis minor.
A nurse inserts a PICC line into a superficial vein located anterolaterally in the arm. Which vein is most likely to have been cannulated?
A) Cephalic vein
The cephalic vein is the major superficial vein located on the anterolateral aspect of the arm.
Which of the following structures mark the level at which the basilic vein moves from superficial to deep venous system in the upper limb?
D) Teres major
At the border of the teres major, the basilic vein moves deep into the arm. Here, it combines with the brachial veins of the deep venous system to form the axillary vein.
Which nodes receives lymph from all the axillary lymph node groups?
D) Apical axillary
The apical axillary nodes receive lymph from efferent vessels of the central axillary lymph nodes, therefore from all axillary lymph node groups.
The pectoral nodes receive lymph primarily from the anterior thoracic wall, including most of the breast.
The humeral (lateral) nodes receive most of the lymph drained from the upper limb.
The central axillary nodes receive lymph via efferent vessels from the pectoral, subscapular, and humeral axillary lymphnode groups.
The majority of the superficial lymphathic vessels accompanying the cephalic vein go on to enter which set of lymph nodes?
B) Apical axillary
What term is used to describe the layer of stratum corneum that extends from the proximal nail fold to the nail plate?
C) Eponychium
A 45-year old carpenter attends A&E after injuring his index finger on a circular wood saw. Damage to which of the following components of the nail unit would most likely affect the long-term cosmetic appearance of the nail?
A) Nail bed
Laceration of the nail bed is most likely to affect the long-term appearance of the nail, as the nail plate slides over the nail bed as it grows.
Which part of the nail unit contributes to the growth of the nail plate?
C) Germinal matrix
Cells within the germinal matrix divide and become keratinized to form the nail plate. Continuous cell division within the matrix pushes the nail plate over the bed as it matures.
Which annular pulleys are the most important in preventing bowstringing of the flexor tendons of the hand?
C) A2 and A4
Which of the following is not true about the annular pulleys of the hand?
A) The A4 pulley overlies the DIP joint.
The A4 pulley overlies the mid-portion of the middle phalanx. The A5 pulley overlies the DIP joint.
The long flexor tendon of the thumb arises from the flexor pollicis longus muscle. The fibrous sheath of the thumb is reinforced by two pulleys.
D) Only the first statement is true.
The fibrous sheath of the thumb is reinforced by three pulleys. The A1 pulley overlies the MCP joint; the oblique pulley overlies the proximal half of the proximal phalanx; and the A2 pulley overlies the distal half of the proximal phalanx.
What is the origin of the pronator quadratus muscle?
A) Distal quarter of the anterior surface of the ulna
The pronator quadratus muscle originates from the distal quarter of the anterior surface of the ulna and inserts into the distal quarter of the anterior surface of the radius.
Its main action is to pronate the forearm.
Which of these bones is fractured often as a result of forceful dorsiflexion?
B) Triquetrum
Triquetrum (“three-cornered”) is a pyramidal bone. The triquetrum lies between the lunate and pisiform bones on the medial side of the proximal row of carpal bones. Fractures of the triquetrum often occur upon forceful dorsiflexion of the hand such that an avulsion fracture occurs on the dorsal aspect of the bone.
What is the arterial supply of the flexor carpi radialis muscle?
D) Ulnar artery
The flexor carpi radialis muscle is innervated by the median nerve and receives its arterial blood supply from the ulnar artery.
The ulnar artery is a terminal branch of the brachial artery and runs along the ulnar aspect of the forearm deep to the flexor muscles before entering the hand via Guyon's canal.after entering the hand, it terminates into the palmar carpal arch, the superficial palmar arch, and the dorsal carpal branch.
What is the origin of the medial head of the triceps brachii muscle?
A) Posterior surface of the humerus, inferior to the radial groove
The triceps brachii muscle has three heads with separate origins:
1. Long head originates from the infraglenoid tubercle of the scapula.
2. Lateral head originates from the posterior surface of the humerus, superior to the radial groove.
3. Medial head originates from the posterior surface of the humerus, inferior to the radial groove.
The fibers converge to a single tendon to insert onto the olecranon process of the ulna.
What is the insertion of the pronator teres muscle?
B) Middle third of the lateral surface of the radius
The pronator teres muscle originates from the medial epicondyle of the humerus and coronoid process of the ulna, and inserts into the middle of the lateral surface of the radius.
Its primary action is pronation and flexion of the forearm (at the elbow).
Which of the following muscles do not attach to the hook of hamate?
C) Abductor digiti minimi
The abductor digit minimi attaches proximally to the pisiform, pisohamate ligament and tendon of flexor carpi ulnaris. It abducts the little finger at the metacarpophalangeal joint.
Which major nerve runs on the volar surface above the carpal tunnel?
D) Ulnar nerve
The ulnar nerve follows the course of the brachial artery in the arm: sitting medially to the brachial artery. As the brachial artery enters the cubital fossa the ulnar nerve splits, wrapping around the medial epicondyle. It then enters the anterior compartment of the forearm lying deep with the ulnar artery before emerging superficially at the distal forearm. Both the ulnar nerve and artery then pass superficial to the flexor retinaculum that comprises the roof of the carpal tunnel. In fact, this space created above the flexor retinaculum is called Guyon's canal through which the ulnar nerve and artery enter the hand. Therefore, carpal tunnel syndrome does not generally affect the ulnar nerve. The ulnar nerve innervates the 5th digit and half of the 4th digit in the hand. It also innervates most of the intrinsic muscles of the hand.
What is the origin of the pronator teres muscle?
B) Medial epicondyle of the humerus and coronoid process of the ulna
The pronator teres muscle originates from the medial epicondyle of the humerus and coronoid process of the ulna, and inserts into the middle of the lateral surface of the radius.
Its primary action is pronation and flexion of the forearm (at the elbow).
The axillary artery is divided into 3 based on the position of which muscle?
E) Pectoralis minor
The axillary artery is portioned into three sections based on the position of the pectoralis minor muscle. The axillary artery begins at the lateral border of the first rib as a continuation of the subclavian artery. The first part of the axillary artery is from the lateral border of the first rib to the superficial border of the pectoralis minor muscle. The second part of the axillary artery lies inferiorly to the pectoralis minor and the third section of the axillary artery lies from the inferior border of the pectoralis minor muscle to the inferior border of the teres major.
The axillary artery supplies oxygenated blood to the upper limb, axilla and lateral thoracic wall.
What is the insertion of the flexor carpi radialis muscle?
C) Base of the 2nd metacarpal bone
The flexor carpi radialis muscle originates from the medial epicondyle of the humerus and inserts into the base of the 2nd metacarpal bone in the hand.
Its primary action is flexion and abduction of the hand at the wrist.
30-year-old Duke Athie limps into the orthopaedic long bone clinic for review of his complicated tibial fracture. From reading his notes you see that he had a motorcycle accident ten years ago in which he broke both legs and injured his neck. You introduce yourself, but when you offer to shake his hand he grimaces and awkwardly shrugs the right side of his chest in response. You notice that his right arm is held unnaturally; it is turned inward at the shoulder, tucked into his side, fully extended at the elbow and his fingers are pointing out behind him.
At which level do you suspect his brachial plexus may have been compromised?
C) C5-C6
The brachial plexus arises from the nerve roots exiting the vertebral foramina between the 5th cervical and 2nd thoracic vertebrae (i.e. nerve roots C5-T1). These nerve roots pass between the bellies of the anterior and middle scalenes and into the posterior triangle of the neck, where roots C5 and C6 join to form the upper trunk. C7 continues as the middle trunk, and C8 joins T1 to form the lower trunk. Each of these trunks then gives rise to anterior and posterior divisions, which lie deep to the clavicle. These divisions then form lateral, medial and posterior cords deep to pectoralis minor, and emerge from underneath its lateral border into the axilla as the musculocutaneous, ulnar and radial nerves respectively. The medial and lateral cords contribute fibres to become the median nerve, so named as it runs down the median of the forearm from the antecubital fossa to the wrist.
The upper brachial plexus is vulnerable to injury when the neck is flexed to the contralateral side and the ipsilateral shoulder depressed, as occurs in complications of forceps delivery or high energy trauma such as motorcycle accidents and hard rugby tackles. The characteristic picture is of the ‘waiter’s tip’ or ‘cheeky cigarette’ deformity where injury to C5-C6 and the lateral cord results in functional loss of supraspinatus and deltoid and hence loss of abduction; infraspinatus and teres minor with loss of external rotation; and biceps brachii and supinator with loss of elbow flexion and forearm supination.
Which of the following structures passes through the triangular space of the shoulder?
C) Circumflex scapular artery
The correct answer is the circumflex scapular artery. It passes through the triangular space which is bordered inferiorly by teres major, laterally by the long head of triceps and superiorly by the lower border of teres minor.
The posterior circumflex humeral artery and axillary nerve pass through the quadrangular space which is bordered medially by the long head of triceps, laterally by the humeral shaft, superiorly by teres minor and inferiorly by teres major.
The profunda brachii artery and radial nerve pass through the triangular interval which is bordered superiorly by teres major, laterally by the lateral head of the triceps or the humerus and medially by the long head of the triceps.
The suprascapular artery and suprascapular nerve pass around the suprascapular notch to run through the supraspinous fossa before passing around the great scapular notch to run in the infraspinous fossa.
The dorsal scapular nerve passes alongside the medial border of the scapular, deep to the rhomboid muscles.
A midshaft fracture of the humerus is most likely to cause damage to which nerve?
B) Radial nerve
A midshaft fracture of the humerus is most likely to cause damage to the radial nerve.
Compression of the median nerve at the carpal tunnel can cause carpal tunnel syndrome.
Injury of the ulnar nerve can occur throughout its course but most commonly at the medial epicondyle.
Injury to the musculocutaneous nerve is often associated with severe brachial plexus injuries and rarely presents in isolation.
Anterior dislocation of the shoulder or forced abduction can damage the axillary nerve.
A 75-year-old lady attends a hand clinic for a follow-up regarding her existing Osteoarthritis. The consultant surgeon mentions the removal of a bone at the base of the thumb to alleviate some of her symptoms.
Which of the following bones would the surgeon remove?
E) Trapezium
The trapezium is the bone at the base of the thumb.
The two most proximal carpal bones are the scaphoid (attached to radius) and the lunate (attached to the ulnar process).
The more distal carpal bones, from lateral to medial are the trapezium (between the base of the thumb and the scaphoid carpal bone), trapezoid (base of index finger), capitate (base of middle finger), and hamate (in between the ring and little finger).
A common Mnemonic that medical students use: "Some Lovers Try Positions that they can't handle" to indicate = Scaphoid, Lunate, Triquetrum, Pisiform, Trapezoid, Trapezium, Capitate, Hamate
What is the arterial supply of the brachialis muscle?
A) Brachial and recurrent radial arteries
The brachialis receives its arterial supply from muscular branches of the brachial artery and the recurrent radial artery, and is innervated by the musculocutaneous and radial nerves.
The brachialis is the strongest flexor of the elbow joint (stronger than the biceps brachii) and helps to protect the joint capsule by maintaining its tension during hyperextension of the elbow.It lies deep to the biceps brachii muscle and forms part of the floor of the cubital fossa.
A 30-year-old right-hand dominant secretary presents to Mr Limbhammer's orthopaedic clinic. She describes paraesthesia in the thumb, index finger, middle finger and the radial aspect of the ring finger, which is worse at night and is disrupting her sleep. Whilst these symptoms initially began when she was pregnant with her second child, they have failed to resolve long after delivery. She has a past history of hypothyroidism and diabetes and a family history of rheumatoid arthritis.
The decision is made to manage her carpal tunnel syndrome operatively. A line is drawn between the radial border of the ring finger and the wrist crease. A longitudinal incision is then made from the wrist crease to the point of intersection with a second line (Kaplan's line), drawn from the hook of the hamate to the distal border of the thenar eminence. Once the flexor retinaculum has been carefully incised, Mr Limbhammer has a clear view of the carpal tunnel and it appears rather crowded.
Which of the following tendons can be seen to accompany the median nerve?
B) Flexor Digitorum Superficialis, Flexor Digitorum Profundus, Flexor Pollicis Longus
The carpal tunnel carries ten structures from the forearm to the hand:
Median nerve
4 tendons of Flexor Digitorum Superficialis
4 tendons of Flexor Digitorum Profundus
1 tendon of Flexor Pollicis Longus
The tendon of flexor carpi radialis also passes under the flexor retinaculum, but in a separate compartment to the median nerve.
The carpal tunnel floor is created by the first carpal row, and the roof is formed by the flexor retinaculum. Its ulnar border is formed by the pisiform and the hook of the hamate, and its radial border is made up of the scaphoid tubercle and trapezium.
Risk factors for developing carpal tunnel syndrome include trauma, rheumatoid arthritis, hypothyroidism, pregnancy, female sex, acromegaly and it is often seen idiopathically in postmenopausal women. Late stages of the disease can result in wasting of the distal muscles supplied by the median nerve.
Billy is a ten-year-old who has fallen from a tree. He’s been a fairly lucky ten-year-old, as a primary survey in the emergency department has revealed no issues with his airway, cervical spine, breathing, circulatory system or neurological status. On examination of his limbs, however, he appears to have unfortunately developed a rare deformity whereby the right wrist and metacarpophalangeal joints are held in extension, the interphalangeal joints are flexed, and he has abnormal sensation over the ulnar border of the hand.
Which roots of the brachial plexus do you suspect have been injured?
E) C8-T1
The brachial plexus arises from the nerve roots exiting the vertebral foramina between the 5th cervical and 2nd thoracic vertebrae (i.e. nerve roots C5-T1). These nerve roots pass between the bellies of the anterior and middle scalenes and into the posterior triangle of the neck, where roots C5 and C6 join to form the upper trunk. C7 continues as the middle trunk and C8 joins T1 to form the lower trunk. Each of these trunks then gives rise to anterior and posterior divisions, which lie deep to the clavicle. These divisions then form lateral, medial and posterior cords deep to pectoralis minor, and emerge from underneath its lateral border into the axilla as true nerves. The medial cord is a continuation of the anterior branch of the lower trunk, and runs down the medial aspect of the arm as the ulnar nerve.
The lower brachial plexus’ position at the base of the posterior triangle of the neck (sternocleidomastoid anteriorly, trapezius posteriorly, middle-third clavicle inferiorly) is vulnerable to compression by congenital abnormalities such as a cervical rib, and again to traumatic injuries such as high-energy clavicular fractures and violent abduction of the shoulder. This is most commonly seen in instances where the patient has gripped with the hand to prevent a fall from height (monkey-bars in children, trees in teenagers and tree surgeons, banisters in trips on the stairs etc) and the arm acts as a lever, distracting the ipsilateral shoulder girdle and stretching the lower components of the plexus. The resulting deformity is known as Klumpke’s paralysis, and manifests as a clawing of the hand due to paralysis of the intrinsic muscles and relative unopposed action of the long flexors of the digits.
From superior to inferior, which of these represent the branches of the brachial plexus?
A patient presents to you with the following complaint:'I have recently had difficulty raising a glass to my lips'
Weakness of which of the following muscles is likely responsible?
D) Brachioradialis
Raising a glass to your mouth involves flexion of the forearm at the elbow, in a mid-prone, mid-supine position. This is done via the brachioradialis muscle. That's why it's sometimes called the 'Beer drinking' muscle! Only brachioradialis can both pronate and supinate, making it the answer to the question
Biceps brachii is predominantly an elbow flexor and supinator.
Coracobrachialis adducts the humerus and flexes the arm.
Brachialis is a powerful flexor of the forearm.
What is the arterial supply of the anconeus muscle?
B) Recurrent interosseous artery
The arterial supply of the anconeus muscle is supplied by the recurrent interosseous artery.
It is a branch of the posterior interosseous artery and runs in the proximal aspect of the posterior forearm compartment, between the lateral epicondyle of the humerus and olecranon to anastomose with the middle collateral artery. During its course, it runs between the fibres of the anconeus and supinator (sometimes piercing the supinator).
Mr Unlucky has never been the superstitious type, frequently crossing paths with black cats and breaking mirrors for fun. Earlier this morning, however, he ducked underneath a ladder in the street and unfortunately received a direct blow to the middle portion of his clavicle from a paint tin from the sky.
Which part of the brachial plexus most commonly lies deep to the clavicle?
D) Divisions
The roots of the brachial plexus emerge between the anterior and middle scalenes. These join to form trunks in the posterior triangle of the neck, which pass over the first rib and dive down beneath the clavicle as divisions. These divisions form cords deep to pectoralis minor, and emerge from the lateral border of this muscle as nerves.
You are observing Dr Gasser anaesthetise a patient prior to open rotator cuff repair surgery. She intends to perform a regional nerve block affecting the brachial plexus and asks you about the relevant anatomy.
Between which two muscles do the roots of the brachial plexus emerge?
A) Anterior and middle scalenes
The brachial plexus arises from the nerve roots exiting the vertebral foramina between the 5th cervical and 2nd thoracic vertebrae (i.e. nerve roots C5-T1). These nerve roots pass between the bellies of the anterior scalene and middle scalene.
What is the main action of the flexor pollicis longus muscle?
A) Flexion of all the phalanges of the thumb
The main action of the flexor pollicis longus muscle is flexion of all the phalanges of the thumb.
It originates from the middle third of the anterior surface of the radius and adjacent interosseous membrane and inserts into the base of the distal phalanx of the thumb.
What is the origin of the latissimus dorsi muscle?
The latissimus dorsi muscle originates from the spinous processes of T6-T12 , thoracolumbar fascia, iliac crest, and the lower 4 ribs and it inserts into the floor of the intertubercular groove of the humerus. Its function is to extend, aDDuct and medially rotate the humerus.
It is innervated by the thoracodorsal nerve and receives its blood supply from the thoracodorsal artery.
Assuming the correct position for a standard chest x-ray is an example of which movement at the patient's shoulder?
C) Protraction
When a patient is referred for a radiograph of the chest they are asked to assume a position and posture to show the lung fields as advantageously as possible.
This includes standing the patient up if possible to extend the diaphragm. The patient is also asked to push their shoulders forward (protraction) and abduct their humerus. This moves the scapula laterally and superiorly in an attempt to clear the lung field. Finally, the x-rays are projected from the posterior to the anterior surface of the patient so that the heard shadow is not magnified.
What is the insertion of the anconeus muscle?
A) Lateral surface of the olecranon and postero-superior surface of the ulna
The anconeus muscle originates from the lateral epicondyle of the humerus and inserts into the lateral surface of the olecranon and postero-superior surface of the ulna.
It is innervated by the radial nerve and its main function is the extension of the elbow (along with the triceps) while also stabilizing the elbow joint during supination and pronation movements.
Which one of the following carpal bones can be easily palpated, as a distinct prominence, during clinical examination of the medial aspect of the anterior wrist?
B) Pisiform
The pisiform can be felt on the anterior aspect of the medial border of the wrist and can be moved from side to side when the hand is relaxed.
Pisiform (“pea-shaped”) is a small round sesamoid bone found in the tendon of the flexor carpi ulnaris. The pisiform articulates with the anterior surface of the triquetrum bone, therefore extending anteriorly to form the bump that can be felt at the medial base of the hand. The pisiform bone forms the ulnar border of the carpal tunnel. In contrast to the other carpal bones, the pisiform is not involved in movements of the wrist.
What is the primary action of the subscapularis muscle?
D) Medial rotation and adduction of the humerus
The subscapularis muscle rotates the head of the humerus medially and adducts it. It also helps to hold the humeral head in the glenoid cavity of the scapula.
What is the origin of the teres major muscle?
B) Dorsal surface of the inferior angle of the scapula
The teres major muscle originates on the dorsal surface of the inferior angle of the scapula and inserts into the medial lip of the intertubercular sulcus of the humerus.
It is supplied primarily by the lower subscapular nerve that arises from the posterior cord of the brachial plexus. The lower subscapular nerve travels inferiorly from the brachial plexus to supply the lower part of the subscapularis muscle. It gives off a branch to the teres major muscle which runs in the angle between the subscapular and circumflex scapular arteries.
Which of the following correctly describes the nerve of the brachial plexus which pierces pectoralis minor to innervate both this muscle and the pectoralis major?
D) Medial pectoral nerve (C8-T1)
The correct answer is the medial pectoral nerve (C8-T1), which comes off the medial cord of the brachial plexus and takes roots from C8-T1. It pierces the pectoralis minor to innervate both this muscle and the pectoralis major.
The medial pectoral nerve (C5-7) is the correct nerve, but the nerve roots described refer to those of the lateral pectoral nerve.
The lateral pectoral nerve (C8-T1) is the correct nerve roots, but the nerve describes that which innervates the pectoralis major but not the pectoralis minor.
The lateral pectoral nerve (C5-7), which comes off the lateral cord of the brachial plexus, correctly describes the nerve which innervates only the pectoralis major but not the pectoralis minor. It does not pierce the later but rather passes superiorly over it.
The long thoracic nerve (C5-7), which branches straight off from the roots of the brachial plexus, correctly describes the nerve which innervates the serratus anterior muscle.
What is the origin of the rhomboid minor muscle?
B) The nuchal ligament and spinous processes of C7 and T1 vertebrae
The origin and insertion of the rhomboid minor muscle are as follows:
1. Origin: nuchal ligament and spinous processes of the C7 and T1 vertebrae
2. Insertion: medial border of the scapula, superior to the insertion of the rhomboid major muscle
What are the origins of the scalene muscles?
C) The transverse processes of the C2 to C7 vertebrae
The origins and insertions of the scalene muscles are as follows:
1. Origin:transverse processes of the C2 to C7 vertebrae
2. Insertion: anterior and middle scalenes insert on first rib, while posterior scalene inserts on the second rib