Arm & Cubital Fossa

A resident quizzes some medical students on the anatomy of the shoulder joint. He shows an AP view of the glenohumeral joint and asks which 3 muscles attach to the proximal medial head of the humerus?

'Pectoralis minor', 'Short head of biceps brachii', 'Coracobrachialis'

While performing a phlebotomy on a patient, a nurse accidentally injures the median nerve in the cubital fossa. Which action(s) can the patient no longer perform?

A. Flexion of the thumb B. Opposition of the thumb You are correct! The recurrent branch of the median nerve supplies the opponens pollicis and flexor pollicis brevis which are responsible for opposition and flexion of the thumb, respectively. Thus, damaging the nerve would impair both these functions. 58% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

The median nerve accompanies which artery in the cubital fossa?

Accompanies the brachial artery to the cubital fossa. Originates from the Median nerve (C5-T1).

Joseph, a 6 year old boy, comes into your office complaining of pain in his right elbow. When taking the history the mother tells you the pain started right after Joseph tried running into the street after a baseball but thankfully his older brother was able to grab his wrist and pull him back onto the sidewalk. So you suspect Joseph suffered a "nursemaid injury". This injury involves which ligament to cause the pain?

Annular Ligament You are correct! Nursemaid injury is caused by a sudden pull on a protanated forearm. This is the case with Joseph. The annular ligament is either torn or stretched distally and may be pinched by the head of the radial bone and this causes the pain. Sometimes the bone will move back into place (subluxation) and no medical help is needed but if the ligament is torn (dislocation) surgery may be required. 85% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

A patient comes in for an angiogram of the elbow. The physician notes that the Deep artery of the Arm has a 100% block. The patient asks the doctor why there is no damage from blood loss. Which of these arteries is not involved in the collateral circulation of the elbow in this case?

Anterior ulnar Recurrant You are correct! Blockage of the Deep artery of the arm will result in blockage initially of the middle and radial collateral. These two will be reperfused by their mates, Interosseous and radial recurrent (respectively) and become larger dude to reduced blood flow into the deep artery. The superior ulnar recurrent also sends blood to the middle collateral artery posteriorly. Thus the only answer that does not send blood to that area is the Anterior Ulnar recurrent 20% of students answered this question correctly. This question's difficulty has been rated as 'difficult' compared to other questions in anatomy.

14-year-old boy presents in the clinic with a fracture of the proximal portion of his humerus. Which of the following nerves is most likely to be injured?

Axillary nerve You are correct! A fracture of the proximal humerus, near the surgical neck, would affect the axillary nerve, which runs posterior to the surgical neck. The radial nerve is found along the radial groove or shaft of the humerus; The musculocutaneous nerve is not in contact with the humerus bone; The ulnar and median nerve are near the humerus at the epicondyle and supracondylar regions. 56% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

The axillary nerve is derived from which spinal segments?

Axillary nerve (C5,6) From the posterior cord of the brachial plexus Travels along with the posterior humeral circumflex vessels, passing through the quadrangular space Innervates: teres minor and deltoid

With which vessels does the axillary nerve travel? Through which space do the nerve/vessels pass?

Axillary nerve (C5,6) From the posterior cord of the brachial plexus Travels along with the posterior humeral circumflex vessels, passing through the quadrangular space Innervates: teres minor and deltoid

58. The following image is the upper arm of a patient (mid humeral axial) with hypochondriasis insisting he has numbness and tingling. The work up is negative. Volkman's contracture ischemia is most associated with an injury to which labeled structure?

B You are correct! The correct answer is B. The brachial artery (associated with Volkman's contracture) is located at location B, lateral to the Basilic vein (D). The Median nerve travels with the Brachial artery and can be seen at location C. Location E is the humerus and location A indicates the Cephalic vein. For referencing the neurovasculature of the upper arm, it is important to understand the Median n. and Brachial a. run medial to the humerus and mainly at the anterior compartment. 79% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

A second semester Ross student is palpating for the brachial artery in order to take blood pressure and is attempting to look for a tendon landmark to aid him. What is the tendon that the student is palpating for?

Biceps Brachii tendon You are correct! The answer is A because by palpating for the distal biceps brachii tendon, one can then feel medially to that tendon and find the brachial pulse and other contents of the median cubital fossa. 92% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

A nerve that travels in your upper arm is damaged. As a result, you experience weakness when you flex your forearm from a supinated position. What muscle is affected as a result of the damage?

Biceps brachii muscle You are correct! The muscle whose function is lost is biceps brachii. The action of biceps brachii is to flex your arm at the elbow joint from a supinated position. And the nerve referred to is the musculocutaneous nerve.

A 50 year old man with hyperlipidemia develops an atherosclerotic plaque that occludes the deep artery of the arm slowly over time. Which of the following choices correctly describes an alternate route of blood flow to supply the rest of the arm and forearm?

Brachial A. > Superior Ulnar Collateral A.>Posterior Ulnar Recurrent A. You are correct! The Superior Ulnar Collateral A. anastomoses with the Posterior Ulnar Recurrent A. posterior to the medial epicondyle. 72% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

In the cubital fossa, what is medial to the biceps brachii tendon?

Brachial', 'artery' In the cubital fossa, the following three structures run from lateral to medial: TAN- biceps brachii Tendon, brachial Artery, and median Nerve.

Which of the following muscles is paired with the nerve that innervates it? A. Coracobrachialis Muscle - Radial Nerve B. Triceps Brachii - Musculocutaneous Nerve C. Biceps Brachii - Median Nerve D.Brachialis - Musculocutaneous Nerve E. Brachioradialis - Ulnar Nerve

Brachialis - Musculocutaneous Nerve You are correct! The Biceps Brachii, Coracobrachialis, and Brachialis muscles are all innervated by the Musculocutaneous Nerve. The Triceps Brachii muscle in the posterior compartment of the arm is innervated by the Radial Nerve The Median Nerve and Ulnar Nerve do not innervate any muscles in the arm. 86% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

Upon returning home from your first semester in medical school, you decide to relieve some tension by going to the gym with a friend who has gotten into bodybuilding. He tells you that you have "sissy arms" and should work on your biceps, "the most important muscle for flexing the forearm". Being that you have gained so much anatomy knowledge, you decide to pimp him and tell him that the biceps is in fact not the most important flexor of the forearm. Rather, it is what muscle?

Brachialis Muscle

A 25-year old female is hit on the side of her forearm and the muscles which make up the floor of the cubital fossa are torn. Which of the following groups of muscles have lost their function?

Brachialis muscle and supinator muscle You are correct! Brachialis and supinator make up the floor of the cubital fossa. Biceps brachii tendon is within the cubital fossa; brachioradialis and pronator teres make up the boundaries of the cubital fossa. 31% of students answered this question correctly. This question's difficulty has been rated as 'difficult' compared to other questions in anatomy.

A man has injured his coracoid process and is unable to use the muscles that originate from there. Which of the following muscles will still permit flexion of his forearm?

Brachialis, brachioradialis, and biceps brachii long head You are correct! Biceps brachii short head and coracobrachialis originate from the coracoid process, and the pectoralis minor inserts on the coracoid process. The correct pairs of muscles that will still permit flexion of the forearm are the brachialis, brachioradialis, and the long head of the ciceps crachii muscle. 73% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

What two muscles make up the medial and lateral borders of the cubital fossa?

Brachioradialis and pronator teres You are correct! The pronator teres makes up the medial border of the cubital fossa, and the brachioradialis makes up the lateral border of the cubital fossa. 77% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

What makes up the lateral border of the cubital fossa?

Brachioradialis muscle You are correct! A. Not part of cubital fossa borders B. Roof of cubital fossa C. Floor of the cubital fossa D. Correct E. Also contributes to the roof 89% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

The elbow anastamoses allows blood flow to the forearm if there is a blockage in the brachial artery. The posterior ulnar recurrent, from the ulnar artery, will anastamose with which artery branching from the brachial artery?

C. Superior ulnar collateral artery You are correct! Choice C is the correct answer. The superior ulnar collateral artery will anastomose with the posterior ulnar recurrent artery. Choice A will anastomose with anterior ulnar recurrent artery. Choice B will anastomose with the radial recurrent artery. Choice D will anastamose with the interosseous recurrent artery. 75% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

During your pediatric rotation you assist on a case of a 10-year-old boy who hurt his elbow while playing soccer. The boy is complaining of numbness on his forearm and tingling sensation on his 4th and 5th digits. What is the origin of the nerve most likely to be damaged?

C8-T1 You are correct! The nerve damaged is the ulnar nerve and origin/roots of this nerve are C8-T1. 82% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

You recently examine a patient with weakened flexion of the arm and parasthesia on the lateral aspect of the forearm. Hypertrophy of which muscle would most likely cause this clinical presentation?

Coracobrachialis You are correct! The damaged nerve that would cause a clinical presentation described above is the Musculocutaneous nerve. The Musculocutaneous pierces through the Coracobrachialis muscle and hypertrophy of this muscle will cause the nerve to be compressed. 31% of students answered this question correctly. This question's difficulty has been rated as 'difficult' compared to other questions in anatomy.

Name: 1) the structure at the tip of the arrow, and the 2) the muscles that insert on the structure.

Coracoid Process; Pectoralis minor, Coracobrachialis, Short head of biceps brachii You are correct! Correct answer is D. The 3 major insertions to the coracoid process are coracobrachialis, pectoralis minor, and the short head of biceps brachii. 84% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

A weight trainer comes to your office complaining of difficulty in flexing his right arm. He recalls hearing a snap after trying to lift a 150lbs dumbbell. You decide to send him to surgery. During the operation, you find that the long head of the biceps brachii is intact and immediately suspect damage to the short head of the biceps brachii instead. Which of the following locations would help you in assessing the short head of the biceps brachii?

Coracoid process You are correct! The short head of the biceps brachii has attachments to the coracoid process of the scapula and the tuberosity of the radius. 77% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

What artery does the radial collateral artery directly come off of?

Deep brachial artery of the arm You are correct! Elbow anastomosis: Radial collateral comes off the deep brachial artery and anastomosis with the radial recurrent artery which comes off the radial artery. 55% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

Describe the Lateral upper limb cutaneous innervation (x3):

From axillary n. — upper lateral cutaneous nerve of the arm From radial n. — lower lateral cutaneous nerve of the arm From musculocutaneous n. — lateral antebrachial cutaneous nerve

Lateral upper limb cutaneous innervation:

From axillary n. — upper lateral cutaneous nerve of the arm From radial n. — lower lateral cutaneous nerve of the arm From musculocutaneous n. — lateral antebrachial cutaneous nerve

Describe the path of the musculocutaneous nerve:

From the lateral cord of the brachial plexus. Pierces through the coracobrachialis, supplying its innervation, then travels between the biceps brachii and the brachialis; becomes the lateral antebrachial cutaneous nerve to supply cutaneous innervation (mentioned above) Innverates: coracobrachialis, biceps brachii, brachialis

What is the largest branch of the brachial plexus? Off of which cord of the brachial plexus does this nerve branch from?

From the posterior cord; the radial nerve (C5-T1) is the largest branch of brachial plexus

Injury to the Radial nerve most likely correlates with which of the following Humeral fractures?

Humeral Shaft Fracture You are correct! Surgical Neck is Axillary nerve. Distal Humerus is Median nerve Humeral Shaft is Radial nerve 92% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

Name the two muscles innervated by the suprascapular nerve.

Innervates: supraspinatus and infraspinatus Suprascapular nerve (C5,6) From upper trunk of brachial plexus Travels deep to the superior transverse ligament through the scapular notch

What is the origin site and innervation points for the short head of the Biceps Femoris?

Linea aspera, common fibular nerve You are correct! Because it isn't a true hamstring muscle. 21% of students answered this question correctly. This question's difficulty has been rated as 'difficult' compared to other questions in anatomy.

midshaft fracture of the humerus. How will the patient most likely present?

Loss of wrist extension You are correct! Radial nerve is at most risk. Need to know action of radial nerve in extension of the wrist and fingers. Damage results in wrist drop.

Which nerves provide the cutaneous innervation for the medial portion of the arm?

Medial upper limb cutaneous innervation: Medial brachial cutaneous n., which joins with the intercostobrachial n. and the medial antebrachial cutaneous n.

You're patient Stephen Huntley, a 42 year old male, was in a car accident. His right distal humerus was crushed in the crash. He's in extreme pain and has weak pronation and flexion in his right forearm, wrist and hand. What nerve is most likely implicated in this situation?

Median You are correct! Axillary n. would be more commonly damaged in a proximal humeral fracture. Radial nerve would be more commonly damaged in a mid shaft humeral fracture C. CORRECT, this nerve would be the more commonly damaged in a distal humeral fracture. The symptoms listed above also correlate to muscles that are innervated by the median nerve. Ulnar nerve would be more commonly damaged in a posterior dislocation of the radius 68% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

A nervous 3rd year medical student was both excited and scared to be on his first rotation in Internal medicine. The student's attending physician asked him to place a simple IV catheter in a patients Right Median cubital vein. With a shaky hand the student inserted the catheter confident that the bicipital aponeurosis would prevent him from damaging what underlying structure?

Median nerve You are correct! The antecubital fossa contains both the brachial artery and the Median nerve. These structures are protected by the Bicipital aponeurosis. That is why our student can rest easy that even missing the Median Cubital vein, he's likely to not damage either structure below. 77% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

There are a number of important anastamoses around the elbow to provide blood flow in the event of an occlusion. Which of the following sets of arteries anastamose posterior to the lateral epicondyle of the humerus?

Middle Collateral & Interosseus Recurrent You are correct! Location of Anastomes: 1) Superior Ulnar Collateral & Posterior Ulnar Recurrent behind medial epicondyle 2) Inferior Ulnar Collateral & Anterior Ulnar Recurrent anterior to medial epicondyle 3) Radial Collateral & Radial recurrent anterior to lateral epicondyle 4)Middle Collateral & Interosseus Recurrent posterior to lateral epicondyle 46% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

21. A blockage to the brachial artery at the mid-shaft level of the humerus will not prevent blood from passing from the deep artery of the arm to the radial and ulnar arteries. What artery in the anastomosis of the elbow is a terminal branch of the deep artery of the arm?

Middle collateral a. You are correct! 41% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

A patient comes to your office complaining of weakness in their left arm. You perform a quick examination and find the patient to have difficulty with flexion and supination at their left elbow. You also note loss of sensation in the left lateral forearm. Damage to which nerve best correlates to your findings?

Musculocutaneous n You are correct! The answer is the musculocutaneous n whose nerve roots are ventral rami of C5-C7. The musculocutaneous n will innervate all the muscles of the anterior brachium. Also there is a continuation of the musculocutaneous n into the forearm which provides cutaneous sensation to the lateral forearm (lateral cutaneous nerve of the forearm). 86% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

Upon neurological testing of a patient, the patient reveals no cutaneous sensation over the lateral aspect of forearm. Such a finding would indicate injury to some portion of which nerve?

Musculocutaneous nerve You are correct! The clinical presentation indicates damage to the musculocutaneous nerve which supplies the lateral side of forearm with cutaneous sensation. 82% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

A 19-year-old male presents to your clinic with a deformity of his upper arm. He was lifting weights and heard a "pop". During your examination you notice that he has a mass that has formed on the distal, anterior aspect of his upper arm. What is the name of the nerve that innervates this muscle?

Musculocutaneous nerve You are correct! The musculocutaneous nerve innervates the biceps brachii, coracobrachialis, and the brachialis. muscles. Rupture of the biceps brachii long head tendon proximally has formed the deformity in this patient and is called a Popeye deformity. 94% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

During a routine physical examination, you perform the biceps reflex test and discover that it is absent, even though it has been present in the past. What nerve is damaged and what spinal levels are associated with this reflex?

Musculocutaneous nerve, C5 and C6 You are correct! The biceps reflex tests the musculocutaneous nerve and the C5, C6 reflex arc. 82% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

Mr. Smith comes into the emergency department after a traumatic fall and consequently fracturing the mid-shaft of his humerus. Mr. Smith also tells you that he cannot extend his forearm. What is the nerve responsible for the extension of the forearm?

Radial nerve You are correct! 91% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

A 26-year-old male comes to your office with the inability to extend his wrist. What nerve is most likely damaged giving this clinical presentation?

Radial nerve You are correct! The clinical correlate is known as wrist drop which is due to damage of the radial nerve. The radial nerve which arises from roots C5-T1 innervates the muscles that extend the wrist. When this nerve is damaged extension of the wrist is not possible, and you get unopposed flexion at the wrist, giving you the characteristic "wrist drop". 90% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

During a surgery in a patient's axillary region, you accidentally sever the patient's musculocutaneous nerve. When they awake you notice that they can still perform some flexion at the elbow. What innervates the muscle that is performing this flexion?

Radial nerve You are correct! The radial nerve innervates the brachioradialis which is most strong in the mid-prone position. 64% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

A patient presents to the ER holding his right arm. He tells you that he was riding his bike when he hit a curb and went over the handle bars and landed on his arm. You order an x-ray and it comes back with mid shaft humeral fracture. What nerve are you most concerned about and what is an associated clinical sign?

Radial nerve - wrist drop You are correct! The radial nerve is at the greatest risk during a mid-shaft humeral fracture. Wrist drop results from a loss of innervation of the extensor muscles on the posterior forearm. Generally the patient will still be able to extend his forearm against resistance because the innervation to the triceps is given off proximal to the mid shaft. 95% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

A pediatric patient is brought into your ER with pain in the elbow region. You assess the patient and determine a subluxation and dislocation of the radius. What is causing the pain?

Radius compressing on the anular ligament You are correct! A. Tearing of the ligament is not usually involved B. The question stem clearly states it is a dislocation, not a fracture. C. Correct D. Radial nerve not damaged 56% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

Which one of the following muscles make up the "floor" of the cubital fossa?

Supinator muscle You are correct! Supinator and Brachialis make up the "floor" of the cubital fossa. The important structures running through the fossa are TAN (biceps brachii TENDON, brachial ARTERY, median NERVE ). 69% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

The ulnar nerve supplies innervation to which muscles? (Generally)

Supplies innervation to muscles in the anterior forearm and to some of the intrinsic muscles of the hand

The suprascapular nerve is derived from which spinal segments?

Suprascapular nerve (C5,6) From upper trunk of brachial plexus Travels deep to the superior transverse ligament through the scapular notch Innervates: supraspinatus and infraspinatus

A woman comes into a blood bank to donate some of her very sought after O negative blood. The nurse inserts the needle into her medial cubital vein. As the nurse inserts the needle, she uses landmark borders to get to the right structure. Which of the following is NOT a border of the superficial cubital fossa?

Tendon of the biceps brachii You are correct! The borders of the superior cubital fossa are: the imaginary line between the lateral epicondyle and the medial epicondyle of the humerus bone, the brachioradialis muscle and the pronator teres muscle. The tendon of the biceps brachii is NOT a border to this fossa. 55% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

28. A lesion of the lateral cord will lead to severe weakness in:

The upper arm flexors You are correct! The musculocutaneous nerve is a branch from the lateral cord. 64% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

A 30-year-old man injured his left arm in a mixed martial arts fight. Radiographs later revealed a fracture of the medial epicondyle of the humerus. Which of the following nerves is most likely injured as a result of this fracture?

Ulnar You are correct! The Ulnar nerve descends down the medial aspect of the arm, immediately posterior to the medial epicondyle. The other nerves listed do not contact the medial epicondyle. 88% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

A fracture of the medial epicondyle of the humerus would most likely injure which of the following nerves?

Ulnar You are correct! Ulnar nerve can be found on the medial side of the arm, running behind the medial epicondyle of the humerus. The other nerves listed are not in close proximity to the medial epicondyle. 94% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

ou want to practice taking blood pressure on your friend. You remember you were taught to look for a tendon as a landmark to find the brachial artery. This tendon belongs to the ______________ muscle.

biceps brachii Correct! The brachial artery is medial to the biceps brachii tendon which is why it is used as a landmark for palpating this artery and taking blood pressure.

Your attending physician requests that you collect a venous blood sample from the median cubital vein. "Great!" you say. "Finally something I actually know how to do." You proceed to locate what you are positive is a blood vessel in the roof of the cubital fossa. Sure enough, when you puncture the vessel, you are able to extract blood. You become alarmed, however, when you notice the blood is bright red and that your patient seems to be in a large amount of pain. Oops! You probably just punctured the:

Ulnar artery You are correct! Typically, the only structures found in the roof of the cubital fossa are the superficial fascia, lateral and medial cutaneous nerves of the forearm (remember: the lateral comes from the musculocutaneous and the medial from the medial cord of the brachial plexus), and the bicipital aponeurosis. The brachial artery, which divides into the radial and ulnar arteries, is contained within the cubital fossa. However, in 3% of the population the brachial artery bifurcates proximal to the elbow and the ulnar artery will traverse the elbow joint in the roof of the cubital fossa, a much more superficial location. This is what you accidentally punctured in your current patient. The blood is red because it is still highly oxygenated and the patient is in a large amount of pain because arteries are more highly innervated than veins (because we want to protect them more). 21% of students answered this question correctly. This question's difficulty has been rated as 'difficult' compared to other questions in anatomy.

Paul was playing a game of baseball and in the process, fell with his arms extended and abducted. His father being a medical doctor was worried that he suffered a posterior dislocation of elbow joint. What nerve is likely to be damaged in this injury?

Ulnar nerve You are correct! The nerve most commonly damaged by this injury is the ulnar nerve. The median nerve can also be damaged but more commonly the ulnar nerve due to its relationship with the medial epicondyle, any disturbance to the elbow affecting the medial epicondyle can affect the ulnar nerve. 43% of students answered this question correctly. This question's difficulty has been rated as 'moderate' compared to other questions in anatomy.

A golfer comes to your office complaining of elbow pain and of difficulty in some hand movements. You suspect that the patient has medial epicondylitis. Which of the following nerves would most likely be affected by this condition?

Ulnar nerve You are correct! The ulnar nerve passes medial to the brachial artery and runs posterior to the medial epicondyle before entering the forearm. 82% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

Your elderly grandmother has been recently experiencing a large amount of pain on the medial side of her right elbow. Because she is still an avid golfer, your first thought is that she may have tendonitis of the common flexor tendon. When she visits the doctor, however, she returns with a diagnosis of humeroulnar arthritis! (Poor Grandma!) Which nerve(s) of the arm innervate the joint capsule of the elbow and relays the perception of pain to your grandmother's brain?

Ulnar, median, radial, and musculocutaneous nerves You are correct! Hilton's Law tells us that if a muscle moves a joint, the nerve that supplies that muscle also innervates the joint capsule. Joints can be manipulated by any muscles that span them. In the case of the elbow, some (not all) of muscles that span the joint are the triceps brachii, brachialis, flexor carpi ulnaris, and the flexor carpi radialis. The innervations to these muscles are the radial, musculocutaneous, ulnar, and median nerves, respectively. Therefore, Hilton's Law states that these nerves must also innervate the joint capsule. 17% of students answered this question correctly. This question's difficulty has been rated as 'difficult' compared to other questions in anatomy.

Patient comes into your office complaining of weakness in his arm. The patient tells you that he often goes to the gym and enjoys heavy weight lifting. This past weekend he was with his buddies and they decided to have a arm wrestling contest. Your patient won the contest but he has not been the same since. He tells you that when he goes to the gym now he is unable to "curl" or flex his arm when lifting the dumbbells. He wants to know what is wrong so you perform a physical exam and determine the cause is of neurovascular origin. Which nerve is most likely damaged?

You are correct! A. Incorrect. If this nerve was damaged the patient would be unable to extend his arm to exercise his triceps. B. Incorrect. This nerve mostly innervates the forearm and hand muscles so the patient would probably present with trouble gripping the weights. C. Correct. This nerve innervates all the flexors of the arm which would allow the patient to perform a "curl" or flex his arm when lifting the dumbbells. D. Incorrect. This nerve innervates the muscles group which helps to life the arm above the head. 90% of students answered this question correctly. This question's difficulty has been rated as 'easy' compared to other questions in anatomy.

Volkman's contracture ischemia is most associated with tissue damage due to obstruction of the labeled structure? See below a mid humeral axial radiograph.

You are correct! The correct answer is B. The brachial artery (associated with Volkman's contracture) is located at location B, lateral to the Basilic vein (D). The Median nerve travels with the Brachial artery and can be seen at location C. Location E is the humerus and location A indicates the Cephalic vein. For referencing the neurovasculature of the upper arm, it is important to understand the Median n. and Brachial a. run medial to the humerus and mainly at the anterior compartment.