Upper Extremity - Exam 3

Which of the following statements are TRUE in regards to the glenohumeral joint? Choose all

- has high mobility, but is relatively unstable - the rotator cuff mm. Assist in stabilizing the joint - movement can occur in three axes, permitting flexion/extension, abduction/addiction, and rotation (external/internal)

Which of the following muscles contribute to movement of the glenonohumeral joint?

-Long head of biceps brachii m. -Short head of biceps brachii m. -Long head of triceps brachii m.

Which of the following structures are found in the quadrangular space? (Choose all that apply)

-axillary n -posterior circumflex a.

Which of the following ligaments comprise the coracoclavicular ligaments?

-conoid l. -trapezoid l.

Origins of the deltoid m?

-lateral 1/3 of clavicle -Spine (of scapula) -Acromion process

A patient presents with paresthesia (numbness, tingling) in their upper limb after sleeping in a hyperabducted position. You determine the medial cord of the brachial plexus is affected. Based on this determination, which locations in the upper limb would be numb because they are ONLY innervated by the medial cord? (choose all that apply)

-medial aspect of forearm -medial aspect of am -digit 5

Which of the following nerves receive contributions from the C5 and C6 ventral rami? (Choose all that apply) **There may be more contributions than just C5 and C6**

-suprascapular n. -axillary n -median n

Which of the following nerves innervates more than one muscle? (Choose all that apply)

-suprascapular n. -medical pectoral n. -Musculocutaneous n.

Which of the following muscles are innervated by the lower subscapular n.?

-teres major -subscapularis

Which of the following statements are TRUE in regards to the glenohumeral joint?

-the rotator cuff mm. assist in stabilizing the joint -Movement can occur in three axes, permiting flexion/extension, abduction/adduction, and rotation (exteral/internal)

Which of the following nerves arise from, or is a terminal branch, of the posterior cord of the brachial plexus? (Choose all that apply)

-thoracodorsal n. -radial n.

A 17 year-old football player reports to your clinic after falling on his right shoulder two days ago. Your evaluation finds the right acromion process to be more prominent, and the right clavicle is slightly displaced. Imaging confirms that there are no fractures present. You suspect this patient has suffered from an acromioclavicular joint dislocation ("shoulder separation"). Which of the following ligaments may be damaged from this injury? (Choose all that apply).

-trapezoid l. -conoid l. -Acromioclavicular l.

Which of the following spaces does the teres major m. border? (Choose all that apply)

-triangular space -triceps hiatus -quadrangular space

A 44 year-old female was involved in a motor vehicle accident. Upon impact a 45" piece of steel rebar pierces her windshield and she was impaled through the neck. Diagnostic imaging revealed a completely severed anterior division of the superior trunk of the brachial plexus. Which of the following muscles would NOT be affect by this injury?

3rd palmar interossei m.

A 15 year old girl was brought to the ER with a tear in the tendons in the first dorsal tunnel of the wrist after bring bitten by a dog. The injured tendons in this tunnel would include which of the following? Choose all

Abductor pollicis longus m. Extensor pollicis brevis m.

Which of the following muscles receive their nerve supply from the radial n. - choose al that apply

Anconeus m. Triceps brachii m. Brachialis m (partly)

What innervates the pronator quadratus m?

Anterior interosseous n.

A mother yanks on her child's are to pull hum form the path of an oncoming car. Immediately after, she notices her son could not straighten his elbow. At the ER, radiographic imaging reveals a dislocated radial head. What structure was most likely injured?

Anular l. Of the elbow

With respect to the flow of lymphatic fluid, which lymph node is the most distal within the axillary group?

Apical node

Which of the following structures are found in the quadrangular space? (Choose all that apply)

Axillary n. Posterior circumflex humeral a.

Which of the following nerves receive contribution from the C5 and C6 ventral rami? Choose all (there may be more than just C5 and C6)

Axillary n. Suprascapular n. Median n.

What structure does the cephalic vein typically drain into?

Axillary vein

Which of the following is NOT a border of the axilla?

Biceps brachii m.

Which of the following muscles receive motor innervation from the musculocutaneous n.? Choose all

Brachialis m. Biceps Brachii m. Coracobrachialis m.

Which of the following muscles does NOT act on the wrist joint?

Brachioradialis m.

Which spinal nerve root level contributes to the dorsal scapular n.

C5

Which spinal nerve root level contributes to the dorsal scapular n.?

C5

A 19 year old athlete has been diagnosed with a herniated nucleus purposes at the vertebral level C6-C7. Which nerve root has the greatest likelihood of being compressed by the herniated disc?

C7

Which of the following arteries is a branch of the subscapular trunk?

Circumflex scapular a.

Which of the following ligaments comprise the coracoclavicular ligaments? (Choose all that apply)

Conoid l. Trapezoid l.

Which of the following is NOT found on the scapula? Choose all

Conoid tubercle Greater tubercle

All of the following are origins of the deltoid m. EXCEPT?

Coracoid process (Lateral ⅓ of clavicle, acromion process and spine of scapula all are)

Which nerve provides motor innervation to the adductor pollicis m.?

Deep branch of ulnar n.

Which ligament connects the heads of metacarpals 2-5?

Deep transverse metacarpal l.

Which of the following muscles would be totally inactive if the axillary n. Is damaged?

Deltoid m.

Which of the following arteries contribute to the scapular anastomoses? Choose all

Dorsal scapular a. Circumflex scapular a. Suprascapular a.

What is the action of the descending portion of the trapezius?

Elevate the scapula

A 57 year old male presents to the emergency department complaining of left arm pain. Imaging reveals an aneurysm of the axillary a., compressing the posterior cord of the brachial plexus. As a result of the compression, which of the following actions would be weakened? Select all

Extension of the humerus Abduction of the humerus Medial AND lateral rotation of the humerus

Which of the following muscles has an attachment on the lateral epicondyle? Choose all

Extensor carpi radial is brevis m. Extensor digitorum m. Supinator m.

Which of the following muscles are innervated by the posterior interosseous n.? (Choose all that apply)

Extensor carpi ulnaris m. Extensor indicis m.

Which of the following muscles are innervated by the posterior interosseous n.? Choose all

Extensor digiti minimi m Extensor indicis m.

Which of the following muscles is a border of the anatomical snuff box?

Extensor polices longus m.

Flexion of the DIP joint (of the hand) is the primary action of which muscle?

Flexor digitorum profundus m.

Which of the following muscles are innervated by the ulnar n.?

Flexor digitorum profundus m.

Which of the following statements is FALSE about the anterior interosseous a.?

Gives rise to interosseous recurrent a.

What is the correct flow of the lymphatic drainage of the axillary region?

Goes in same direction as venous flow (periphery to heart) so proximal to distal lymph nodes would be: humeral, pectoral, subscapular, central, apical

Which carpal bone is distal AND medial to the lunate?

Hamate

What is the anatomical landmark in which the axillary a. Changes its name to the brachial a.

Inferior to teres major m.

Which of the following vessels anastomoses with the middle collateral a.?

Interosseous recurrent a.

Which of the following vessels anastomoses with the middle collateral a?

Interosseous recurrent a.

Which of the following are characteristics of the radial collateral l. of the elbow? (Choose all that apply)

Is a thickening of the fibrous layer of the elbow joint capsule Blends distally with the anular l. Resists varus forces

Which of the following are characteristics of the ulnar collateral l? Choose all

It's primary function is to resist valves forces Includes an anterior bundle (Also resists hyperextension forces but its not a primary function)

What is the origin of the serratus anterior m?

Lateral borders of ribs 1-8

Which arteries can be found deep to the pectoralis minor m.? Select all

Lateral thoracic a. Thoracoacromial a.

Which of the following is a bony landmark found on the proximal humerus?

Lesser tubercle

Which of the following muscles contribute to movement of the GH joint? Choose all

Long head of biceps brachii m. Short head of biceps brachii m. Long head of triceps brachii m.

Which structure has the same destination as the lateral thoracic a.?

Long thoracic n.

What is the primary action of the lumbrical mm.?

MCP flexion and PIP extension

Which of the following muscles receive their nerve supply from the radial n. (Choose all that apply)

Medial head of the triceps brachii m. Lateral head of the triceps brachii m. Anconeus m.

The anterior interosseous n. Is a branch of which of the following nerves in the forearm?

Median n.

The anterior interosseous n. is a branch of which of the following nerves in the forearm?

Median n.

What innervates the first lumbrical m?

Median n.

Which of the following nerves innervates a muscle that attaches to the base of the second metacarpal?Choose all

Median n. Radial n.

Which of the following is true about the anterior interosseous a.?

Passes distally along the anterior aspect of the interosseous membrane Branch of the common interosseous recurrent a. Runs with the anterior interosseous n.

What muscles have an attachment onto the coracoid process? Choose all

Pectoralis minor m. Short head of the biceps brachii m. Coracobrachilais m.

Which of the following structures are found in the quadrangular space? Choose all

Posterior circumflex numeral a. Axillary n.

What innervates the extensor indicis m?

Posterior interosseous n.

Which of the following are branches of the brachial a.? Choose all

Profunda brachii a. Superior ulnar collateral a. Inferior ulnar collateral a.

Which of the following spaces does the teres major border? Choose all

Quadrangular space Triangular space Triangular interval

The deep palmar arch (a.) is a direct branch of which artery?

Radial a.

Which of the following arteries contributes to the elbow anastomoses AND is a direct branch of the profunda brachii a.?

Radial collateral a.

What innervates the extensor carpi radialis longus m.?

Radial n.

Which of the following nerves arise from, or is a terminal branch of the posterior cord of the brachial plexus? choose all

Radial n. Thoracodorsal n.

Which of the following nerves arise from, or is a terminal branch, of the posterior cord of the brachial plexus? (Choose all that apply)

Radial n. Thoracodorsal n.

What innervates the flexor pollicis brevis m.?

Recurrent branch of the median n.

Which of the following is NOT a function of the interosseous membrane in the forearm?

Resisting valgus forces

Which of the following are characteristics of the radial collateral l.? Choose all

Resists varus forces Blends dismally with the anular l. Is a thickening of the fibrous layer of the elbow joint capsule

Which of the following muscles would be affected if the dorsal scapular nerve is damaged?

Rhomboids Levator scapulae

Which of the following muscles do NOT attach to the humerus? (Choose all that apply)

Serratus anterior m. Levator scapulae m. Pectoralis minor m. Subclavius m.

In which of the following joints can an articular disc be found? Choose all

Sternoclavicular joint Acromioclavicular joint

Which of the following muscles are innervated by the lower subscapular n.?

Subscapularis m. Teres major m.

What is the insertion of the supraspinatus m.?

Superior facet of the greater tubercle of the humerus

Which of the following are branches of the brachial a.? (Choose all that apply)

Superior ulnar collateral a. Inferior ulnar collateral a. Profunda brachii a.

A patient presents with tenderness over the greater tubercle, decreased strength during shoulder abduction and external rotation and you note muscle atrophy (wasting) inferior to the spine of the scapula. Which nerve would most likely be affected in the clinical presentation?

Suprascapular n.

What structure can be found passing UNDER the superior transverse scapular l.?

Suprascapular n.

Which of the following nerves branch from the level of the trunks of the brachial plexus and innervates a rotator cuff muscle?

Suprascapular n.

Which of the following sets correctly order the muscles as they attach on the greater tubercle, from INFERIOR to SUPERIOR of the humerus?

Teres minor —> infraspinatus —> supraspinatus

Which of the following statements about the forearm are TRUE? Choose all

The common interosseous a. Is a branch of the ulnar a. The flexor digitorum profundus is innervated by two different nerves

Which of the following is NOT true regarding pronation and supination at the forearm?

The head of the ulna rolls over the radius during pronation and supination

Which is true regarding pronation and supination at the forearm?

The radial head rolls in the radial notch of the ulna during pronation and supination The interosseous membrane guides the radius during pronation and supination During pronation and supination the distal radio-ulnar joint is held together by an articular disc

What is the origin of the vessel that supplies the supraspinatus m, infraspinatus m, the SC joint and the AC joint?

Thyrocervical trunk

What are the two possible origins of the artery that supplies the levator scapulae, rhomboid major and rhomboid minor? Select all

Thyrocervical trunk Direct branch of subclavian a.

If the thyrocervical trunk is occluded at its origin, which of the following arteries will no longer contribute to the scapular anastomoses?

Transverse cervical a.

Which of the following ligaments comprise the coracoclavicular ligaments?

Trapezoid l. Conoid l.

What structure can be found traveling through Guyon's canal (tunnel)?

Ulnar n.

A 22 year old female was victim of a knife attack. The injury resulted in a laceration across her anterior elbow, from the medial epicondyle to the lateral epicondyle, damaging the structures in this region. Which of the following would most likely NOT be damaged?

Ulnar n. (Damage would be to cubital fossa - radial n., brachial a., median n., biceps brachii tendon)

Which of the following arteries is typically a branch of the subscapular trunk?

circumflex scapular a.

Which of the following ligaments has two attachments on the same bone?

coracoacromial l.

Which of the following muscles would be totally inactive if the axillary n. is damaged?

deltoid m.

The muscles attaching to the vertebral border of the scapula are innervated by what nerve?

dorsal scapular nerve

Which of the following a bony landmark found on the proximal humerus?

greater tubercle

What is the insertion of the supraspinatus m.?

greater tubercle, superior facet

Which of the following bony landmarks is found most medially?

impression of costoclavicular l.

What is the anatomical landmark in which the axillary a. changes its name to the brachial a.?

inferior to teres major m.

What is the origin of the serratus anterior m.?

lateral border of ribs 1-8

Which of the following branches of the axillary a. can be described as passing along the axillary border of pectoralis minor m., descending down the lateral thoracic wall, and supplies the breast?

lateral thoracic a.

Which of the following muscles would be affected is the thoracodorsal n. is damaged?

latissimus dorsi m.

A 67 year-old patient arrives to your clinic with complaints of decreased shoulder motion. Your evaluation finds the patient is unable to perform shoulder abduction past 30 degrees. Which of the following muscles is likely affected?

middle deltoid m.

From which structure of the brachial plexus does the axillary n. arise?

posterior cord

Which structure of the brachial plexus gives rise to two (2) of the nerves that supply the rotator cuff?

posterior cord

You examine a patient who sustained a glenohumeral joint dislocation and determine the patient has decreased abduction, extension and external rotation strength. The patient does not remember the direction of the dislocation, but does know a nerve was pinched. Based on this information, into which neurovascular area did the glenohumeral joint most likely dislocate?

quadrangular space

Which of the following nerves receive contributions from the C7 and C8 ventral rami? (Choose all that apply) **There may be more contributions than just C7 and C8*

radial n. thoracodorsal n.

A 34 year-old female patient complains of decreased shoulder stability after undergoing a masectomy. During the procedure, the surgeon accidentally cut a nerve traveling along the lateral border of the thoracic cage. You notice that your patient has significant "winging" of her right scapula. Which muscle is most likely affected by the nerve that was cut during surgery?

serratus anterior m.

In which of the following joints can an articular disc be found?

sternoclavicular joint

A patient presents with tenderness over the greater tubercle, decreased strength during shoulder abduction and external rotation, and you note muscle atrophy (wasting) inferior to the spine of the scapula. Which nerve would most likely be affected with this clinical presentation?

suprascapular n.

Which of the following nerves branches from the level of the trunks of the brachial plexus AND innervates a rotator cuff muscle? (Choose all that apply)

suprascapular n.

Borders of the axilla:

teres major m. subscapularis m. pectoralis major m. Lattissimus dorsi m.

Which of the following muscles is innervated by the axillary n.?

teres minor m.

Which of the following nerves innervate a muscle which performs internal rotation of the glenohumeral joint?

thoracodorsal n.

If the thyrocervical trunk is occluded at its origin, which of the following arteries will no longer contribute to the scapular anastomosis? You Answered

transverse cervical a.