Anatomy- Upper Limbs

Structure Clinical Importance Plate # in Netter

SKELETAL SYSTEM
Clavicle Most clavicular fractures are caused from a fall on an outstretched arm or direct trauma delivered to the lateral side of 408, 409
the shoulder. Middle third of the clavicle is most commonly fractured due to the changing bony morphology of the
clavicle, its strutlike function, and ligament attachments.
Humerus The proximal humerus, especially the surgical neck, is fractured due to low-energy falls in the elderly and high-energy 409-411
trauma in youth. The axillary nerve is in harm’s way and the circumflex humeral arteries can be injured. Midshaft
fractures are also relatively common and place the radial nerve in harm’s way.
Ulna Subcutaneous location of olecranon makes it vulnerable to fracture by direct trauma, especially when elbow is flexed; 426, 429
ulnar styloid process may also be fractured in distal radial fractures
Radius Fractures of distal radius are most common fracture of upper extremity, typically caused by fall on outstretched hand 429
Scaphoid Most commonly fractured carpal bone; fracture is often due to fall on outstretched hand 439, 440, 442
MUSCULAR SYSTEM
Rotator (compressor) cuff muscles Injuries to this group of muscles can be from an acute injury or chronic overuse injury leading to common causes of 412, 415, 422
shoulder pain and disability
Supraspinatus tendon Most commonly injured rotator (compressor) cuff muscle tendon complex. Often torn beneath the acromion 415-417, 422
Biceps brachii tendon Proximally the long head of the biceps tendon tears in the elderly from falls on an outstretched arm, and distally the 421, 423
biceps tendon is used to perform flexor compartment reflex assessing the C5 and C6 spinal nerves
Long head of biceps brachii When long head has been ruptured, it pulls off supraglenoid tubercle and retracts down into arm; muscle bulges 421
(Popeye deformity) at midshaft of humerus
Posterior forearm muscles Repetitive use of muscles arising from common extensor origin can damage tendons and produce pain over lateral 431
epicondyle, associated with tennis elbow
Anterior forearm muscles Repetitive use of muscles arising from common flexor origin can damage tendons and produce pain over medial 423,433
epicondyle, associated with golfer’s elbow
NERVOUS SYSTEM
Long thoracic Nerve Injury may produce “winged scapula” caused by denervation of serratus anterior 417, 419
Axillary Nerve Postiion of nerve close to medial aspect of humeral head makes it vulnerable to injury with fractures of surgical neck 422
humerus of humeral dislocations
Median Nerve Commonly compressed in carpal tunnel, producing pain and paresthesia in lateral three and one-half digits 450, 466
Recurrent branch of median nerve May be injured in superficial lacerations of palm over thenal eminence 450, 466
Ulnar nerve Vulnerable to compression or injury where it passes posterior to medial epicondyle of humerus, and at writs in ulnar 462, 467
tunnel (Guyon’s canal )
Radial nerve Vulnerable to compression or injury where it lies against humerus in radial groove (e.g., with humeral fracture); 468, 469
common symptom is “wrist drop” due to weakness of wrist extensors
CARDIOVASCULAR SYSTEM
Median cubital vein Accessed in cubital fossa for venipuncture 405
Suprascapular, dorsal scapular, and Provide collateral circulation around scapula, allowing blood to reach distal part of upper extremity if axillary is 418
circumflex scapular arteries blocked of compressed
Brachial Artery Palpated in cubital fossa to assess brachial pulse prior to taking blood pressure measurement 423, 424
Radial artery Palpated at lateral aspect of wrist to assess radial pulse 424
 Anatomy- Upper Limbs
MUSCLE MUSCLE ORIGIN INSERTION INNERVATION BLOOD SUPPLY MAIN ACTIONS
GROUP
 Anatomy- Upper Limbs
Medial side of base of
Abductor digiti Pisiform bone and tendon of flexor carpi Ulnar nerve (deep Deep palmar branch
Hand proximal phalanx of little Abducts little finger
minimi ulnaris branch) of ulnar artery
finger (5th digit)
Abductor Flexor retinaculum, tubercles of scaphoid and Base of proximal phalanx of Median nerve Superficial palmar
Hand Abducts thumb
pollicis brevis trapezium bones thumb (recurrent branch) branch of radial artery
Radial nerve
Abductor Posterior Posterior surface of ulna, radius and Posterior interosseous Abducts and extends thumb at
Base of 1st metacarpal (posterior
pollicis brevis forearm interosseous membrane artery carpometacarpal joint
interosseous)
Oblique head: bases of 2nd and 3rd metacarpals
Adductor and capitate bone and adjacent bones Base of proximal phalanx of Ulnar nerve (deep
Hand Deep palmar arch Adducts thumb
pollicis Transverse head: anterior surface of 3rd thumb branch)
metacarpal
Lateral surface of Assists triceps brachii in
Posterior surface of lateral epicondyle of
Anconeous Arm olecranon and posterior Radial nerve Deep brachial artery extending elbow, abducts ulna in
humerus
proximal ulna pronation
Radial tuberosity, fascia of
Long head: supraglenoid tubercle of scapula Musculocutaneous Muscular branches of Flexes and supinates forearme at
Biceps brachii Arm forearm via bicipital
Short head: coracoid process of scapula nerve brachial artery elbow
aponeurosis
Brachialis Arm Distal half of anterior surface of humerus Coronoid process and Musculucutaneous Radial recurrent arter, Flexes forearm at elbow
tuberosity of ulna nerve and radial muscular branches of
nerve crahcial artery
Brachioradialis Posteiror Proximall 2/3 of lateral supracondular ridge Lateral side of distal end of Radial nerve Radial recurrent artery Weak flesxion of forearm when
forearm of humerus radius forearm is midpronated
Coracobrachialis Arm Coracoid process of scapula Middle third of medial Musculocutaneous Muscular brances of Flexes and adducts arm at
surface of humerus nervw brachila artery shoulder

Deltoid Shoulder Lateral third of clavicle, acromion, spine of Deltoid tuberosity of Axillary nerve Posterior circumflex Clavicular part: flexes and
scapula humerus humeral arter, deltoid medially rotates arm
branch of Acromial part: abducts arm
thoracoacromial artery beyond initial 15 degrees done by
supraspinatus
Spinous part: extends and laterally
rotates arm
Dorsal Hand Sides of two adjacent metacarpal bones Base of procimal Ulnar nerve (deep Deep palmar arch Abducts digits; flex digits at
interosseous phalangeal bones, extensor branch) metacarpopharyngeal joint and
muscles expansion of digits 2-4 extend interphalangeal joints
Extensor carpi Posterior Base of 3rd metacarpal and Radial nerve (deep Radial artery, radial
Lateral epicondyle of humerus Extends and abducts hand at wrist
radialis brevis forearm slip to 2nd metacarpal branch) recurrent artery
Extensor carpi Posterior Distal third of lateral supracondylar ridge of Base of 2nd metacarpal and Radial artery, radial
Radial nerve Extends and abducts hard at wrist
radialis longus forearm humerus slip to 3rd metacarpal recurrent artery
Radial nerve
Extensor carpi Posterior Lateral epicondyle of humerus and posterior Posterior interosseous
Base of 5th metacarpal (posterior Extends and adducts hand at wrist
ulnaris forearm border of ulna artery
interosseous nerve)
Radial nerve
Extensor digiti Posterior Extensor expansion of 5th Posterior interosseous
Lateral epicondyle of humerus (posterior inter- Extends 5th digit- and adduction
minimi forearm digit artery
osseous nerve)
Extensor Posterior Lateral epicondyle of humerus Extensor expansions of Radial nerve Posterior interosseous Extends medial four digits, assists
 Anatomy- Upper Limbs
(posterior inter-
digitorum forearm medial four digits artery in wrist extension
osseous nerve)
Radial nerve
Posterior Posterior surface of ulna and Extensor expansion of 2nd Posterior interosseous Extends 2nd digit and helps extend
Extensor indicis (posterior
forearm interosseous membrane digit artery hand at wrist
interosseous nerve)
Radial nerve
Extensor pollicis Posterior Posterior surface of radius and Dorsal base of proximal Posterior interosseous Extends proximal phalanx of
(posterior
brevis forearm interosseous membrane phalanx of thumb artery thumb at carpophalangeal joints
interosseous nerve)
Radial nerve
Extensor pollicis Posterior Posterior surface of middle third of ulna, Dorsal base of distal Posterior interosseous
(posterior Flexes and abducts hand at wrist
longus forearm interosseous membrane phalanx of thumb artery
interosseous nerve)
Flexor carpi Anterior
Medial epicondyle of humerus Base of 2nd metacarpal Median nerve Radial artery Flexes and adducts hand at wrist
radialis forearm
Superficial head:
medial epicondyle Pisiform bone, hook of
Flexor carpi Anterior Posterior ulnar
of humerus hamate bone, base of 5th Ulnar nerve Flexes and adducts hand at wrist
ulnaris forearm recurrent artery
Deep head: olecranon metacarpal
and posterior border of ulna
Medial side of base of
Flexor digiti Ulnar nerve (deep Deep palmar branch Flexes proximal phalanx of little
Hand Flexor retinaculum and hook of hamate bone proximal phalanx of little
minimi brevis branch) of ulnar artery finger
finger
Medial part: ulnar Anterior interosseous
Flexor Palmar base of distal Flexes distal phalangeal bones of
Anterior Medial and anterior surface of proximal 3/4 nerve artery, muscular
digitorum phalangeal bones of medial medial four digits, assists with
forearm of ulna and interosseous membrane Lateral part: branches of ulnar
profundus four digits flexion of hand at wrist
median nerve artery
Humeroulnar head:
Flexor Bodies of middle Flexes middle and proximal
Anterior medial epicondyle of humerus, coronoid, Ulnar and radial
digitorum phalangeal bones of medial Median nerve phalangeal bones of medial four
forearm process of ulna, ulnar collateral ligament arteries
superficialis four digits digits, flexes hand at wrist
Radial head: superior half of anterior radius
Median nerve
Flexor pollicis Flexor retinaculum and tubercle of trapezium Lateral side of base of Superficial palmar
Hand (recurrent Flexes proximal phalanx of thumb
brevis bone proximal phalanx of thumb branch of radial artery
branch)
Median nerve
Flexor pollicis Anterior Anterior surface of radius and Palmar base of distal Anterior interosseous
(anterior Lateral phalangeal bones of thumb
longus forearm interosseous membrane phalanx of thumb artery
interosseous nerve)
Infraspinatus Shoulder Infraspinous fossa of scapula and deep fascia Greater tubercle of humerus Suprascapular nerve Suprascapular artery Lateral rotation of arm
Thoracodorsal artery,
dorsal perforating
Spinous processes of T7–L5, branches of 9th, 10th,
Intertubercular sulcus of Extends, adducts and medial
Latissimus dorsi Shoulder thoracolumbar fascia, iliac crest, and last Thoracodorsal nerve and 11th posterior
humerus rotates humerus
three ribs intercostal, subcostal,
and first three lumbar
arteries
Dorsal scapular artery,
Anterior rami of C3–
Levator Superficia Posterior tubercles of transverse Medial border of scapula transverse cervical Elevates scapula medially,
C4 and
scapulae l back processes of C1–C4 from superior angle to spine artery, ascending inferiorly rotates glenoid fossa
dorsal scapular nerve
cervical artery
Lumbrical, first Hand Lateral two tendons of flexor digitorum Lateral sides of extensor Median nerve Superficial and deep Extends digits at interphalangeal
 Anatomy- Upper Limbs
(digital joints, flex metacarpophalangeal
and second profundus expansion of digits 2 and 3 palmar arches
branches) joints
Extend digits at interphalangeal
Lumbrical, third Medial three tendons of flexor digitorum Lateral sides of extensor Ulnar nerve (deep Superficial and deep
Hand joints, flex metacarpophalangeal
and fourth profundus expansion of digits 4 and 5 branch) palmar arches
joints
Opponens digiti Palmar surface of 5th Ulnar nerve (deep Deep palmar branch Draws 5th metacarpal anteriorly
Hand Flexor retinaculum and hook of hamate bone
minimi metacarpal branch) of ulnar artery and rotates it to face thumb
Median nerve
Opponens Flexor retinaculum and tubercle of trapezium Lateral side of 1st Superficial palmar Draws 1st metacarpal forward and
Hand (recurrent
pollicis bone metacarpal branch of radial artery rotates it medially
branch)
Palmar Bases of proximal phalanx
Ulnar nerve (deep Adducts digits; flexes digits and
interosseous Hand Sides of metacarpal bones 2, 4, and 5 and extensor expansion of Deep palmar arch
branch) extends interphalangeal joints
muscles digits 2, 4, and 5
Palmar aponeurosis and flexor Skin of medial border of Superficial branch of Superficial palmar Deepens hollow of hand, assists
Palmaris brevis Hand
retinaculum palm ulnar nerve arch grip
Distal half of flexor
Anterior Posterior ulnar Flexes hand at wrist and tenses
Palmaris longus Medial epicondyle of humerus retinaculum and palmar Median nerve
forearm recurrent artery palmar aponeurosis
aponeurosis
Pectoral branch of
Pectoral/ Sternal half of clavicle, sternum to 7th rib, thoracoacromial
Lateral lip of intertubercular Medial and lateral Flexes, adducts, and medially
Pectoralis major axillary cartilages of true ribs, aponeurosis of external artery, perforating
sulcus of humerus pectoral nerves rotates arm
regions abdominal oblique muscle branches of internal
thoracic artery
Pectoral branch of
Pectoral/ thoracoacromial
Medial pectoral Lowers lateral angle of scapula
Pectoralis minor axillary Outer surface of upper margin of ribs 3–5 Coracoid process of scapula artery, and superior
nerve and protracts scapula
regions and lateral thoracic
arteries
Median nerve
Pronator Anterior Distal fourth of anterior Anterior interosseous
Distal fourth of anterior ulna (anterior intero- Pronates forearm
quadratus forearm radius artery
sseous nerve)
Anterior Two heads: medial epicondyle of humerus Midway along lateral Anterior ulnar Pronates forearm and weakly
Pronator teres Median nerve
forearm and coronoid process of ulna surface of radius recurrent artery flexes elbow
Dorsal scapular OR
deep branch of
transverse cervical
Medial border of scapula Fixes scapula to thoracic wall and
Rhomboid Superficia Dorsal scapular artery, dorsal
Spinous processes of T2–T5 vertebrae below base of spine of retracts and rotates it to depress
major l back nerve perforating branches
scapula glenoid cavity
of upper five or six
posterior intercostal
arteries
Rhomboid Superficia Nuchal ligament, spines of C7 and T1 Medial border of scapula at Dorsal scapular Dorsal scapular artery Fixes scapula to thoracic wall and
minor l back vertebrae spine of scapula nerve OR deep branch of retracts and rotates it to depress
transverse cervical glenoid cavity
artery, dorsal
perforating branches
of upper five or six
posterior intercostal
 Anatomy- Upper Limbs
arteries
Costal surface of medial Protracts and rotates scapula and
Serratus anterior Shoulder Lateral surfaces of upper 8–9 ribs Long thoracic nerve Lateral thoracic artery
border of scapula holds it against thoracic wall
Inferior surface of middle Clavicular branch of
Subclavius Shoulder Upper border of 1st rib and its cartilage Nerve to subclavius Anchors and depresses clavicle
third of clavicle thoracoacromial artery
Medially rotates and adducts arm;
Upper and lower Subscapular artery,
Subscapularis Shoulder Subscapular fossa Lesser tubercle of humerus helps hold humeral head in
subscapular nerves lateral thoracic artery
glenoid fossa
Supinator Lateral epicondyle of humerus, radial Lateral, posterior, and Radial recurrent
Posterior Radial nerve (deep
(Always on collateral and angular ligaments, anterior surfaces of artery, posterior Supinates forearm
forearm branch)
practical) supinator fossa, and crest of ulna proximal third of radius interosseous arteries
Supraspinatus Shoulder Supraspinous fossa of scapula and deep fascia Greater tubercle of humerus Suprascapular nerve Suprascapular artery Initiates arm abduction
Medial lip of intertubercular Lower subscapular Circumflex scapular
Teres major Shoulder Posterior surface of inferior angle of scapula Adducts and medially rotates arm
sulcus of humerus nerve artery
Upper 2/3 of posterior surface of lateral Inferior facet of greater Circumflex scapular
Teres minor Shoulder Axillary nerve Laterally rotates arm
border of scapula tubercle of humerus artery
Transverse cervical
Superior nuchal line, external occipital Lateral third of clavicle, artery, dorsal Elevates, retracts, and rotates
Superficia Accessory nerve
Trapezius protuberance, nuchal ligament, spinous acromion, and spine of perforating branches scapula; lower fibers depress
l back (cranial nerve XI)
processes of C7–T12 scapula of posterior intercostal scapula
arteries
Long head:
infraglenoid
Extends forearm at elbow; long
tubercle of scapula Lateral head: upper half
Posterior surface of Branch of profunda head stabilizes head of abducted
Triceps brachii Arm of posterior Radial nerve
olecranon process of ulna brachii artery humerus and extends and adducts
humerus
arm
Medial head: distal 2/3
of medial and posterior humerus
 Anatomy- Upper Limbs
1. A 21-year-old patient has a lesion of the upper trunk interosseous muscles abduct the fingers. The flexor 8. A patient comes in complaining that she cannot flex
of the brachial plexus (Erb–Duchenne paralysis). Which digito- rum profundus flexes the distal interphalangeal her proximal interphalangeal joints. Which of the
of the following is the most likely diagnosis? (DIP) joints. following muscles appear(s) to be paralyzed on further
(C) Arm tending to lie in medial rotation examination of her finger?
A lesion of the upper trunk of the brachial plexus results 5. A 27-year-old patient presents with an inability to (D) Flexor digitorum superficialis
in a condition called “waiter’s tip hand,” in which the draw the scapula forward and downward because of The flexor digitorum superficialis muscle flexes the
arm tends to lie in medial rotation because of paralysis paralysis of the pectoralis minor. Which of the following proximal interphalangeal joints. The flexor digitorum
of lateral rotators and abductors of the arm. The long would most likely be a cause of his condition? profundus muscle flexes the DIP joints. The palmar and
thoracic nerve, which arises from the root (C5–C7) of (C) Fracture of the coracoid process dorsal interossei and lumbricals can flex
the brachial plexus, innervates the serratus anterior The pectoralis minor inserts on the coracoid process, metacarpophalangeal joints and extend the
muscle that can elevate the arm above the horizontal. originates from the second to the fifth ribs, and is interphalangeal joints. The palmar interossei adduct the
The dorsal scapular nerve, which arises from the root innervated by the medial and lateral pectoral nerves that fingers, and the dorsal interossei abduct the fingers.
(C5), innervates the rhomboid major. The medial side of arise from the medial and lateral cords of the brachial
the arm receives cutaneous innervation from the medial plexus. It depresses the shoulder and forms the anterior 9. A 21-year-old woman walks in with a shoulder and
brachial cutaneous nerve of the medial cord. The wall of the axilla. The pectoralis minor has no arm injury after falling during horseback riding.
adductor pollicis is innervated by the ulnar nerve. attachment on the clavicle. Examination indicates that she cannot adduct her arm
because of paralysis of which of the following muscles?
2. A patient comes in with a gunshot wound and requires 6. A 22-year-old patient received a stab wound in the (C) Latissimus dorsi
surgery in which his thoracoacromial trunk needs to be chest that injured the intercostobrachial nerve. Which of The latissimus dorsi adducts the arm, and the
ligated. Which of the following arterial branches would the following conditions results from the described supraspinatus muscle abducts the arm. The
maintain normal blood flow? lesion of the nerve? infraspinatus and the teres minor rotate the arm
(E) Superior thoracic (D) Loss of sensory fibers from the second laterally. The serratus anterior rotates the glenoid cavity
The superior thoracic artery is a direct branch of the Intercostal nerve of the scapula upward, abducts the arm, and elevates it
axillary artery. The thora- coacromial trunk has four The intercostobrachial nerve arises from the lateral above a horizontal position.
branches: the pectoral, clavicular, acromial, and cutaneous branch of the second intercostal nerve and
deltoid. pierces the intercostal and serratus anterior muscles. It 10. A 35-year-old man walks in with a stab wound to the
may communicate with the medial brachial cutaneous most medial side of the proximal portion of the cubital
3. A 29-year-old man comes in with a stab wound, nerve, and it supplies skin on the medial side of the arm. fossa. Which of the following structures would most
cannot raise his arm above horizontal, and exhibits a It contains no skeletal motor fibers but does contain likely be damaged?
condition known as “winged scapula.” Which of the sympathetic postganglionic fibers, which supply sweat (E) Median nerve
following structures of the brachial plexus would most glands. The contents of the cubital fossa from medial to lateral
likely be damaged? side are the median nerve, the brachial artery, the
(D) Roots 7. A 16-year-old boy fell from a motorcycle, and his biceps brachii tendon, and the radial nerve. Thus, the
Winged scapula is caused by paralysis of the serratus radial nerve was severely damaged because of a fracture median nerve is damaged. The radial recurrent artery
anterior muscle that results from damage to the long of the midshaft of the humerus. Which of the following ascends medial to the radial nerve.
thoracic nerve, which arises from the roots of the conditions would most likely result from this accident?
brachial plexus (C5–C7). (A) Loss of wrist extension leading to wrist 11. The police bring in a murder suspect who has been
Drop in a gunfight with a police officer. The suspect was
4. A 16-year-old patient has weakness flexing the Injury to the radial nerve results in loss of wrist struck by a bullet in the arm; his median nerve has been
metacarpophalangeal joint of the ring finger and is extension, leading to wrist drop. The median nerve damaged. Which of the following symptoms is likely
unable to adduct the same finger. Which of the following innervates the pronator teres, pronator quadratus, and produced by this nerve damage?
muscles is most likely paralyzed? opponens pollicis muscles and the skin over the ventral (D) Ape hand
(E) Palmar interosseous aspect of the thumb. The ulnar nerve innervates the
The dorsal and palmar interosseous and lumbrical dorsal interosseous muscles, which act to abduct the Injury to the median nerve produces the ape hand (a
muscles can flex the meta- carpophalangeal joints and fingers. hand with the thumb permanently extended). Injury to
extend the interphalangeal joints. The palmar the radial nerve results in loss of wrist extension,
interosseous muscles adduct the fingers, while the dorsal leading to wrist drop. Damage to the upper trunk of the
 Anatomy- Upper Limbs
brachial plexus produces waiter’s tip hand. A claw hand pollicis longus, and the flexor digitorum superficialis thoracodorsal nerve supplies the latissimus dorsi, which
and flattening of the hypothenar eminence or atrophy of and profundus run deep to the flexor retinaculum. can adduct, extend, and rotate the arm medially. The
the hypothenar muscles result from damage to the ulnar upper and lower subscapular nerves supply the
nerve. 16. A patient with Bennett fracture (a fracture of the subscapularis, and the lower subscapular nerve also
base of the first metacarpal bone) experiences an supplies the teres major; both of these structures can
12. An automobile body shop worker has his middle impaired thumb movement. Which of the following adduct and rotate the arm medially. The
finger crushed while working on a transmission. Which intrinsic muscles of the thumb is most likely injured? musculocutaneous nerve supplies the flexors of the arm,
of the following muscles is most likely to retain and the radial nerve supplies the extensors of the arm.
(C) Opponens pollicis
function? The dorsal scapular nerve supplies the levator scapulae
The opponens pollicis inserts on the first metacarpal. All
and rhomboid muscles; these muscles elevate and
(C) Palmar interosseous other intrinsic muscles of the thumb, including the
adduct the scapula, respectively.
The extensor digitorum, flexor digitorum profundus, abductor pollicis brevis, the flexor pollicis brevis, and
dorsal interosseous, and lumbrical muscles are attached the adductor pollicis muscles, insert on the proximal
to the middle digit, but no palmar interosseous muscle is phalanges. 20. A 17-year-old boy with a stab wound received
attached to the middle digit. multiple injuries on the upper part of the arm and
17. A 27-year-old pianist with a known carpal tunnel required surgery. If the brachial artery were ligated at its
13. A 14-year-old boy falls on his outstretched hand and syndrome experiences difficulty in finger movements. origin, which of the following arteries would supply
has a fracture of the scaphoid bone. The fracture is most Which of the following intrinsic muscles of her hand is blood to the profunda brachii artery?
likely accompanied by a rupture of which of the paralyzed? (C) Posterior humeral circumflex
following arteries? (C) Lateral two lumbricals and opponens The posterior humeral circumflex artery anastomoses
(D) Radial artery Pollicis with an ascending branch of the profunda brachii
The scaphoid bone forms the floor of the anatomic The median nerve innervates the abductor pollicis artery, whereas the lateral thoracic and subscapular
snuffbox, through which the radial artery passes to enter brevis, opponens pollicis, and two lateral lumbricals. arteries do not. The superior ulnar collateral and radial
the palm. The radial artery divides into the princeps The ulnar nerve innervates all interossei (palmar and recurrent arteries arise inferior to the origin of the
pollicis artery and the deep palmar arch. dorsal), the adductor pollicis, and the two medial profunda brachii artery.
lumbricals.
14. A 12-year-old boy walks in; he fell out of a tree and 21. A 23-year-old woman who receives a deep cut to her
fractured the upper portion of his humerus. Which of the 18. A 31-year-old roofer walks in with tenosynovitis ring finger by a kitchen knife is unable to move the
following nerves are intimately related to the humerus resulting from a deep penetrated wound in the palm by a metacarpophalangeal joint. Which of the following pairs
and are most likely to be injured by such a fracture? big nail. Examination indicates that he has an infection of nerves was damaged?
(C) Radial and axillary in the ulnar bursa. This infection most likely resulted in (D) Ulnar and radial
The axillary nerve passes posteriorly around the necrosis of which of the following tendons? The metacarpophalangeal joint of the ring finger is
surgical neck of the humerus, and the radial nerve lies (C) Tendon of the flexor digitorum profundus flexed by the lumbrical, palmar, and dorsal interosseous
in the radial groove of the middle of the shaft of the The ulnar bursa, or common synovial flexor sheath, muscles, which are innervated by the ulnar nerve. The
humerus. The ulnar nerve passes behind the medial contains the tendons of both the flexor digitorum extensor digitorum, which is innervated by the radial
epicondyle, and the median nerve is vulnerable to injury superficialis and profundus muscles. The radial bursa nerve, extends this joint. The musculocutaneous and
by supracondylar fracture of the humerus, but these envelops the tendon of the flexor pollicis longus. The axillary nerves do not supply muscles of the hand. The
nerves lie close to or in contact with the lower portion of tendons of the flexor carpi ulnaris and the palmaris median nerve supplies the lateral two lumbricals, which
the humerus. The musculocutaneous nerve is not in longus are not contained in the ulnar bursa. can flex metacarpophalangeal joints of the index and
direct contact with the humerus. middle fingers.
15. A man injures his wrist on broken glass. Which of 19. An 18-year-old boy involved in an automobile
the following structures entering the palm superficial to accident presents with an arm that cannot abduct. His
the flexor retinaculum may be damaged? paralysis is caused by damage to which of the following
(D) Ulnar artery and ulnar nerve nerves?
(A) Suprascapular and axillary
22. A 27-year-old baseball player is hit on his forearm
Structures entering the palm superficial to the flexor
by a high-speed ball during the World Series, and the
retinaculum include the ulnar nerve, ulnar artery, The abductors of the arm are the deltoid and
muscles that form the floor of the cubital fossa appear to
palmaris longus tendon, and palmar cutaneous branch supraspinatus muscles, which are innervated by the
of the median nerve. The median nerve, the flexor axillary and suprascapular nerves, respectively. The
 Anatomy- Upper Limbs
be torn. Which of the following groups of muscles have half fingers; and the dorsal side of the index finger, the (C) Two medial lumbricals
lost their functions? middle finger, and one-half of the ring finger. The radial The ulnar nerve innervates the two medial lumbricals.
(B) Brachialis and supinator nerve innervates the skin of the radial side of the hand However, the median nerve innervates the two lateral
The brachialis and supinator muscles form the floor of and the radial two and one-half digits over the proximal lumbricals, the flexor digitorum superficialis, the
the cubital fossa. The brachioradialis and pronator teres phalanx. opponens pollicis, and the pronator teres muscles.
muscles form the lateral and medial boundaries,
respectively. The pronator quadratus is attached to the 26. A patient with a deep stab wound in the middle of 29. A secretary comes in to your office complaining of
distal ends of the radius and the ulna. the forearm has impaired movement of the thumb. pain in her wrists from typing all day. You determine
Examination indicates a lesion of the anterior that she likely has carpal tunnel syndrome. Which of the
23. A 23-year-old man complains of numbness on the interosseous nerve. Which of the following muscles is following conditions would help you determine the
medial side of the arm following a stab wound in the paralyzed? diagnosis?
axilla. On examination, he is diagnosed with an injury of (C) Flexor digitorum profundus and pronator (C) Flattened thenar eminence
his medial brachial cutaneous nerve. In which of the Quadratus The carpal tunnel contains the median nerve and the
following structures are the cell bodies of the damaged The anterior interosseous nerve is a branch of the tendons of flexor pol- licis longus, flexor digitorum
nerve involved in numbness located? median nerve and supplies the flexor pollicis longus, profundus, and flexor digitorum superficialis muscles.
(B) Dorsal root ganglion half of the flexor digitorum profundus, and the pronator Carpal tun- nel syndrome results from injury to the
The medial brachial cutaneous nerve contains sensory quadratus. The median nerve supplies the pronator median nerve, which supplies the thenar muscle. Thus,
(general somatic afferent [GSA]) fibers that have cell teres, flexor digitorum superficialis, palmaris longus, injury to this nerve causes the flattened thenar
bodies in the dorsal root ganglia, and an injury of these and flexor carpi radialis muscles. A muscular branch eminence. The middle finger has no attachment for the
GSA fibers causes numbness of the medial side of the (the recurrent branch) of the median nerve innervates adductors. The ulnar nerve innervates the medial half of
arm. It also contains sympathetic postganglionic fibers the thenar muscles. the flexor digitorum profundus muscle, which allows
that have cell bodies in the sympathetic chain ganglia. flexion of the DIP joints of the ring and little fingers.
The anterior horn of the spinal cord contains cell bodies 27. A 29-year-old patient comes in; he cannot flex the The ulnar nerve sup- plies the skin over the medial one
of skeletal motor (general somatic efferent [GSE]) distal interphalangeal (DIP) joint of the index finger. His and one-half fingers and adductor pollicis muscle.
fibers, and the lateral horn contains cell bodies of physician determines that he has nerve damage from a
sympathetic preganglionic fibers. The posterior horn supracondylar fracture. Which of the following 30. A man is unable to hold typing paper between his
contains cell bodies of interneurons. conditions is also a symptom of this nerve damage? index and middle fingers. Which of the following nerves
(C) Loss of sensation over the distal part of the was likely injured?
24. A 38-year-old homebuilder was involved in an second digit (C) Ulnar nerve
accident and is unable to supinate his forearm. Which of The flexor digitorum profundus muscle flexes the DIP To hold a typing paper, the index finger is adducted by
the following nerves are most likely damaged? joints of the index and middle fingers and is innervated the palmar interosse- ous muscle, and the middle finger
(D) Radial and musculocutaneous by the median nerve, which also supplies sensation over is abducted by the dorsal interosseous muscle. Both
The supinator and biceps brachii muscles, which are the distal part of the second digit. The same muscle muscles are innervated by the ulnar nerve.
innervated by the radial and musculocutaneous nerves, flexes the DIP joints of the ring and little fingers but
respectively, produce supination of the forearm. This is receives innervation from the ulnar nerve, which also 31. The victim of an automobile accident has a
a question of two muscles that can supinate the forearm. innervates the hypothenar muscles. The median nerve destructive injury of the proximal row of carpal bones.
innervates the thenar muscles. The radial nerve Which of the following bones is most likely damaged?
25. A 31-year-old patient complains of sensory loss over innervates the supinator, abductor pollicis longus, and (D) Triquetrum
the anterior and posterior surfaces of the medial third of extensor pollicis longus and brevis muscles. The ulnar The proximal row of carpal bones consists of the
the hand and the medial one and one-half fingers. He is nerve innervates the adductor pollicis. The scaphoid, lunate, triquetrum, and pisiform bones,
diagnosed by a physician as having “funny bone” musculocutaneous nerve supplies the biceps brachii that whereas the distal row consists of the trapezium,
symptoms. Which of the following nerves is injured? can supinate the arm. trapezoid, capitate, and hamate bones.
(D) Ulnar
The ulnar nerve supplies sensory fibers to the skin over 28. A 27-year-old man with cubital tunnel syndrome 32. A patient has a torn rotator cuff of the shoulder joint
the palmar and dorsal surfaces of the medial third of the complains of numbness and tingling in the ring and little as the result of an automobile accident. Which of the
hand and the medial one and one-half fingers. The finger and back and sides of his hand because of damage following muscle tendons is intact and has normal
median nerve innervates the skin of the lateral side of to a nerve in the tunnel at the elbow. Which of the function?
the palm; the palmar side of the lateral three and one- following muscles is most likely to be paralyzed? (C) Teres major
 Anatomy- Upper Limbs
The rotator cuff consists of the tendons of the ligaments and inverted or retracted nipple because of following conditions is most likely to cause a loss of this
supraspinatus, infraspinatus, subscapularis, and teres pulling on the lactiferous ducts. Polymastia is a nerve function?
minor muscles. It stabilizes the shoulder joint by holding condition in which more than two breasts are present. (D) Inferior dislocation of the head of the
the head of the humerus in the glenoid cavity during Humerus
movement. The teres major inserts on the medial lip of 36. A patient with a stab wound receives a laceration of Inferior dislocation of the head of the humerus may
the intertubercular groove of the humerus. the musculocutaneous nerve. Which of the following damage the axillary nerve, which arises from the
conditions is most likely to have occurred? posterior cord of the brachial plexus, runs through the
33. A patient complains of having pain with repeated (A) Lack of sweating on the lateral side of the quadrangular space accompanied by the posterior
movements of his thumb (claudication). His physician Forearm humeral circumflex vessels around the surgical neck of
performs the Allen test and finds an insufficiency of the The musculocutaneous nerve contains sympathetic the humerus, and supplies the deltoid and teres minor,
radial artery. Which of the following conditions would postganglionic fibers that supply sweat glands and which are lateral rotators of the arm.
be a result of the radial artery stenosis? blood vessels on the lateral side of the forearm as the
(D) A marked decrease in the blood flow in the lateral ante- brachial cutaneous nerve. The 40. A 49-year-old woman is diagnosed as having a large
princeps pollicis artery musculocutaneous nerve does not supply the extensors lump in her right breast. Lymph from the cancerous
The radial artery divides into the princeps pollicis artery of the forearm and the brachioradialis. This nerve also breast drains primarily into which of the following
and the deep pal- mar arterial arch. Thus, stenosis of the supplies tactile sensation on the lateral side of the nodes?
radial artery results in a decreased blood flow in the forearm but not the arm and supplies blood vessels on (B) Anterior (pectoral) nodes
princeps pollicis artery. The superficial palmar arterial the lateral side of the forearm but not the hand. Lymph from the breast drains mainly (75%) to the
arch is formed primarily by the ulnar artery, which axillary nodes, more specifically to the anterior
passes superficial to the flexor retinaculum. The 37. A 20-year-old man fell from the parallel bar during (pectoral) nodes.
extensor compartment of the forearm receives blood the Olympic trial. A neurologic examination reveals that
from the posterior interosseous artery, which arises he has a lesion of the lateral cord of the brachial plexus. 41. A 17-year-old boy fell from his motorcycle and
from the common interosseous branch of the ulnar Which of the following muscles is most likely weakened complains of numbness of the lateral part of the arm.
artery. However, the radial and radial recurrent arteries by this injury? Examination reveals that the axillary nerve is severed.
supply the brachioradialis and the extensor carpi (E) Pectoralis major Which of the following types of axons is most likely
radialis longus and brevis. The pectoralis major is innervated by the lateral and spared?
medial pectoral nerves originating from the lateral and (C) Preganglionic sympathetic axons
34. A patient bleeding from the shoulder secondary to a medial cords of the brachial plexus, respectively. The The axillary nerve contains no preganglionic
knife wound is in fair condition because there is vascular subscapularis, teres major, latissimus dorsi, and teres sympathetic general visceral efferent (GVE) fibers, but it
anastomosis around the shoulder. Which of the minor muscles are innervated by nerves originating contains postganglionic sympathetic GVE fibers. The
following arteries is most likely a direct branch of the from the posterior cord of the brachial plexus. axillary nerve also contains GSA, GSE, and general
subclavian artery that is involved in the anastomosis? visceral afferent (GVA) fibers.
Dorsal scapular artery 38. A 24-year-old carpenter suffers a crush injury of his
The dorsal scapular artery arises directly from the third entire little finger. Which of the following muscles is
part of the subclavian artery and replaces the deep most likely to be spared?
(descending) branch of the transverse cervical artery. (D) Dorsal interossei 42. A construction worker suffers a destructive injury of
The suprascapular and transverse cervical arteries are The dorsal interossei are abductors of the fingers. The the structures related to the anatomic snuffbox. Which of
branches of the thyrocervical trunk of the subclavian little finger has no attachment for the dorsal the following structures would most likely be damaged?
artery. The thoracoacromial artery is a short trunk from interosseous muscle because it has its own abductor. (E) Radial artery
the first or second part of the axillary artery and has Therefore, the dorsal interosseous muscle is not
pectoral, clavicular, acromial, and deltoid branches. affected. Other muscles are attached to the little finger; The radial artery lies on the floor of the anatomic
35. During a breast examination of a 56-yearold woman, thus, they are injured. snuffbox. Other structures are not related to the
the physician found a palpable mass in her breast. Which snuffbox. The tendons of the extensor pollicis longus,
of the following characteristics of breast cancer and its 39. A 7-year-old boy falls from a tree house and is extensor pollicis brevis, and abductor pollicis longus
diagnosis is correct? brought to the emergency department of a local hospital. muscles form the boundaries of the anatomic snuffbox.
(D) Dimpling of the overlying skin On examination, he has weakness in rotating his arm The scaphoid and trapezium bones form its floor.
Breast cancer may cause dimpling of the overlying skin laterally because of an injury of a nerve. Which of the
because of shortening of the suspensory (Cooper)
 Anatomy- Upper Limbs
43. A rock climber falls on his shoulder, resulting in a a pulmonary embolism Questions 51 to 55: A 10-year-old boy falls off his bike,
chipping off of the lesser tubercle of the humerus. Which The fractured clavicle may damage the subclavian vein, has difficulty in moving his shoulder, and is brought to
of the following structures would most likely have resulting in a pulmonary embolism; cause thrombosis of the emergency department. His radiograph and
structural and functional damage? the subclavian artery, resulting in embolism of the angiograph reveal fracture of the surgical neck of his
(C) Subscapularis muscle brachial artery; or damage the lower trunk of the humerus and bleeding from the point of the fracture.
The subscapularis muscle inserts on the lesser tubercle brachial plexus.
of the humerus. The supraspinatus, infraspinatus, and 51. Which of the following nerves is most likely
teres minor muscles insert on the greater tubercle of the Questions 48 to 50: A 21-year-old man injures his right injured as a result of this accident?
humerus. The coracohumeral ligament attaches to the arm in an automobile accident. Radiographic (B) Axillary
greater tubercle. examination reveals a fracture of the medial epicondyle The axillary nerve runs posteriorly around the surgical
of the humerus. neck of the humerus and is vulnerable to injury such as
44. A 22-year-old female Macarena dancer fell from the 48. Which of the following nerves is most likely injured fracture of the surgical neck of the humerus or inferior
stage and complains of elbow pain and inability to as a result of this accident? dis- location of the humerus. The other nerves listed are
supinate her forearm. Which of the following nerves are (E) Ulnar not in contact with the surgical neck of the humerus.
most likely injured from this accident? The ulnar nerve runs down the medial aspect of the arm
(C) Radial and musculocutaneous nerves and behind the medial epicondyle in a groove, where it 52. Following this accident, the damaged nerve causes
The supinator and biceps brachii muscles supinate the is vulnerable to damage by fracture of the medial epi- difficulty in abduction, extension, and lateral rotation of
forearm. The supinator is innervated by the radial nerve, condyle. Other nerves are not in contact with the medial his arm. Cell bodies of the injured nerve involved in
and the biceps brachii is innervated by the epicondyle. movement of his arm are located in which of the
musculocutaneous nerve. following structures?
49. Which of the following muscles is most likely (C) Anterior horn of the spinal cord
Questions 45 to 47: A 37-year-old female patient has a paralyzed as a result of this accident? The (injured) axillary nerve contains GSE fibers whose
fracture of the clavicle. The junction of the middle and (D) Adductor pollicis cell bodies are located in the anterior horn of the spinal
lateral thirds of the bone exhibits overriding of the The ulnar nerve innervates the adductor pollicis muscle. cord, and these GSE fibers supply the deltoid and teres
medial and lateral fragments. The arm is rotated The radial nerve innervates the abductor pollicis longus minor muscles. The axillary nerve also contains GSA
medially, but it is not rotated laterally. and extensor pollicis brevis muscles, whereas the and GVA fibers, whose cell bodies are located in the
median nerve innervates the abductor pollicis brevis and dorsal root ganglia, and sympathetic postganglionic
45. The lateral portion of the fractured clavicle is opponens pollicis muscles. fibers, whose cell bodies are located in sympathetic
displaced downward by which of the following? chain ganglia. The lateral horn of the spinal cord
(E) Deltoid muscle and gravity 50. After this injury, the patient is unable to do which of between T1 and L2 contains cell bodies of sympathetic
The lateral fragment of the clavicle is displaced the following? preganglionic fibers. The posterior horn of the spinal
downward by the pull of the deltoid muscle and gravity. (E) Adduct his index finger cord contains cell bodies of interneurons.
The medial fragment is displaced upward by the pull of The fingers are adducted by the palmar interosseous
the sternocleidomastoid muscle. None of the other muscles; abduction is performed by the dorsal 53. The damaged nerve causes numbness of the lateral
muscles are involved. interosseous muscles. The palmar and dorsal side of the arm. Cell bodies of the injured nerve fibers
interosseous muscles are innervated by the ulnar nerve. involved in sensory loss are located in which of the
46. Which of the following muscles causes upward The proximal interphalangeal joints are flexed by the following structures?
displacement of the medial fragment? flexor digitorum superficialis, which is innervated by the (D) Dorsal root ganglia
(D) Sternocleidomastoid median nerve. However, the DIP joints of the index and Axillary nerve contains GSE, GSA, GVA, and
middle fingers are flexed by the flexor digitorum sympathetic postganglionic GVE fibers. Cell bodies of
The sternocleidomastoid muscle is attached to the profundus, which is innervated by the median nerve GSA and GVA fibers are located in the dorsal root
superior border of the medial third of the clavicle, and (except the medial half of the muscle, which is ganglia. Cell bodies of GSE fibers are located in the
the medial fragment of a fractured clavicle is displaced innervated by the ulnar nerve). The median nerve anterior horn of the spinal cord. Cell bodies of
upward by the pull of the muscle. supplies sensory innervation on the palmar aspect of the sympathetic post- ganglionic GVE fibers are located in
middle finger. The abductor pollicis brevis is innervated the sympathetic chain ganglia, but cell bodies of
47. Which of the following conditions is most likely to by the median nerve; the abductor pollicis longus is sympathetic preganglionic GVE fibers lie in the lateral
occur secondary to the fractured clavicle? innervated by the radial nerve. horn of the spinal cord.
(B) Thrombosis of the subclavian vein, causing
 Anatomy- Upper Limbs
54. This accident most likely leads to the damage of 58. Which of the following nerves is most likely shaft of the humerus. The posterior humeral circumflex
which of the following arteries? damaged? artery accompanies the axillary nerve around the
(C) Posterior humeral circumflex (B) Radial nerve surgical neck of the humerus. Other arteries are not
The posterior humeral circumflex artery accompanies The radial nerve runs in the radial groove on the back of associated with the radial groove of the humerus.
the axillary nerve that passes around the surgical neck the shaft of the humerus with the profunda brachii
of the humerus. None of the other arteries are involved. artery. The axillary nerve passes around the surgical 62. After this accident, supination is still possible
neck of the humerus. The ulnar nerve passes the back of through contraction of which of the following
55. Following this accident, the boy has weakness in the medial epicondyle. The musculocutaneous and muscles?
rotating his arm laterally. Which of the following median nerves are not in contact with the bone, but the (D) Biceps brachii
muscles are paralyzed? median nerve can be damaged by supracondylar A lesion of the radial nerve causes paralysis of the
(B) Teres minor and deltoid fracture. supinator and brachioradialis. The biceps brachii
The lateral rotators of the arm include the teres minor, muscle is a flexor of the elbow and also a strong
deltoid, and infraspinatus muscles, but the infraspinatus 59. As a result of this fracture, the patient shows lack of supinator; thus, supination is still possible through
muscle is innervated by the suprascapular nerve. sweating on the back of the arm and forearm. Cell bodies action of the biceps brachii muscle. Other muscles
of the damaged nerve fibers involved in sweating are cannot supinate the forearm.
Questions 56 to 57: A 64-year-old man with a history of located in which of the following structures?
liver cirrhosis has been examined for hepatitis A, B, and (D) Sympathetic chain ganglion 63. A cyclist is thrown over his handle bars and breaks
C viruses. In an attempt to obtain a blood sample from The (damaged) radial nerve contains sympathetic his clavicle as he hits the ground on his shoulder. Which
the patient’s median cubital vein, a registered nurse postganglionic nerve fibers whose cell bodies are of the following is correct regarding the development of
inadvertently procures arterial blood. located in the sympathetic chain ganglion. Sympathetic the clavicle?
postganglionic fibers supply sweat glands, blood vessels, (A) It develops through intramembranous
56. The blood most likely comes from which of the and hair follicles (arrector pili muscles). The radial ossification
following arteries? nerve also contains GSE fibers whose cell bodies are The clavicle is the only upper limb bone to develop
(A) Brachial located in the anterior horn of the spinal cord, and GSA through intramembranous ossification. It is the first
The median cubital vein lies superficial to the bicipital and GVA fibers whose cell bodies are located in the upper limb bone to begin ossification and is the last
aponeurosis and thus separates it from the brachial dorsal root ganglion. The lateral horn of the spinal cord bone to complete ossification. The clavicle forms from
artery, which can be punctured during intravenous between T1 and L2 contains cell bodies of sympathetic somatic lateral plate mesoderm and the associated
injections and blood transfusions. preganglionic nerve fibers. muscles develop from somitic mesoderm (from somites).

57. During the procedure, the needle hits a nerve medial 60. Following this accident, the patient has no cutaneous 64. A patient presents with pain in the neck, numbness
to the artery. Which of the following nerves is most sensation in which of the following areas? and tingling in the fingers, and a week grip. This
likely damaged? (D) Area of the anatomic snuffbox presentation suggests thoracic outlet syndrome. Which
(B) Median The superficial branch of the radial nerve runs distally of the following causes has an embryological etiology?
The median nerve is damaged because it lies medial to to the dorsum of the hand to innervate the radial side of (C) Cervical rib
the brachial artery. The bicipital aponeurosis lies on the the hand, including the area of the anatomic snuffbox
brachial artery and the median nerve. The V-shaped and the radial two and one-half digits over the proximal A cervical rib is a congenital abnormality that can cause
cubital fossa contains (from medial to lateral) the phalanx. The medial aspect of the arm is innervated by thoracic outlet syn- drome because the space that
median nerve, brachial artery, biceps tendon, and radial the medial brachial cutaneous nerve; the lateral aspect transmits the neurovasculature to the arm is reduced.
nerve. The ulnar nerve runs behind the medial of the forearm is innervated by the lateral antebrachial Other causes listed are not a result of embryological
epicondyle; the lateral and medial ante- brachial cutaneous nerve of the musculocutaneous nerve; the development.
cutaneous nerves are not closely related to the brachial palmar aspect of the second and third digits is
artery. innervated by the median nerve; and the medial one and Questions 65 to 66: A 11-year-old boy falls down the
one-half fingers are innervated by the ulnar nerve. stairs. A physician examines the radiograph of the boy’s
Questions 58 to 62: A 17-year-old boy is injured in an shoulder region (see Figure below).
automobile accident. He has a fracture of the shaft of the 61. Which of the following arteries may be damaged?
humerus. (C) Profunda brachii artery
The radial nerve accompanies the profunda brachii
artery in the radial groove on the posterior aspect of the
 Anatomy- Upper Limbs
Questions 70 to 71: Choose the appropriate lettered site
or structure in the following radiograph of the wrist and
hand (see Figure below).

67. Destruction of this area would most likely cause

weakness of supination and flexion of the forearm. B.
The radial tuberosity is the site for tendinous attachment 70. Destruction of the structure indicated by the letter E
of the biceps brachii muscle, which supinates and flexes most likely causes weakness of which of the following
65. If the structure indicated by the letter A is calcified, the forearm. When the tuberosity is destroyed, the biceps
which of the following muscles is most likely paralyzed? muscles?
brachii is paralyzed. (C) Flexor carpi ulnaris
(D) Infraspinatus
The scapular notch transmits the suprascapular nerve The hook of hamate and the pisiform provide insertion
68. Destruction of this area would most likely cause for the flexor carpi ulnaris.
below the superior transverse ligament, whereas the weakness of pronation of the forearm and flexion of the
suprascapular artery and vein run over the ligament.
wrist joints. E. The medial epicondyle is the site of 71. If the floor of the anatomic snuffbox and origin of
The suprascapular nerve supplies the supraspinatus and
origin for the common flexor tendon and pronator teres. the abductor pollicis brevis are damaged, which of the
infraspinatus muscles. The axillary nerve innervates the
The common flexors include the flexor carpi radialis and following bones is most likely to be involved?
deltoid and teres minor muscles. The subscapular nerves
ulnaris and palmaris longus muscles, which can flex the (B) B
innervate the teres major and subscapularis muscles.
elbow and wrist joints. Thus, destruction of this area The scaphoid forms the floor of the anatomic snuffbox
66. If the structure indicated by the letter B is fractured,
causes weakness of pronation because the pronator and provides a site for origin of the abductor pollicis
which of the following structures is most likely injured?
teres is paralyzed but the pronator quadratus is normal. brevis.
(D) Posterior humeral circumflex artery Similarly, destruction of this area causes paralysis of the
Fracture of the surgical neck of the humerus occurs flexors of the wrist. However, it can be weakly flexed by
commonly and damages the axillary nerve and the the flexor pollicis longus, flexor digitorum superficialis,
posterior humeral circumflex artery. and profundus muscles.

69. A lesion of the radial nerve would most likely cause

paralysis of muscles that are attached to this area. D.
The olecranon is the site for insertion of the triceps
brachii, which is innervated by the radial nerve. When
Questions 67 to 69: Choose the appropriate lettered site
the olecranon is destroyed, the triceps brachii is
or structure in the radiograph of the elbow joint (see
paralyzed.
Figure below) and its associated structures to match the
following descriptions.
 Anatomy- Upper Limbs
Questions 72 to 75: Choose the appropriate lettered site
or structure in this transverse magnetic resonance
imaging through the middle of the palm of a woman’s
right hand (see Figure below) that matches the following
descriptions.

72. The patient is unable to abduct her middle finger

because of paralysis of this structure. D. This is the
second dorsal interosseous muscle, which abducts the
middle finger.

73. A lesion of the median nerve causes paralysis of this

structure. A. This is the flexor pollicis longus, which is
innervated by the median nerve.

74. The patient is unable to adduct her little finger

because of paralysis of this structure. G. This is the third
palmar interosseous muscle, which adducts the little
finger.

75. Atrophy of this structure impairs extension of both

the metacarpophalangeal and interphalangeal joints. E.
The extensor digitorum extends both the
metacarpophalangeal and interphalangeal joints.