Muscles
A 45 year old man comes to the emergency department after sustaining an injury to his left arm during a bicycle race. The patient has pain and swelling of his left elbow. Physical examination shows warmth, swelling and tenderness of the left elbow with decrease sensation over the medial 1 1/2 digits. An X-ray of the left upper limb is shown. Which of the following muscles is most likely paralyzed?
A: Flexor digitorum superficialis
B: Biceps Brachii
C: Brachioradialis
D: Flexor carpi ulnaris
E: Supinator
D: Flexor carpi ulnaris
Affected nerve is the ulnar nerve
Laboratory studies in the outpatient clinic on a 24 year old women included assessment of circulating blood chemistry. Which of the following arteries is most likely at risk during venipuncture of the cubital fossa?
A: brachial
B: common interosseous
C: ulnar
D: anterior interosseous
E: radial
A: brachial
A 25 year man is brought to the emergency department because he fell on a slippery trail and injured his right upper limb. Physical examination shows abrasions over his triceps brachii muscle. Which of the following nerves innervates the tricep brachii muscle?
A: Radial
B: Axillary
C: Median
D: Ulnar
E: Musculocutaneous
A: Radial
A 25 year man is brought to the emergency department because he fell on a slippery trail and injured his right upper limb. Physical examination shows abrasions over triceps brachii muscle. An X-ray of his arm shows a fracture at mid-body humerus. Which of the following will most likely be present during physical examination?
A: Wrist drop
B: Inability to flex his wrist and loss of pronation
C: Inability to flex the index and middle fingers at the DIP and PIP
D: Inability to flex the ring and little fingers at DIP
E: Paralysis of the lumbricals and interosseous muscles
A: Wrist drop
A 48 year old women comes to the physician because of a 1year history of pain and paraesthesia in her right hand that has increased in severity during the past month. The pain has been persistent after falling on her outstretched hand one year ago. Physical examination shows loss of sensation in the radial 3 1/2 digits of her right hand. Her left shows no abnormalities. Which muscle is most likely weakened in the condition?
A: Dorsal interossei
B: Lumbricals III and IV
C: Thenar
D: Palmar interossei
E: Hypothenar
C: Thenar
The thenar muscles and lumbricals I and II are innervated by the median nerve which runs through the carpal tunnel. Carpal tunnel is caused by compression of the median nerve. All the other answer choices are innervated by the ulnar nerve.
A 21 year old women comes to the emergency department after she was struck in the arm by a line drive during a softball game. Physical examination shows weakness on abduction and extension of the thumb. There is also weakness on extension of the wrist and metacarpophalangeal joints. An X-ray of the arm shows no abnormalities. An MRI shows soft tissue injury to the central aspect of the lateral humerus. Which of the following muscles is most likely spared from injury?
A: Flexor carpi ulnaris
B: Extensor indicis
C: Brachioradialis
D: Extensor carpi radialis longus
E: Supinator
A: Flexor carpi ulnaris
A 14 year old boy is brought to the emergency department after falling on his out stretched hand. Physical examination shows point tenderness above the humeral epicondyles and a pulsatile mass just above the cubital fossa. There is weakness on pronation, wrist flexion, and grip strength. Thumb flexion and opposition are also impaired. Flexion at the DIP joints of the fourth and fifth digits is normal. An X-ray shows a supracondylar fracture of the humerus. Which of the following structures are most likely injured?
A: Axillary nerve and posterior circumflex humeral artery
B: Radial nerve and deep brachial artery
C: Median nerve and brachial artery
D: Superficial radial nerve and radial artery
E: Ulnar nerve and ulnar artery
C: Median nerve and brachial artery
An 18 year old man is brought to the emergency department because of left arm pain after an injury while playing rugby. Physical examination shows significant bruising over the left arm. An X-ray of the arm shows a transverse fracture of the humerus about 1 inch proximal to the epicondyles. Which of the following nerves is most likely injured by the jagged edges of broken bone at this location?
A: Axillary
B: Median
C: Musculocutaneous
D: Radial
E: Ulnar
B: Median
A: axillary and posterior humeral circumflex
R: Radial and deep brachial
M: Median and brachial
A 60 year old man is brought to the emergency department after he accidentally slashed his left wrist with his butcher knife. Vitals signs are within normal limits. Physical examination shows loss of sensation on the medial 1 1/2 digits and decreased grips strength of the left hand. An X-ray of the wrist shows no other abnormalities. Which of the following actions would most likely be lost as a result of this injury?
A: Flexion of the PIP joint of the fifth digit
B: Extension of the thumb
C: Adduction of the fifth digit
D: Abduction of the thumb
E: Opposition of the thumb
C: Adduction of the fifth digit
A 34 year old women is brought to the emergency department after being involved in a motor vehicle collision. Vital signs are within a normal limits. She has severe pain and limited mobility of the finger. Physical examination shows a mallet finger. Which of the following is expected to be present during radiographic examination?
A: A lesion of the ulnar nerve at the distal flexor crease of the wrist
B: A separation of the extension expansion over the middle IP joints
C: Compression of the deep ulnar nerve by dislocation of the lunate bone
D: Avulsion fracture of the dorsum of the distal phalanx
E: Fracture of the fourth or fifth metacarpal bone
D: Avulsion fracture of the dorsum of the distal phalanx
A 48 year old women comes to the physician because of pain and numbness in the right wrist. She works as a secretary in a large law firm. Physical examination shows that maximal flexion of the wrist with the elbows flexed and abducted position reproduces the pain in the right hand. Tinel sign is positive. Which of the following muscles will most likely be weakened by this condition?
A: Dorsal and palmar interosseous
B: Lumbricals III and IV
C: Thenar and lumbricals I and II
D: Flexor digitorum superficialis and profundus
E: Hypothenar
C: Thenar and lumbricals I and II
Tinel sign is used to diagnose carpal tunnel. Carpal tunnel is the compression of the median nerve. The median nerve innervates the Thenar muscles and lumbricals I and II.
The ulnar nerve innervates Lumbricals III and IV, the dorsal and palmar interosseous and the hypothenar.
The median nerve innervates the Flexor digitorum superficalis and profundus are innervated by the median nerve but before it reachers the carpal tunnel that is compressed so it will not effect these muscles
A 22 year old football player is brought to the emergency department because of a wrist injury after falling on his outstretched hand. During surgery, the anatomical snuffbox is exposed and an artery is visualized crossing the fractured bone that forms the floor for this space. Which of the following arteries was most likely visualized?
A: ulnar
B: radial
C: anterior interosseous
D: inferior interosseous
E: deep palmar arch
B: radial
A 67 year old women is brought to the emergency department after injuring her left shoulder from a fall. She has a history of osteoporosis. Physical examination shows bruising and dimpling of the upper part of the arm with exquisite tenderness. over the affected area. Which of the following nerves is most likely injured?
A: Radial
B: Axillary
C: Ulnar
D Median
E: Musculocutaneous
B: Axillary
A 22 year old man comes to the emergency department because of a hand injury from broken glass. Physical examination shows a deep laceration across the entire length of the distal transverse crease on the anterior surface of the wrist. There is no injury to the flexor retinaculum. During physical examination which neuromuscular deficits will most likely be found on physical examination?
A: Weakened pronation of the forearm
B: Inability to abduct the thumb
C: Weakened flexion of thumb
D: Weakened opposition of the thumb
E: Inability to adduct the thumb
E: Inability to adduct the thumb
The ulnar nerve travels superficial to the flexor retinaculum and innervates the adductor pollicis muscle which adducts the thumb
A 28 year old man is brought to the emergency department after injuring his right hand in a knife fight. Physical examination shows loss of extension of the fourth and fifth digits at the IP joints and loss of abduction of the fingers of the right hand. Which of the following muscles is most likely responsible for the loss of IP extension of the medial two fingers?
A: Dorsal interosseous muscles
B: Extensor digitorum
C: Lumbrical muscles
D: Palmar interosseous muscles
E: Extensor digiti minimi
C: Lumbrical muscles
A 22 year old women comes to the physician for a routine examination. During venipuncture, the phlebotomist is unable to withdraw blood and quickly realizes that she passed the needle completely through the vein. Which of the following structures located deep to the median cubital vein has acted as a barrier and has prevented her from puncturing an artery?
A: Flexor retinaculum
B: Pronator teres muscle
C: Bicipital aponeurosis
D: Brachioradialis
E: Biceps brachii tendon
C: Bicipital aponeurosis
A 56 year old women is brought to the emergency department after being involved in a motor vehicle collision. A large area of her chest wall needed to be surgically removed and replaced with a musculo-osseous scapular graft involving the medial border of the scapula. Which of the following arteries will most likely compensate for the blood supply to the entire scapula?
A: Suprascapular
B: Dorsal scapular artery
C: Posterior circumflex humeral artery
D: Lateral thoracic
E: Superior thoracic artery
A: Suprascapular
A 55 year old man is brought to the emergency department after sustaining a blow from a baseball bat at the junction of his neck and shoulder on the right. Physical examination shows asymmetry of the right scapula on pushing forward with the arm. There is also asymmetry during diaphragmatic excursion. Which part of the brachial plexus is most likely injured?
A: Cords
B: Divisions
C: Ventral rami
D: Terminal branches
E: Trunks
C: Ventral rami
The long thoracic nerve arises from the upper three ventral rami of the brachial plexus (C5-C7). The long thoracic nerve innervates the serratus anterior, which protracts the scapula. An injury to the long thoracic nerve will result in winging of the scapula.
A 34 year old man comes to the emergency department with pain in the arm after a fall onto a concrete floor. The patient denies head trauma or loss of consciousness. Physical examination shows weakness in abduction and adduction of his fingers. Flexion of the digits is normal. Sensation over the palmar surface of the fourth and fifth finger is decreased. Which of the following is the most likely diagnosis?
A: Compression of the median nerve in the carpal tunnel
B: Injury of the radial nerve from fractured humerus
C: Compression of the median nerve as it passes between the two heads of the pronator teres
D: Compression of the radial nerve by the supinator
E: Injury of the ulnar nerve by a fractured pisiform
E: Injury of the ulnar nerve by a fractured pisiform
A 25 year old man is brought to the emergency department because of pain in his right wrist 2 hours after falling on an outstretched hand while performing the pole vault. Physical examination shows mild swelling on the dorsal wrist and tenderness upon palpation of the anatomical snuffbox. An X-ray of his hand shows no abnormalities. If a fracture is suspected, which bone is most likely involved?
A: Lunate
B: Scaphoid
C: Capitate
D: Hamate
E: Trapezoid
B: Scaphoid
A 41 year old women is brought to the emergency department after being involved in a motor vehicle collision. Vital signs are within normal limits. Physical examination shows a laterally deviated proximal portion of the radius. An X-ray of the forearm shows a transverse fracture of the radius proximal to the attachment of the pronator teres muscle. Which of the following muscles is most likely responsible for this deviation?
A: pronator teres
B: pronator quadratus
C: brachialis
D: supinator
E: brachioradialis
D: supinator
The supinator muscle attaches to the radius proximally and when fractured would cause lateral deviation
A 41 year old women comes to the physicians office for a follow up examination. One year ago she underwent a mastectomy of her left breast. She is scheduled for a latissimus dorsi muscle flap to cosmetically augment the site of her absent breast. During surgery, part of the latissimus dorsi muscle is advanced to the antierior thoracic wall. Which artery forms the vasculature base of this flap?
A: thoracodorsal artery
B: dorsal scapular artery
C: transverse cervical artery
D: lateral thoracic artery
E: thoracoacromial artery
A: thoracodorsal artery
A 29 year old man comes to the physician because of weakness of his right hand. A few weeks ago, he grabbed a branch as he was falling from a tree. Physical examination shows weakness in abduction and adduction of his digits. He is unable to oppose the thumb of his right hand. Which of the following structures was most likely injured?
A: Lower trunk of the brachial plexus
B: Median nerve
C: Musculocutaneous
D: Ulnar nerve
E: Upper trunks of the brachial plexus
A: Lower trunk of the brachial plexus
interosseous muscles are innervated by ulnar
opponens and abductors are innervated by recurrent median nerve
A 34 year old women is brought to the emergency department after being involved in a motor vehicle collision. She had dull pain in the left shoulder. Vital signs are within normal limits. Physical examination shows that the patient is unable to flex the elbow and shoulder and is also unable to imitate abduction of her arm without first establishing lateral momentum of the limb. An X-ray of the arm shows marked edema, hematoma of the proximal arm, and no fractures. Which portion of the brachial plexus is most likely injured?
A: Superior trunk
B: Middle trunk
C: Inferior trunk
D: Lateral cord
E: Medial cord
A: Superior trunk
The superior trunk of the brachial plexus includes C5 and C6 which gives rise to the suprascapular nerve which innervates the supraspinatous which is the primary muscle that abducts the arm.
A 24 year old women comes to the emergency department after being bitten on her hand by a dog. She washed the wound with copious amounts of water, but the wound has progressively worsened in the last 6 hours. Physical examination shows tenderness and swelling at the base of the thumb, and difficulty with grasping and pinching movements. The infection eventually spreads to the radial bursa. The tendon of which muscle will most likely be effected?
A: Flexor digitorum profundus
B: Flexor digitorum superficialis
C: Flexor pollicis longus
D: Flexor carpi radialis
E: Flexor pollicis brevis
C: Flexor pollicis longus
Tenosynovitis can be due to an infection of the synovial sheath of the digits. Tenosynovial in the thumb may spread through the synovial sheath of the flexor pollicis longus tendon also known as the radial bursa.
The tendons flexor digitorum superficialis and profundus are stored in the synovial flexor sheath or ulnar bursaFlexor carpi radialis and flexor pollicis brevis are not in flexor sheaths