GROSS ANATOMY

SELF-EVALUATION EXAM - UPPER LIMB

By O.W. Henson, Jr., Ph.D.

University of North Carolina at Chapel Hill

Answer True (T) or False (F)

The pisiform bone:

_____ 1. can be easily palpated at the wrist.

_____ 2. lies just medial to (on the ulnar side of) the ulnar nerve at the wrist.

_____ 3. is closely associated with the tendon of the flexor carpi ulnaris muscle.

_____ 4. articulates with the 4th metacarpal.

The capitate bone:

_____ 5. is the largest of the carpal bones.

_____ 6. lies at the base of the third metacarpal and its position can be easily identified by following the third metacarpal proximally.

_____ 7. provides an area of attachment for the flexor retinaculum.

_____ 8. is named capitate because of its large dome-like articular surface for the radiocapitate joint.

The third metacarpal bone:

_____ 9. lies along the axis of the hand and is one of the most stable of the metacarpals.

_____ 10. provides an area for the insertion of the extensor carpi radialis brevis.

_____ 11 provides an area for the insertion of the flexor carpi radialis m.

_____ 12. provides an area for the origin of one of the lumbrical muscles.

During pronation and supination the joints that must function properly to permit smooth rotatory movements are the:

_____ 13. humeroradial joint.

_____ 14. proximal radioulnar joint supported by the annular ligament.

_____ 15. distal radioulnar joint.

_____ l6. radiocarpal joint.

Muscles that rotate the humerus medially (internally) include:

_____ 17. teres minor.

_____ 18. teres major.
_____ 19. pectoralis minor.
_____ 20. subscapularis.

Muscles that help flex the elbow include the:

_____ 21. brachialis.
_____ 22. anconeus.
_____ 23. pronator teres.
_____ 24. brachioradialis.

Muscles that extend interphalangeal joints include the:

_____ 25. extensor indicis.

_____ 26. extensor pollicis brevis.
_____ 27. palmar interossei.
_____ 28. lumbricals.

The trapezius muscle:

_____ 29. is the only muscle of the upper limb capable of elevating the tip of the shoulder (shrugging)

_____ 30. is a strong internal rotator of the humerus.

_____ 31. is innervated by the dorsal scapular nerve.

_____ 32. has attachments on the transverse processes of the cervical and thoracic vertebrae.

The lumbricals differ from the interosseous muscles in that they:

_____ 33. take origin from the anterior surface of the metacarpal bones.

_____ 34. are anterior to the superficial tranverse metacarpal ligament.

_____ 35. insert into the extensor tendon (or “hood”).

_____ 36. receive branches of the median or the ulnar nerve.

The biceps brachii muscle is typically:

____ 37. a strong supinator.

____ 38. innervated by the median nerve.

____ 39. attached to the humerus.

____ 40. attached to the scapula at two different points.

The flexor digitorum profundus:

_____ 41. is the only muscle capable of flexing the distal phalanges of the four fingers.

_____ 42. is innervated by the median and ulnar nerves.

_____ 43. has tendons which serve as moveable origins for the lumbrical muscles.

_____ 44. has tendons which split to allow the superficial flexor tendons to become superficial.

The pectoralis major muscle:

_____ 45. is a strong external rotator of the humerus.

_____ 46. arises in part from the clavicle.

_____ 47. is innervated by nerves arising from the medial and lateral cords of the brachial plexus.

_____ 48. inserts on the crest of the lesser tubercle (medial lip of the intertubercular groove) of the humerus.

The ulnar nerve:

_____ 49. arises from the lateral cord of the brachial plexus.

_____ 50. lies posterior to the medial epicondyle at the elbow.

_____ 51. supplies motor innervation to the flexor carpi ulnaris and part of the flexor digitorum superficialis.

_____ 52. carries sensory fibers from the anterior and posterior aspects of the hand including all or part of the little finger.

Muscles of the shoulder that are supplied by branches from the posterior cord of the brachial plexus include the:

_____ 53. deltoid.

_____ 54. supraspinatus.
_____ 55. trapezius.
_____ 56. teres major.

Section of the deep branch of the radial nerve would be expected to result in:

_____ 57. paralysis of the extensor carpi ulnaris.
_____ 58. paralysis of the abductor pollicis longus.
_____ 59. paralysis of the extensor carpi radialis longus.
_____ 60. some loss of sensation on the dorsum of the hand.

A patient is seen several weeks after receiving a stab wound in the right axilla. He complains of numbness on the dorsum of the hand between the first and second metacarpals and over a portion of the middle of the posterior surface of the right forearm. Examination confirms the loss of cutaneous sensibility mentioned. Additionally, the patient exhibits weakness on the right side in extension of the fingers, abduction of the thumb, extension of the wrist, and extension at the elbow. No other loss of sensibility is detected, and all other movements of the upper limb are present and forceful. The structure(s) most likely damaged by the wound is (are) the:

_____ 61. median nerve and axillary artery.
_____ 62. lateral cord of the brachial plexus.
_____ 63. posterior cord of the brachial plexus.
_____ 64. radial nerve near its origin.

A patient is unable to oppose the right thumb to the ring finger and has diminished sensibility in the skin over the thenar eminence and along the palmar surface of the index finger. The thenar eminence is atrophied as compared with that of the left hand. No other disabilities are demonstrated. The signs could be explained by injury to the:

_____ 65. ulnar nerve at the elbow.
_____ 66. median nerve at the wrist.
_____ 67. median nerve at the elbow.
_____ 68. lateral cord of the brachial plexus.

If the lateral cord of the brachial plexus were damaged, one would expect:

_____ 69. diminished ability to rotate the arm externally.
_____ 70. weakness in flexing the elbow.
_____ 71. inability to abduct the fingers.

_____ 72. loss or diminution of cutaneous sensibility over the ulnar side of the forearm and hand.

For the most effective abduction of the arm above 90˚ the following nerves should be intact:

_____ 73. axillary.
_____ 74. thoracodorsal.
_____ 75. suprascapular.
_____ 76. accessory (eleventh cranial nerve).

Nerves that are concerned with producing either pronation or supination of the forearm include the:

_____ 77. median.

_____ 78. musculocutaneous.
_____ 79. radial.
_____ 80. ulnar.

Severing the recurrent (muscular) branch of the median nerve in the palm is likely to interfere with:

_____ 8l. flexion of the terminal phalanx of the thumb.
_____ 82. opposition of the thumb.
_____ 83. adduction of the thumb.

_____ 84. extension of the thumb.

Postganglionic sympathetic fibers supplying muscle in the walls of arteries of the little finger:

_____ 85. course in the ulnar nerve.

_____ 86. leave the sympathetic trunk by way of gray rami communicantes extending to spinal nerves C8 and Tl.

_____ 87. have their cell bodies in lower cervical and upper thoracic segments of the spinal cord.

_____ 88. reach the sympathetic trunk by way of white rami communicantes arising from upper thoracic spinal nerves.

Sweat glands in the skin overlying the brachioradialis muscle are supplied by postganglionic sympathetic fibers whose cell bodies are located chiefly in:

_____ 89. the cervical spinal cord.

_____ 90. the upper five thoracic segments of the spinal cord.

_____ 91. the cubital fossa.

_____ 92. cervical sympathetic trunk ganglia.

The radial artery usually:

_____ 93. arises as a terminal branch of the brachial artery.

_____ 94. descends in the forearm deep to the brachioradialis muscle and anterior to the radius.

_____ 95. supplies all of the muscles on the dorsal side of the forearm.

_____ 96. enters the hand by passing through the anatomical snuff box.

The superficial palmar arch usually:

_____ 97. receives a branch from the radial artery and is the chief continuation of the ulnar artery.

_____ 98. gives rise to several common digital arteries.

_____ 99. lies anterior to the common digital nerves.

_____100.has connections with the deep palmar arch.

SELF-EVALUATION EXAM - UPPER LIMB

KEY

The following numbered statements are True (T) :

1. 46. 97.

2. 47. 98.

3. 50. 99.

5. 52 100.

6. 53

9. 56.

l0. 57.

11 58

l3. 64.

14. 66.

15 70.

l8. 73

20. 75.

21. 76.

23. 77

24. 78.

25. 79.

28. 82

29. 85.

36. 86.

88.

37. 92.

40. 93.

41. 94.

42 95.

43. 96.