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109 Upper Extremity Questions and Answers


1.      What are the only muscles that perform internal rotation at the GHJ?  
a.       Latissimus Dorsi, Teres Major, Pec Major, Subscapularis
2.      All of the SCJ ligaments check depression except which one?
a.       Costoclavicular Ligament
3.      What may a “winged Scapula” indicate?
a.       Damage to the Long Thoracic Nerve (or weakness to Serratus Ant.)
4.      What muscles in the posterior forearm are innervated by the radial nerve?
a.       Anconeus, Extensor Carpi Radialis Longus (ECRL), Brachioradialis
5.      How many synovial planar joints are there in the UE?
a.       Four: Intercarpals, Intermetacarpals, ACJ, Carpometacarpals
6.      What separates the Lateral and Medial heads of the triceps?
a.       Radial groove, Radial Nerve, Profunda Brachial Artery
7.      Both the Brachialis and Biceps automatically fire during normal elbow flexion?
a.       False (Biceps requires a forceful challenge!)
8.      What nerve innervates the floor of the axilla?
a.       Intercostal Brachial
9.      How many muscles are involved in the six tunnels of the extensor retinaculum?
a.       Nine (APL/EPB, ECRL/ECRB, EPL, ED/EI, EDM, ECU)
10. How many nerves innervate the skin of the UE?
a.       11: axillary, radial, musculocutaneous, medial brachial cutaneous, medial antibrachial cutaneous, median, superficial ulnar, superficial radial, palmar cutaneous, dorsal cutaneous, intercostal brachial nerve.
11. Once the radial nerve passes through the radial groove, where does it go?
a.       Passes through the intermuscular septum between the lateral head of the triceps and the brachialis.
12. Annie, a 5 year old, was playing with her bros when one pulled her arm hard. She cried but stopped when a bro attempted to find the injury by pronating and supinating her hand. What condition did she have?
a.       Nursemaid’s elbow
13. Latissimus Dorsi would be innervated by what type of rami/nerve?
a.       Anterior Rami, Thoracodorsal (C6,C7,C8)
14. What are the borders of the deltopectoral triangle?
a.       Anterior Deltoid, Lateral Clavicular head of Pectoralis Major, Clavicle
15. Which is more lateral? The Conoid Tubercle or Trapezoid Line? (Think Clavicle!)
a.       Trapezoid Line
16. Headache from the back of the neck, up over the back of the head, is due to “strangulation” of the greater occipital nerve by what muscle?
a.       The Trapezius (Via origin from greater occipital protuberance)
17. How many muscles pass through the carpal tunnel?
a.       3 (Flexor Digitorum Profundus, Flexor Digitorum Superficialis, Flexor Pollicis Longus)
18. If a person lost motor capability of the intrinsic hand muscles, as well as sensory capacity in 5th digit and ulnar half of 4th digit, where is the ulnar nerve damaged?
a.       After Guoyans’ Canal
19. What muscles/tendons can be palpated through the deltopectoral triangle?
a.       Pectoralis Minor and Subscapularis
20. What is the only ligament that not only checks movements, but also induces it?
a.       Coracoclavicular
21. How many nerves innervate muscles of the axillary wall?
a.       6 (Posterior Border = Upper Subscapular, Thoracodorsal, Lower Subscapular. Anterior Border = Lateral Pectoral, Medial Pectoral. Median Border = Long Thorasic)
22. How many types of joints are in the hand?
a.       4 (Planar, Sellar, Condyloid, Synovial Ginglymus)
23. What attaches to the supraglenoid tubercle?
a.       Lateral head Biceps, Superior GH Ligament, Glenoid Labrum, Joint Capsule
24. T/F: All superficial back muscles assist in retraction?
a.       False, the Levator Scapula does not
25. Damage to what peripheral nerve(s) would impair external rotation at the GHJ?
a.       Suprascapular and Axillary nerves
26. How many muscles in the UE have more than one head?
a.       7: Biceps(L/S), FCU (H/U), PT (H/U), Triceps (Long, Lat, Med), FPB (Superficial/Deep), Pec. Major (Sternocostal/Clavicular), Adductor Policis (Oblique/Transverse)
27. T/F: (#Supinators + #Pronators)/2 = # External Rotators
a.       True (2)
28. How many ligaments check the movement of the GHJ?
a.       4 (Superior GHL, Mid. GHL, Inferior GHL, Coracohumeral Ligament)
29. How many muscles and ligaments induce/cause posterior rotation at the SCJ?
a.       5 (Coracoclavicular Ligament, Pec. Minor, Serratus Anterior, Lower Trap., Upper Trap) *NOTE: anything that causes ABduction @ ACJ will induce Posterior Rotation @ SCJ
30. A 10yr old fractures her humerus @ surgical neck. What damage should you check for & how?
a.       Axillary Nerve Damage. Profound atrophy in Deltoid, check stars/stripes of skin
31. If median nerve is cut after it passes through PT, would you experience weakness in Pronation?
a.       Yes, the Pronator Quadratus (innervated by the Ant. Interosseous Nerve) is damaged.
32. What muscle sin the UE are innervated by 2 nerves?
a.       Pectoralis Major, Pec. Minor, Subscapularis, FDP, FPB, Opponens Pollicis
33. Like the action of the Seratus Anterior at@ the SCJ, which other muscles produce the same movement at this location?
a.       Lower Trap., Middle Trap., Rhomboids. (External Rotation at the ACJ)
34. What is the “Unhook the Brassier” Muscle?
a.       Pectoralis Minor
35. The articular disk of the wrist is between the ulna and the proximal row of carpal bones. Why can’t the ulna directly attach to the carpal bones?
a.       Ulna does not move during pronation & supination (wouldn’t affect the carpals)
36. What are the only structures in the body that are both mobilizing and stabilizing?
a.       Accessory Fibrocartilaginous Structures
37. T/F: If Sober Sally is diagnosed with a median neuropathy, she would experience the same location of cutaneous sensory alteration (radiating pain), regardless of the specific location of nerve damage?
a.       True (carpal tunnel & pronator syndromes have same cutaneous alterations)
38. How many muscles attach to the Extensor Expansions?
a.       13: PADs (3), DABs (4), Lumbricals (13), Extensor Indices, Ext. Digiti Minimi
39. How many Rami are in the cervical region?
a.       Eight (C1 -> C8, C8 lies between vertebrae C7 & T1)
40. What structures travel between the lateral and medial heads of the triceps?
a.       Radial Nerve, Profundus Brachial Artery, Radial Groove
41. What is the profound atrophy of Median Nerve damage in the carpal tunnel? What is the Hallmark posture?
a.       Thenar Compartment = Ape Hands (No opposable thumb? Anything but that!!!)
42. What bones articulate with the Capitate?
a.       Hamate, Lunate, Scaphoid, Trapezoid, Metacarpals 2, 3, & 4
43. All GH ligaments check what movements of the GHJ?
a.       External Rotation and Hyperextension
44. T/F: The Supraspinatus is always torn with a rotator cuff tear?
a.       True
45. T/F: When the suprascapular nerve is injured in the sphinoglenoid notch, the supraspinatus and infraspinatus will be weak?
a.       False (it already innervated the supraspinatus before the notch)
46. What type of joint allows for NO rotation?
a.       Ellipsoidal
47. What nerve surrounds the lateral and medial head of the triceps brachii?
a.       Radial Nerve
48. Most ligaments of the SCJ check what movement?
a.       Depression
49. This aspect of the GHJ allows for maximal range of movement, even though it usually is a stabilizing structure:
a.       Inferior GH (axillary pouch)
50. Of the SCJ, ACJ, and GHJ, which contains the most ligaments?
a.       GHJ ligament (clearly, have you seen the ball in socket lately???)
51. What muscle allows for Abduction over 90 degrees?
a.       Lower Trapezius (pulls the superior angle of the scapula downward)
52. How many different types of joints are associated with the ulna?
a.       3: Elbow (ginglymus), Distal&Prox. RUJ (Trochoid), Middle RUJ (syndesmosis) *NOTE: the ulna does not articulate with carpal bones!
53. What are the attachments for the flexor retinaculum?
a.       Hook of Hamate, Scaphoid tubercle, Trapezoid tubercle, Tubercle of Triquetral
54. How many metacarpals articulate with the capitate?
a.       Metacarpals 2, 3 , & 4
55. T/F: Glenoid Labrum is an intrinsic ligament?
a.       False: it is not a ligament (aha! A trick question!)
56. How many muscles attach to the borders of the scapula?
a.       6 (LH Triceps, Teres Minor, Serratus Ant., Levator, Rhomboids, Teres Major)
57. T/F: The capsule of the elbow joint encloses 2 bones/1 joint, and attaches to 1 ligament?
a.       False: 1 Capsule, 2 Joints (proximal and distal RUJ)
58. How many muscles make attachments to the Interosseous Membrane?
a.       6 (FPL, FDP, EPL, EPB, APL, EI)
59. What does the lower subscapular nerve innervate?
a.       Subscapularis and Teres Major
60. Destruction of the Deep Radial nerve would leave which functions the UE intact?
a.       Wrist Ext. and Radial Deviation (via Ext.Carpi and radial Longus), all elbow flexion (via brachioradialis)
61. What are the branches of the ulnar nerve?
a.       Superficial, Deep, Palmar, Dorsal
62. What is the function of Listers’ Tubercle?
a.       Used as a pulley for the Ext. Pollicis Longus
63. T/F: Damage to the Suprascapular Nerve will cause weakness in Abduction of GHJ?
a.       True (supraspinatus. While Infraspinatus only creates horizontal AB)
64. How many ligaments are half intrinsic and half extrinsic?
a.       2: Intervlavicular (SCJ), Coracohumeral (GHJ)
65. What 7 things attach to the coricoid?
a.       SH Biceps, Pec.Minor, Coricoclavicular Lig., Coricobrachialis, Coricoacromial Lig., Coricohumeral Lig., Tranverse Scapular ligament
66. How many/what muscles cause acromioclavicular external rotation?
a.       5 (Low Trap, Mid Trap, Lat Dorsi, Rhomboids, Serratus Anterior)
67. If radial nerve is cut at the lateral intermuscular septum, what will be affected?
a.       Brachioradialis (ECRL), all posterior compartment muscles (except anconeus), dorsum 1st web space (cutaneous problems) **NOTE: Not the posterior forearm because that branch has already been split before the cut
68. What are the 3 signs of Colles’ Fracture?
a.       Radial bone becomes shorter (more proximal), Wrist drifts to the radial side, “Dinner Fork” deformity
69. What muscles cause SCJ depression?
a.       Lower trap., Lat. Dorsi, Pec Major/Minor, Subclavius
70. T/F: There will be profound weakness in the MPJ flexion of 4th/5th digit if the MN is cut after the cubital tunnel?
a.       False (still have function of Lumbricals and FDP, only FDS is lost)
71. If a patient shows symptoms of the “claw hand” when they try to fully extend, they have damage to what nerve?
a.       Ulnar
72. What kind of muscle weakness does Erb’s Palsy cause?
a.       “Tip Takers” (No arm flexion or wrist extension)
73. Which muscles could be worked in order to compensate for a weakened serratus due to peripheral neuropathy of the long thoracic nerve?
a.       Pec Major/Minor (both do protraction, the muscle action lost)
74. What are the contents of the Deltopectoral Triangle?
a.       7: Coracoid Process, Pe Minor, Axillary Artery/Vein, Cords of the Brachial Plexus, Lymph Nodes, Tendon of the Subscapularis
75. How many muscles insert on carpal bones?
a.       1: Flexor Carpi Ulnaris
76. Of the 6 tunnels, which one(s) have muscle origins in the posterior aspect of the Radius and Ulna?
a.       Tunnel #1, 3, 4
77. Which part of a synovial joint is highly vascularized? Why?
a.       Stratum Synovium (mobilization via synovial fluid production and filtration)
78.  A person complains of shoulder pain that arises while Abducting his arm at the GHJ. The pain is not there until his arm passes 90 degrees. What could be the 4 possibilities that could be causing this pain?
a.       Supraspinatus, GHJ capsule, LH Biceps (Tendonitis), Subacromial/Deltoid Bursa
79. Which of these act on the IPJ? APB, FPB, OP, Adductor Pollicis?
a.       None, they only act on the MPJ and CMPJ of the Thumb
80. T/F: If the ulnar artery is cut just proximal to Guyon’s canal, then all three arches in the hand will be affected?
a.       False (dorsal branch was sent proximally to the wrist)
81. How many muscles have superficial innervations in the UE?
a.       2 (serratus anterior, flexor digitorum profundus)
82. If a patient has damage to their suprascapular nerve, which action(s) would be affected?
a.       External Rotation, ABduction, Horiz. ABduction, Inferior Glide
83. What seperates the 2 heads of the pronator teres?
a.       Median Nerve
84. What are the 6 things the radial nerve does as it approaches the radial groove?
a.       Innervates triceps, anconeus, posterior arm skin, posterior forearm skin
85. How many joints come together to form the hand?
a.       6 (DIPS, PIPs, MPJs, CMCJs, Inter MC, Intercarpal
86. The median nerve branches just before the carpal tunnel. If this branch is cut, what muscles and what skin will lose innervations?
a.       No skin. Radial ½ FDP, FPL, Pronator quadrates
87. How many muscles originate from the lateral epicondyle?
a.       6 (ECRB, ECU, ED, EDM, Anconeus, Supinator)
88. What passes through the supraglenoid notch?
a.       Suprascapular artery and nerve
89. The muscles of which compartment are affected in carpal tunnel syndrome?
a.       Anterior compartments (approximately layers 2 and 3)
90. How many muscles of the posterior compartment attach directly to the bones of the digits?
a.       1 (Extensor Digitorum)
91. T/F: The number of muscles which originate from the medial epicondyle equal the number of muscles which original from the lateral epicondyle?
a.       False (5 from M.E., 6 from L.E.)
92. T/F: The 1st MC articulates with the 2nd metacarpal creating an intermetacarpal joint?
a.       False
93. Where does scaption occur (what joint) & what muscles perform this action?
a.       At the GHJ (Anterior and middle deltoid, Supraspinatus, Pec. Major –Clavicular head, Coracobrachialis, Biceps).
94. Loss of medial and lateral pectoral nerves only cause the loss of one function? What is it?
a.       Shoulder stability and upward + lateral movements
95. Deep palmar arch is made up of what artery (predominantly)
a.       Radial
96. Of the muscles that attach to the scapula, how many affect the GHJ?
a.       9 (T. Major/minor, supraspinatus, infraspinatus, subscapularis, coracobrachialis, S/L head biceps, long head triceps, and deltoid)
97. What muscles originate on the anterior shaft of the ulna?
a.       FDP, FPL, PQ
98. If you have weakness in MPJ flexion, what nerves are damaged?
a.       Median and Deep Ulnar
99. T/F: The supraglenoid tubercle has more attachments than the infraglenoid tubercle?
a.       True
100.                      T/F: Loss of the articular cartilage in a joint will increase its stabilization?
a.       True
101.                      What muscles cause extension of the 2nd digit?
a.       ED, Lumbricals, PADs, DABs, EI
102.                      T/F: There are 2 muscle attachments to the olecranon of the ulna?
a.       False, 3: Anconeus, triceps (Insertion), FCU (origin)
103.               &