Endeavour

Anatomy
Volume-4 (Superior Extremity, Inferior Extremity)
For Written (SAQ, MCQ), Viva (SOE) & Practical

All questions of last 10 years of DU, CU, RU & SUST

upto November-2019 have been solved

Jahir Uddin Mohammed Sharif

ArifMahbub

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 Contents
Chapter Page number

Volume-4
Chapter-07 : Superior extremity 877
Anatomical points .878
,.879
Surface markings
X-rays ..882
X-ray shoulder ..882
X-ray elbow joint ..884
X-ray wrist joint ..885
X-ray of hand ..886
Pectoral region „887
Breast (Mammary gland) „890
Axilla „896
The back ,„904
Cutaneous nerves & Dermatomes „906
Venous drainage of upper limb ...907
Lymphatic drainage of upper limb .... ...910
The shoulder / scapular region, ...911
The arm
Cubital fossa 928
Forearm & hand ; 929
Front of the forearm and Hand 929
Back of the forearm and Hand 948
Bones & Joints 952
MCQ of superior extremity 966

Chapter-08: Inferior extremity 977

Anatomical points
Surface markings 979
X-rays
X-ray of hip joint
X-ray of knee joint 981
X-ray of ankle joint
Gluteal region 983
Iliac region 987
Compartments of thigh 989
Front of the thigh 1
990
Medial compartment of thigh 1001
Back of thigh 1004
Popliteal fossa 1009
Front of the leg 1011
Lateral side of the leg 1015
Back of the leg 1016
Sole of the foot 1020
Bones & Joints 1022
Page => III

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 SUPERIOR EXTREMITY '

. . A '
‘

Chapter Page number

Anatomical points 878

Surface markings 879
X-rays 882
X-ray shoulder . 882
X-ray elbow joint 884
X ray wrist joint ... 885
X-ray of hand 886
Pectoral region 887
Breast (Mammary gland) 890
Axilla . 896
904 .
Cutaneous nerves & Dermatomes.. 906
Venous drainage of upper limb 907
Lymphatic drainage of upper limb 910
The shoulder / scapular region 911
The aim ••....■■■•■■•■■■•■h................
918
928
Front of the forearm and Hand .......929
Back of the forearm and Hand 948
Bones & Joints 952
MCQ of superior extremity 1^966

877

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 WOWOIJR ANATOMY FOR WRITTEN
(SAO, MCQL&Vri^
878

This is the scapula of right / left side.

Anatomical points: glenoid cavity or fossa, which is directed
Ti^eml or glenoid angle is broad and bears the
0«' and is dircc,ed and f°™ards'
the suprasptnous and,
]£Si surface is convex, and is divided by the triangular sptne ,nto

4. T^eXSest border runs from the glenoid cavity above to the

inferior angle below.

Clavicle:
This is clavicle or right / left side.
Anatomical points:
1 . The lateral end is flat, and the medial end is large and quadrilateral.

f
2. The shaft is slightly curved, so that it is convex forwards in its medial two-thirds, and concave
forwards in its lateral one-third.
3. The inferior surface is grooved longitudinally in its middle one-third.

Humerus:
; '■
This is humerus of right / left side.
.. ........ .„.
-

.. "
'/v. !
Anatomical points:
1. The upper end is rounded to form the head, which is directed medially, backwards & upwards.
2. The lower end is expanded from side to side and flattened from before backwards.
3. The lesser tubercle projects from the front of the upper end and is limited laterally by the
intertubercular sulcus or bicipital groove.

Radius: This is radius of right / left side

Anatomical points: di: i
'■ possesses a disc shaped head & its upper surface presents
cu uvUlaT bUrraCe. ~ "--r •».,». »« ...... , ,, (
a cup shaped
1 4

2. Radial tuberosity lies below the medial part of

the heck
S'0’- ^°CeSS Pr°jeCtS downwards
4 Medial or interosseous border
4. the lateral surface of the lower end
is thin and sharp.
' ••soj’-i’jX.i
•
Ulna:
»*«»«•!
‘ S '1
This is ulna of right / left side. J
Anatomical points:
forwards‘
• ointed styloid process lies crest-like.
medial to the rounded head of ulna.
Articulated skeleton of hand-
is articulated skeleton o'fright/left hand.
Anatomical points:
Carpal b°neS are short wh«ch lies
2 Tho above
r and shorter than others
and is situated laterally.

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 Chapter-07: Superior extremity 879

Surface markings
Axillary artery:
1 . Take a point at the middle of the lower border of the clavicle.
2. Another point at the junction of anterior one-third and posterior two-thirds of the lateral wall of the
axilla, where the pulsation of the artery is felt immediately below the prominence of the coraco¬
brachial is muscle.
Join the two points by a straight line which represents the axillary artery.

Brachial artery:
It corresponds to a line by joining the following points:
1 . A point in the axilla at the termination of axillary artery.
2. A point in the cubital fossa about 1 cm below the bend of the elbow and just medial to the
tendon of biceps brachi. At this point brachial artery bifurcates into radial and ulnar arteries.
The line joining the two points passes along the medial side of the upper part of the arm, and then deviates
slightly laterally at the point of termination in the cubital fossa.

Radial artery:
• In the forearm:
1 . A point about 1 cm below the bend of the elbow and just medial to the tendon of biceps brachii.
2. Another point above the front of the wrist between the anterior border of the lower part of radius
and the tendon of the flexor carpi radialis. Pulsation of the artery is commonly felt in this interval.
The line joining these two points represents the artery, which presents a lateral convexity in upper one-third,
and undergoes a vertical course in the lower two-thirds.
• At the wrist:
1 . In addition to the last point in the forearm, take a point in the anatomical snuff box just below the
tip of the styloid process of the radius;
2. A point in the proximal part of the first inter-metacarpal space, where the artery enters the palm.
Join these points, by a line to represent the artery. In this part artery passes obliquely downward and
laterally deep to the tendons of abductor pollicis longs, extensor pollicis brevis and longus and superficial to
the lateral ligament of the wrist joint, and finally disappears between the two heads of the first dorsal
interosseous muscle.

Ulnar artery:
1 . Take a point about 1 cm below the bend of the elbow, just medial to the tendon of biceps brachii;
2. A point on the radial side of the pisiform bone. Join this point to the medial epicondyle by a straight
line.
3. Take a point on this line at the junction of upper one third and lower two-thirds. Wipe out the proximal
part of the line above this point. .
Join this new point with the first point by a line which slopes downward and medially, and the rest of the
line extends vertically downwards. The total course of the ulnar artery is thus represented by the oblique
upper part and vertical lower put of the composite line.

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 880 ENDEA FOUR ANA TOMY FOR WRITTEN (SAO. Me
Superficial palmar arch:
bone;
1 A point on the radial side of the pisiform
bone about 2 cm below the first point and in line with the
2. A point on the hook of the hamate ulnar
border of the ring finger.
along the distal border of the extended thumb.
Draw a horizontal helping line across the palm
3. Take a point near the middle of the thenar eminence.
Join the points (1) and (2) by a vertical line, and the points (2) and
(3) by a curved line which is convex
extend below the horizontal distall
line drawn across the palm. Finally
but the summit of the convexity does not wipe
out the horizontal line.
Thus the superficial palmar arch is represented by a "J" shaped curved line.

Deep palmar arch:

1 . Take a point just distal to the hook of the hamate bone.
2. Draw a horizontal line from this point 4 cm laterally. This represents the deep palmar arch, which lies
about 1.25 cm proximal to the superficial palmar arch and describes a slight convexity towards the
fingers.

Radial nerve:
• In the arm:
1 . A point at the junction of the anterior l/3rd and posterior 2/3rd of the lateral wall of axilla, where
the pulsation of the axillary artery is felt (see the terminal point for the axillary artery).
2. A point at the junction of upper 1/3"1 and 2/3rd of a line joining the insertion of the deltoid and the
lateral epicondyle of the humerus;
3. A point on the front of the elbow at the level of lateral epicondyle, about 1 cm lateral to the
tendon of biceps brachii.
Join the points (1) and (2) by an oblique line in the back of the arm across the elevation produced by the
long and lateral head of the triceps. It corresponds to the radial nerve in the spiral groove, and the second
point demarcates the site where the nerve pierces the lateral inter-muscular septum. The line is continued by
joining the points (2) and (3), to mark the course of the nerve in the anterior compartment of the arm.
• In the fore arm:
1 . Put a point 1 cm lateral to the tendon of biceps brachii at the level of the lateral epicondyle.
2. A point at the junction of upper two-thirds and lower one-third of the lateral border of the fore
' :
arm.
3. A point in the anatomical snuffbox.
Join these points by a fire which represents the nerve in the fore arm.

Ulnar nerve:
• In the arm:
1. A point at the termination of axillary artery (see above). .
2. A point at the middle of the medial border of the arm.
3. Put a point behind the base of the medial epicondyle by rolling the nerve against the bone.
Join these points by a fine which represents the ulnar nerve in the arm. The second point is the site where
the nerve pierces the medial inter-muscular septum and then descends behind the medial epicondyle.
• In the fore arm:
1 . As mentioned before, a point on the dorsal aspect of the base of the medial epicondyle.
2. A point on the radial side of the pisiform bone.
3. A line joining these points represents the ulnar nerve in the fore arm.
-

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 CltapW'O?'' Superior extremit \ 881

-^A point at the termination of axillary artery (see the axillary artery)- /
? XpointTn from ofll^^W' °f thcclbow> Just medial to the tendon of biceps brachii;
J
these tendons are made °
mnd prominent by ^twecn tbc tendons of palmaris longus and flexor carpi radialis;
producing flexion of the wrist against resistance.
The line joining these points represents the entire course of median nerve.

Axillary nerve (Circumflex nerve):

1. Murk a point 2 cm above the mid-point of a line joining the tip of the acromion and the insertion of the
deltoid muscle.
2. Diaw a horizontal line through this point across the rounded prominence of the deltoid; this corresponds
with the axillary nerve.

Musculo-cutaneous nerve:
1 . Take a point about 3 cm above the termination of axillary artery (see axillary artery).
2. Put another point lateral to the tendon of biceps brachii about 2 cm above the bend of the elbow, where
the nerve pierces the deep fascia and continues as the lateral cutaneous nerve of the fore arm.
Join these points by an oblique line which crosses the prominence of coracobrachialis and the biceps brachii.

Flexor retinaculum of the hand:

1 . A point on the pisiform bone.
2. A point on the tubercle of the scaphoid.
3. A point on the hook of the hamate.
4. A point on the crest of the trapezium.
Join the first and second points by a line concave upward; it represents the upper limit of flexor retinaculum
and corresponds to the lower of the two transverse creases in front of the wrist. Join the third and fourth
points by a line concave downwards and represent the lower limit of the retinaculum; it lies about 2 cm
below the upper limit.

Extensor retinaculum:
1. A point on the salient lower part ofthe anterior border of the radius.
2. Take a point 2 cm above the first point.
3. A point on the tip of the styloid process of the ulna.
4. Take a point 2 cm below the third point on the medial side of the carpus.
the lines slope
Join the second and third points by a line, and first and fourth points by another line. Both
limits of the
downwards and medially across the back of the wrist, and represent the upper and lower
extensor retinaculum.

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 X-ray shoulder 1

Q. Identify this X-ray.

Answer
Identification: This is the plain X-ray of left shoulder joint A-P view.
Q. What type of joint it is?
Answer
Ball & socket type of synovial joint.

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 Chapter-07: Superior extremity
— 3^3
Q. Mention and show the movements of shoulder joints with muscles producing movement.
Answer
Show the movement; flexion, extension, abduction, adduction, medial rotation, and lateral rotation.

Movements & muscles producing movements:

Movements < Muscles producing movements
I. Flexion • Pectoralis major (clavicular head)
• Anterior fibres of deltoid • •

• Coracobrachialis
• Short head of biceps
2. Extension • Posterior fibres of deltoid
• Latissimus dorsi
• Teres major
• Long head of triceps
3. Adduction • Pectoralis major
• Latissimus dorsi
• Teres major
• Short head of biceps
• Long head of triceps
4. Abduction • Deltoid
• Supraspinatus
• Serratus anterior
• Upper & lower fibres of trapezius

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 WRITTEN CSAQ,
884 ^FAVOUR ANATOMY FOR
Muscles producing mw
Movements
5. Medial rotation • Pectoralis major
• Anterior fibres of deltoid
• Latissimus dorsi
• Teres major
• Subscapularis
6. Lateral rotation • Posterior fibres of deltoid
• Infraspinatus
• Teres minor
[Ref- A.K. Datta / 3rd / 143 + BD Chaurasia / 7th / 149|

Q. What are the nerves lies in relation to the humerus?

Answer
• Axillary nerve
• Radial nerve&
• Ulnar nerve.
Q. Which nerve will be injured if fracture occurs near the surgical neck of humerus and at the
shaft?
Answer
• Axillaiy nerve will be injured if fracture occurs near the surgical neck of humerus
• Radial nerve will be injured if fracture occurs at the shaft
Q. What are the contents of bicipital groove?
Answer
• Long head of biceps brachii with its synovial sheath
• Ascending branch of anterior circumflex humeral artery.

X-ray elbow joint

Q. Identify the X-rav

Answer
and end view (A-P and lateral) inchlding of

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 Chapter-07: Superior extremity
-■■« , . ,_ OQC
oo3
Q. What type of joint it is? Mention the articular surfaces.
Answer
Type: This is hinge variety of synovial joint.
Articular surfaces:
• Upper; The capitulum & trochlea of the humerus.
• Lower:
1 . Upper surface of the head of the radius articulates with capitulum.
2. Trochlear notch of the ulna articulates with the trochlea of the humerus.

Q. Show the movements of this joint mentioning the muscles responsible for movements.
Answer
• Flexion: By brachialis, biceps brachii and brachioradialis.
• Extension: By triceps, and anconeus
Q. Which nerve is closely related behind medial epicondyle?
Answer
Ulnar nerve is closely related behind the medial epicondyle.

X-ray wrist joint

Q- Identify the X-ray.

Answer
Identification: This is the plain X-ray of wrist joint A-P view.
Q. What type of joint it is?
Answer . \
Ellipsoid type of synovial joint.
•'
Q. Show the joints at the wrist. . '.s'
Answer •’ . / ’• "/'Hi;
. :.s .o ; :‘v
• Radiocarpal joint .''A' '■
H.". ,■ .

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 ENDEAVOUR ANATOMY FOR WRITTEN (SAQ, MCQ) & Viy^
• Carpocarpal (intercarpal) joints
• Midcarpal joint
• Carpo-mctacarpal joints
• Distal radio-ulnar joint
and ulna?
Q. What type of joint is formed between radius
. Superior radionlnar joint: Pivot type of synovial joint
joint
• Middle radioulnar joint: Syndesmosis type of synovial
inferior radioulnar joint: Pivot type of synovial joint
•
Q. Show and identify the carpal bones? Mention their morphological type.
Answer
• Proximal row: Scaphoid, lunate, triquetral, pisiform
• Distal row: Trapezium, trapezoid capitate, and hamate
Morphologically they are short bones.

Q. Mention the characteristics of short bone.

Answer
Each short bone is cubical in shape and presents six surfaces. Out of these four surfaces are articular
and the remaining two surfaces are non-articular. Carpal and tarsal-bones are examples of short
bones.
Q. Which carpal bones ossify at the last?
Answer
The pisiform is ossified last among the carpal bones (12th year).

X-ray of hand

Q- Identify the X-ray.

Answer
-ray of hand A-P
view.
Q- Identify the
bones you are seeing |,cr(.?M ,
Answer
l"»0»lbelr„,„rph0|0 lca|
^jghlcarpal
short bones”
bmS~ (scaphoid tyP'Cal ,Ong
bones.
P d’ lunale> triquetral,
pisiform
. > apezium, trapezoid, capitate, hamate):

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 Chapter-07: Superior extremity — 887
• Five nictncarpnl bones: miniature long bones
• Phalangeal bones: miniature long bones.
Q. What are the joints of hand? Mention their types.
Answer
• Intcrcarpal joints: Plane type of synovial joint.
• Mid-carpal joint: Plane type of synovial joint.
• Carpometacarpal intcrmetacnrpal joints: The first carpometacarpal joint is a saddle type of
synovial joint while the remaining four arc all ellipsoid type of synovial joint. Intermetacarpal joints are
plane type of synovial joint.
• Metacarpophalangeal joints: Ellipsoid type of synovial joint.
• Intcrphalangeal joints: Hinge type of synovial joint.

Q. Mention the type of epiphysis of first metacarpal bone.

Answer
Aberrant epiphysis.

Q. Explain anatomically- Metacarpal bone is a miniature long bone.

[DU-18N]
Answer
Explanation:
Metacarpal bones have a miniature appearance and often they have only one epiphysis. So, it is called
miniature long bone.

Pectoral region
Q. Write short note on: Clavipectoral fascia. [RU-15Ju,09J,07Ju,05Ju]
Q. Write briefly on: Clavipectoral fascia. [DU-14Ju]
Answer
Clavipectoral fascia:
It is a fibrous sheet situated deep to the clavicular portion of the pectoralis major muscle.
Extension: It extends from the clavicle above to the axillary fascia below.
Attachment:
• Medially: Attached to the first rib & to the costoclavicular ligament.
• Laterally: Attached to the coracoid process & blends with the coracoclavicular ligament. The upper part
. of the fascia is thick and is called the costocoracoid ligament. - .

:
Enclosed rhuscles:
1 . Its upper part splits to enclose the subclavius muscle.
2. Inferiorly, the clavipectoral fascia splits to enclose the pectoralis minor muscle.
Structures piercing it: ? i; :
1. Lateral pectoral nerve. j. ...
2. Cephalic vein.
3. Thoracoacromial vessels.
4. Lymphatics passing from the breast & pectoral region to the apical group of axillary lymph nodes.
(Ref- B. D. Chaurasia / 7th / 45]
- • • i ; . , ,

Q. Write short note on: Platysma.

Answer
Platysma:
The platysma is a thin, broad sheet of subcutaneous muscle. The fibres of the muscle arise from the
deep fascia covering the pectoralis mayor; run upwards and medially crossing the clavicle and the side of the
neck; and are inserted into the base of the mandible and into skin over the posterior and lower part of the face.

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 888 _ j^^EAVOURANATOi^^
Nerve supply'.. Facial nerve.
Functions!
a. When the angle or
,
me ruuum H lled down, the
• muscle contracts and wrinkles the skin of the

the external jugular vein (which underlies the muscle) from external
b Tlwplatysma may protect
pressure.
|Rcf- B. D. Chaurasia / 7,h / 36|

O Give the origin, insertion and

nerve supply of muscles of pectoral region.
Q. Write in a tabulated form the origin, insertion and nerve supply of pectoralis major muscle.
[DU-18N,15N/J,13J]
Q. Short note: Pectoralis major. [SUST-18M]
Answer
Muscles of pectoral region:
Muscles of pectoral region are-
1. Pectoralis major.
2. Pectoralis minor.
Subclavius.

Figure: Muscles of pectoral region

Origin, insertion and nerve supply of muscles of pectoral region

Muscle^
Pectoralis 1 ) Anterior surface of medial half of
Mmmb
It
supply
is inserted by a Medial and lateral . .
major clavicle. bilaminar tendon on the pectoral nerves.'
2) Half the breadth of anterior lateral lip of the bicipital
surface of manubrium and groove.
sternum upto 6th costal cartilages.
3) Second to sixth costal cartilages
4) Aponeurosis of the external
oblique muscle of abdomen.
Pectoralis 1 ) 3™, 4", 5“ ribs, near the Medial border and upper Medial and lateral
minor costochondral junction. surface of the coracoid pectoral nerves.
2) Intervening fascia covering process.
external intercostal muscles.
Subclavius • First rib at the costochondral
junction.
Subclavian groove in the Nerve to subclavius
middle one-third of the from upper trunlc of '
'
clavicle. brachial plexus.
[Ref- B. D. Chaurasia 1 7* / 431

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 Chapter-07: Superior extremity — 889
Q. Give the actions of muscles of pectoral region.
Q. Give the actions of pectoralis major muscle. [DU-13J]
Answer
Actions of muscles of pectoral region:
Muscle \ Actions
Pectoralis major Acting as a whole the muscle causes:
• Adduction and
• Medial rotation of the shoulder (arm).
Clavicular part produces:
• Flexion of the arm.
Sternocostal part is used in:
• Extension of flexed arm against resistance.
• Climbing.
.
Pectoralis minor • Draws the scapula forward (with serratus anterior).
• Depresses the point of the shoulder.
• Helps in forced inspiration.
Subclavius • Steadies the clavicle during movements of the shoulder.
[Ref- B. D. Chaurasia / 7th / 44]

Q. Give the origin, insertion, nerve supply and action of serratus anterior muscle.
Answer
Serratus anterior:
Serratus anterior muscle is not strictly a muscle of the pectoral region, but it is convenient to consider it here.
Origin: Serratus anterior muscle arises by eight digitations from the upper eight ribs, and from the fascia
covering the intervening intercostal muscles.
Insertion: . .. .

The muscle is inserted into the costal surface of the scapula along its medial border. The first digitation
is inserted from the superior angle to the root of the spine. The next two or three digitations are inserted lower
down on the medial border. The lower four or five digitations are inserted into a large triangular area over the
!
inferior angle.
r>; ' tz'1? r? i:;'-' ' '? '.uP 'Ji'- ./~1; i > ;
’ /
Nerve supply:
The nerve to the serratus anterior is a branch of the brachial plexus. It arises from roots C5, C6 and C7.
Actions:
1 Along with the pectoralis minor, the muscle pulls the scapula forwards around the chest wall to
protract
the upper limb (in pushing and punching movements).
2. The fibres inserted into the inferior angle of the scapula pull it forwards and rotate the
scapula.
3. The muscle steadies the scapula during weight carrying. .
< '
z-
4. It helps in forced inspiration. '

{
-
|Ref- B. D. Chaurasia / 7th i 45-47]

Q. Explain anatomically -why winging of the scapula occurs. [RU-15M]

Q. What is winging of the scapula? [CU-14Ju]
Answer " 1
< r- ' •<
' 11
> t

When serratus anterior muscle is paralysed the medial margin of the scapula gets
Winging of the scapula:
This is called ‘winging of the scapula’.
raised especially when pushing movements are attempted.
into the inferior angle of the scapula pull it forwards and the
rotate
Cause: The fibres of serratus anterior inserted upwards. In this action, the serratus anterior is he ped by
thTscanula so that the glenoid cavity is turned w.ngmg of.be scapul .
traS« upwards and backwards. So. i.s paralysis causes
. ! , |Ref- B. D. Chaurasia / 7 / 13]

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 FAVOUR ANATOMY FOR WRITTEN
(SAQ^MCQ) &
890 epiphysis. [DU-18N]
Coracoidprocess of scapula is an atavistic
Q. Explain analon.to.lly -
Answer
Explanation: independent bone and is attached secondarily on
is phylogcnctically an
Coracoid process of the scapulareason, it is an atavistic epiphysis.
scapula to receive nutrition. For this

Breast (Mammary gland)

of female breast. [CU- 1 5Ju, RU-06J, SUST-1 7M, 1 6M,
Q. Give the gross anatomy & structure

Answer
Breast: Pectoral fascia
The breast or mammary gland is a Pectoralis major muscle
modified sweat gland. It is found in both sex but is muscles
rudimentary in male. It forms an important ^Intercostal
, Suspensory ligaments
accessor)' organ of the female reproductive
system, and provides nutrition to the newborn in Lactiferous sinus
the form of milk.
Ribs
i
Situation:
The breast lies in the superficial fascia of
the pectoral region. A small extension called the
axillary tail of Spence, pierces the deep fascia and Lung
lies in the axilla. Lactiferous duct
Extent:
1. Vertically, it extends from 2nd to 6lh rib. \ Gland lobules
2. Horizontally, it extends from the lateral Fat
border of the sternum to the mid-axillary
line. Figure: Gross anatomy, relations of mammaiy gland.
Deep relations: The deep surface of the breast is related to the following structures:
1 . The breast lies on the deep fascia (pectoral fascia) covering the pectoralis major
muscle.
2. Still deeper, there are the parts of the pectoralis major, the serratus
anterior & the external oblique
muscles. . \ . . .
3. The breast is separated from the pectoral fascia by loose areolar
tissue, sometimes called retromammary
space.
i

; Clavicle
Clavicle Subclavius-
Nipple Pectoral fascia -
Pectoralis Areola
Major Pectoralis
Outline major
of breast - Sternum
Retromammary
Serratus - Axillary tail space
anterior External Foramen
of Pectoralis'
oblique Langer minor

Figure: Gross anatomy and relations of

mammary gland
|Ref- A. K. Datta / 3rd / 33, 34 + B. D. Chaurasia / 7,h / 36,37]

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Chapter-07: Superior extremity 891
q Write short note on: Axillary tail.
Answer
Axillary
’
talk
Sometimes a tail like projection from the upper and outer quadrant of the breast enters the axilla through
of
an opening in the axillary fascia known as foramen Langer. This process comes in contact with the anterior
eroup of axillary lymph nodes. This is called axillary tail.
When it is enlarged, it may be mistaken as a lipoma.
(Ref- A. K. Datta / 3rd / 33(

O Describe the histological structure of breast. [DU-08J]

Q Give the components of female breast. [SUST-15Ju,14/12Ju,HJ,09Ju]
Q Give the different structural components of female breast. [SUST-19M,13Ju]
Answer
Histological structure of breast:
The breast is divided into:
1. Skin
2. Parenchyma
3. Stroma
Skin: It covers the gland & presents the
following features:
1. Nipple: A conical projection, called
the nipple is present just below the
centre of the breast at the level of the
4th intercostal space. The nipple is
pierced by 1 5 to 20 lactiferous ducts.
It contains circular & longitudinal
smooth muscle fibers. It also contains
modified sweat & sebaceous gland. Figure: Structure and histology of mammary gland.
2. Areola: N. circular area formed by pigmented skin surrounding the base of the nipple is called areola.
This region is rich in modified sebaceous glands, some sweat glands & accessory mammary glands.
The skin of the areola & nipple is devoid of hair & there is no fat subjacent to it.
Parenchyma: - —
It is made up of glandular tissue which secretes milk. The gland consists of 15 to 20 lobes. Each lobe is
a cluster of alveoli & is drained by a lactiferous duct. The lactiferous ducts converge towards the nipple & open
into it. Near its termination, each duct has a dilatation, called a lactiferous sinus.
Alveolar epithelium is cuboidal in resting phase and columnar during lactation.
Stroma: It forms the supporting framework of the gland. It is partly fibrous & partly fatty.

I Ref- A. K. Datta/ 3rd / 33, 34 + B. D. Chaurasia / 7,h / 40,41]

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 .OVRAtUTOMrEQKJ^TEN^SA
892
of female breast. [RU-OM, SUST-1 1 J
Q. Give the Wood supply
Answer
Blood Supply of female brca^

‘“^S^gtad is extremely vascular.

following lenes- al
U is supplied by brandies of a branch of
artery,
1 Internal thoracic
subclavian artery through its
perforating branches.
thoracic
2. The lateral thoracic, superior the
& acromiothoracic branches of
axillary artery.
3. Lateral branches of the posterior
intercostal arteries.
Venous drainaseL
1 . The superficial veins drain into the
internal thoracic vein & into the
superficial veins of the lower part of
the neck.
2. The deep veins drain into the internal
thoracic, axillary & posterior
intercostals veins.
[Ref- A. K. Datta / 3 / 35 + B. D. Chaurasia / 7 / 38|

Q. Describe the lymphatic drainage of female breast. [DU-19N,15M,15Ju,12Ju,l 1 Ju,10Ju,09J,08J,

CU-15M, RU-18M,16M,15J,12Ju,10Ju,09Ju,08J,06J, SUST-19M,18N,17M,16M,15M,14Ju, 13Ju,
12Ju,09J,08Ju/J,07Ju]
Q. Describe the lymphatic drainage of female breast. [DU-12Ju,l 1 Ju,10Ju,09J,08J, CU-17M]
Q. Write down the lymphatic drainage of breast. [DU-17N,16M,14Ju, RU-17M, CU-16MJ5Ju,
14Ju]
Answer
Lymphatic drainage of female breast:
Lymph nodes:
1 . The lymph from the breast drains into
following lymph nodes- the axillary lymph
nodes, chiefly the anterior (or pectoral)
group. The posterior, lateral, central and
apical groups of nodes also receive lymph
from the breast either directly or indirectly.
2. The internal mammary nodes, which lie
along the internal thoracic vessels.
3. Some lymph from the breast also
reaches the
supraclavicular nodes, the cephalic
node, the
posterior intercostal nodes and the
subdiaphragmatic & subperitoneal lymph
plexuses.
Lymphatic vessels:
1 . The superficial lymphatics
drain the skin nvf>r tka u
2. The deep lymphatics drain the parenchvma f°r the nipple and
the breast. ^Cept
y of th They also drain the nipple & areola.

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Chapter-07: Superior extremity $93
Spine points of interest about the lymphatic drainage of breast:
> About 75% of the lymph from the breast drains into the axillary nodes, 20% into the internal mammary
nodes & 5% into the posterior intercostal nodes.
> Among the axillary nodes, the lymphatics end mostly in the anterior group and partly in the posterior &
apical groups.
> Lymph from the anterior & posterior groups passes to the central & lateral groups and through them to
the apical group. Finally it reaches the supraclavicular nodes.
|Ref- B. D. Chaurasia / 7<h / 38-40]

O Give the applied anatomy or clinical importance of lymphatic drainage of the female breast.
[DU-1 9N, 1 7N, 1 0Ju,08J, RU- 1 8M, 1 6M, 1 5 J, SUST- 1 9M, 1 5M, 1 1 Ju]
Answer
Applied anatomy or clinical importance of lymphatic drainage of breast:
Obstruction of superficial lymph vessels by cancer cells may produce oedema of the skin giving rise to
“

an appearance like that of the skin of an orange (Peau d' orange appearance).
7 Because of communications of the superficial lymphatics of the breast across the midline, cancer may
spread from one breast to another.
3 Because of communications of the lymph vessels with those in the abdomen cancer of the breast may
spread to the liver and cancer cells may drop into the pelvis and produce secondary deposits especially
on the surface of ovary forming Krukenberg’s tumour.
[Ref- A. K. Datta 1 3rd / 37 + B. D. Chaurasia / 7th 1 39,40]

Q. What is the importance of lymphatic drainage of the breast to a surgeon?

Answer
The importance of lymphatic drainage of the breast to a surgeon:
Lymphatic drainage of the breast assumes great importance to the surgeon because; carcinoma of the
breast spreads mostly along the lymphatics to the regional lymph nodes.
[Ref- B. D. Chaurasia / 7th / 39[

Q. Explain anatomically- Incisions into the breast are usually made radially.
Answer
Incisions into the breast are usually made radially:
Incisions into the breast are usually made radially to avoid cutting the lactiferous duct.
[Ref- B. D. Chaurasia 1 7th / 40]

Q. What is peau d' orange? [DU-12Ju,08J]

Q. What do you mean by peau d’ orange? [DU-14Ju]
Answer
Peau d* orange:
Peau d' orange is a condition where obstruction of the superficial lymphatics by cancer cells may
produce oedema of skin giving rise to an appearance like that of the skin of an orange.
[Ref- B. D. Chaurasia / 7th 1 41[
Q. How breast cancer can spread to the vertebra? [RU-13Ju,06J]
Answer
Breast cancer can spread to the vertebra:
Breast cancer can spread to the vertebra by the venous route because, the veins draining the breast
communicate with the vertebral venous plexus of veins.
[Ref- B. D. Chaurasia / 7th / 41]

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 endea VOUR ana TQMYFQR written
(SA
894 —
RU-17M]
Q. Write about the development of the breast. [SUST-09Ju,
line)? [RU-19N,06J]
Q. What is mammary line (milk
Answer

sr—
disappears over most of its extent persisting
only in the

2 The pwreS part ofSecondary

the mammary ridge is converted
buds grow down from
into a mammary pit.
the floor of the pit. These buds divide and subdivide to
form the lobes of the gland. The entire system is first
solid, but is later canalized. At birth or later, the nipple
is everted at the site of the original pit.
3. Growth of the mammary glands, at puberty, is caused
by estrogens. Apart from estrogens, development of
secretory alveoli is stimulated by progesterone and by
the prolactin hormone of the hypophysis cerebri.
Mamman' line (milk line): The breast develops from an
ectodermal thickening that extends from axilla to the groin
during the fourth week of intrauterine life which is called
mamman' line or milk line.

[Ref- B. D. Chaurasia / 7*h / 40[

Q. What are the age related changes of mammary gland? [DU-09

J]
Q. Discuss histological differences between non-pregnant,
1 8M j
pregnant
and lactating breast. [SUST-
Answer
Agerelated changes of mammary gland: The structure of the
different period of life as follows: glandular elements varies considerably at
°f er ^andu*ar tissue consists entirely of ducts (lactiferous ducts and
sinuses), that have small cellular
i
aggregates in their extremities
b) During puberty:
Phase I: Elevation of breast bud.
Phase 2: Glandular subareolar
tissue is present. Both nipple &
Phase 3: Areola increases &
become pigmented. Proliferation of breast project as a single mass.
Phase 4: Nipple & areola form a breast tissue occurs.
Phase 5: Smooth contour of secondary mass.
breast.
C) During
menstruation: -. u
> JJ
i
i , • j;

Stromal density increases & J

> lumen contains secretion.

3-14 days: Luminal expansion
of ducts.
d) During pregnancy:
The duct undergoes
marked proliferation
and form buds which enlarge into alveoli,
expansion o t e
obules occurs, interlobular
unng the second half of fat and
material.
pregnancy, alveoli enlarge connective tissue decrease in amount,
and begin to elaborate some secretory
At the end of
pregnancy some cloudy,
e) During lactation: watery fluid, colostrum, is secreted.

5
Many alveoli become
dilated
They are distended by milk and appear as saccules.
and have low epithelial wall.

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 Chapter-07: Superior extremity 895
0 Postmenopausal:
> Progressive atrophy of lobules & ducts.
> Fatty replacement of glandular tissue.
[Ref- Gray / 40,h / 935]

Figure: Age related changes of breast.

Q. What is radical mastectomy? [RU-10Ju,08J]

Answer , J..,?.?;.'
Radical mastectomy: Excision of the whole breast, a large portion of skin, the center of which, overlies the'
tumour including the nipple and all of the fat, fascia & lymph nodes of the axilla is called radical mastectomy.
In this operation following structures arc removed:
1. A large area of skin overlying the tumour including the nipple.
2. All the breast tissue.
3. Pectoralis major and minor and their associated fascia. ;
'

4. All the fat, fascia and lymph nodes in the axilla.

5. The fascia covering the rectus sheath, the serratus anterior, the Subscapularis and the latissimus dorsi
muscle.
[Ref- Snell / 8,h / 432]
Q. Mention developmental anomalies of mammary gland? [RU-17M]
Answer
Developmental anomalies of mammary gland
• Accessory breast • •

• Amastia
• Amazia . .? •.
• Atheha
• Micromastia .
• Supernumerary nipple (Polythelia)
• Symmastia
• Tuberous breasts

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 ENDEA vo„llAMTOMYFQSJl'RrTTEN(SAQJilC^
&

Of polythelia. [RU-I9M,I5J,10Ju]
896
Q. Give the dcvdopmeutul
1 SM.
Q. What is polythelia? [RU-
, au 1— „ n linp extending
along a line
I exicnumt, from the anterior fold of the axilla to
nippies. It occurs
Polythelia^
itmeans- supemumeraiy ninnies
fragments of the mammary line.
due to .1>C persistence of |Rcf- Langman / 12th / 336]

Q. What is gynaccomastia?
Enlargement of male breast (unilateral
or bilateral) is known as gynaecomastia.

Causes:
1. Unknown.
2. Hormonal imbalance.
3. Chronic liver disease.
4. Klinefelter’s syndrome.
5. Some drugs. Datta / yi y J4J
Snell ; 8<h f 432 + A

Q. What is polymastia? [RU-19M,18M]

Answer ;; ;
Polymastia:
Polymastia, also known as accessory breasts or mammae erraticae, is the condition of having
an additional breast. Extra breasts may appear with or without nipples or areolae.

Q. Which quadrant is more dangerous in carcinoma breast and why?

Answer J •• ,•
More dangerous quadrant in carcinoma breast:
Lower and inner quadrant is more dangerous because it may communicate with the subdiaphragmatic
and subperitoneal lymph plexus through the upper part of the linea alba. So, carcinoma can spread to the
peritoneal cavity as well as mediastinum. .

Q. Give the steps of dissection of axilla. [RU-19M,16M,15Ju,13Ju

» 07JulJ
Answer
Steps of dissection:
L
ht3v^^arm
laterally to the
aXillary f°ld be&inning from the level of the nipple extending
for about 6.25 cm. r

axil a^fol'd3' 'nC'S'°n frOm the med*al end °f first

incision extending downwards to the posterior

' £heT^
4' 1" the °f the f,rst tncisi°n to the posterior border of the arm.
,laP ot skln and superficial fascia is reflected
/ fascia is
5 The deep to be reflected by preserving the
6. ; Then the contents of axilla are seen. cutaneous structures.
structures

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 Chapter-07: Superior extremity _ 897
Q. What is axilla? Give the boundary and contents of the axilla. [DU-09Ju, RU-19M 1 IJu 07Ju
05Ju, SUST- 1 9N, 1 7N, 1 5N/M, 1 4Ju, 1 3Ju, 1 1 J,06Ju]
Q. Give the contents of the axilla. [RU-17N, !6M,13Ju]
Answer
Axilla: The axilla or armpit is a four-sided pyramidal shaped space
situated between the upper part of the arm & the chest wall. It has an
apex, a base & 4 walls - anterior, posterior, medial & lateral.
Boundaries:
I . Apex: It is directed upwards & medially towards the root of the
neck. It is bounded
• Anteriorly: By the clavicle.
• Posteriorly: By the superior border of the scapula.
• Medially: By the outer border of the first rib.
2. Rase: It is directed downwards & is formed by skin & fasciae.
3. Anterior wall: It is formed by-
• Pectoralis major and
• Clavipectoral fascia enclosing the pectoralis minor &
subclavius. Figure: Boundary of axilla.

4. Posterior wall: It is formed by -

• Subscapularis above
• Teres major & latissimus dorsi below.
5. Medial wall: Formed by-
• Upper four ribs with their intercostal muscles.
• Upper part of the serratus anterior muscle.
6. Lateral wall: Formed by-
• Upper part of the shaft of the humerus in the bicipital
groove
• Coracobrachialis & short head of the biceps.
Contents of axilla:
1) Axillary artery & its branches. Figure: Dimension of axilla.
2) Axillary vein & its tributaries.
3) Infraclavicular part of the brachial plexus.
4) Five groups of axillary lymph nodes & the associated lymphatics.
5) The long thoracic & intercostobrachial nerves.
6) Axillary fat & areolar tissue.

Clavicle Axillary artery

Subclavius
-Subscaputaris

Pectoralis
Major Axillary
fascia
Pectoralis • Teres
Minor Major
- Dorsi
LatissiMUS

Figure: Anterior & Porterior wall of axilla

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 ^tiwyfoR written (saq,mcq)& viva
FNDEA YOUR.

Long
Biceps Brachii
Coracobrachialis
Nerve to subscapuiaris
Axillory vein
_ Axillary artery
Medial pectoral nerve
Lateral pectoral nerve
Short head of
Biceps Brachii

Figure: Contents of axilla

[Ref- B. D. Chaurasia / 7lh / 48-50]

Axillary lymph nodes are clinically

Q. Explain anatomically/ developmentally/ histologically-
important. [CU-18N,15J,13Ju]
Q. Classify axillary lymph nodes. [SUST-18N] tt^tt im
Q. Write briefly on: Axillary group of lymph nodes and their area of drainage. [DU-18M, 17M,
15N/J, SUST-18M]
Q. Mention the groups of axillary lymph nodes with their importance? [RU-17N,05Ju, SUST-
1 7N]
Q. Give the distribution of axillary group of lymph nodes. [SUST-06J]
Answer
’
:
Axillary group of lymph nodes:
Axillary group of lymph nodes are scattered in fibro-fatty tissue of the axilla. The axillary nodes are
divided into five groups - anterior, posterior, lateral, central & apical.
1. Anterior or pectoral:
> Situation: Along the lateral thoracic vein
at the lower border of the pectoralis
minor.
> Afferent: From the upper half of the Supraclavicular
anterior wall of the trunk and from the
major part of the breast. "
> Efferent: To central & apical nodes. Anterior axillary
Posterior or subscapular: Central axillary
• Situation: Along the subscapular vessels - Posterior axillary
in the posterior wall of axilla on
subscapularis muscle
_ Lateral axillary
• Afferent: From the posterior wall of the
upper half of the trunk & from the
axillary tail of the breast, Figure: Axillary lymph
• Efferent: \nio central & apical nodes. nodes
3. Lateral group:
V the lateral
z Afferent From the entirewall of the axilla posteromedial io
upper limb.
me axillary
'“‘ to the axillary vein
vein.
Z Efferent: Into central & apical lymph
nodes.

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 Chapter-07: Superior extremity — $$$
4. Central group:
> Situation: Situated close to the base of the axilla embedded in fat.
> Afferent: From the preceding three groups.
> Efferent: Into the apical groups.
5. /Kpical group:
• Situation: At the apex of the axilla medial to the axillary vein.
• Afferent: From the central group.
• E/fornC Efferents from the apical group form the subclavian trunk which drains as follows:
a) Mostly at the junction of subclavian & internal jugular veins.
b) Sometimes joins with the right lymphatic duct or thoracic duct on the left side.
c) A few efferents terminate into inferior deep cervical lymph nodes.
Importance of axillary lymph nodes;
1) They drain lymph from the upper limb, breast and the anterior & posterior body walls above the level of
umbilicus. So, infections or malignant growths in any part of their territory of drainage give rise to
involvement of the axillary lymph nodes.
2) An abscess in the axilla may arise from infection & suppuration of particular groups of axillary lymph
nodes.
[Ref- B. D. Chaurasia / 7th I 55[

Q. Explain anatomically/ developmentally/ histologically- Axillary nodes are clinically

important. [CU- 13Ju] . „ f

Answer
Clinical importance of axillary lymph nodes;
1 . They drain lymph from the upper limb, breast and the anterior & posterior body walls above the level of
umbilicus. So, infections or malignant growths in any part of their territory of drainage give rise to
involvement of the axillary lymph nodes.
2. An abscess in the axilla may arise from infection & suppuration of particular groups of axillary lymph
nodes.
[Ref- B. D. Chaurasia / 7th / 55]

Q. Mention the extension and branches of axillary artery. [RU-19M,15M]

Q. Write short note on: axillary artery. [CU-18/17N]
Answer .

Axillary artery:

Origin: Axillary artery is the continuation of the subclavian artery.

Extension: It extends from the outer border of the first rib to the lower border of the teres major muscle.
Termination: The axillary artery continues as the brachial artery.
Parts; The axillary artery can be divided into three parts by the pectoralis minor muscle.
1 ) First part: Superior (proximal) to the muscle
2) Second part: Posterior (or deep) to the muscle.
3) Third part-. Inferior (distal) to the muscle.
Branches:
1 ) Superior thoracic artery.
2) Thoracoacromial artery.
3) Lateral thoracic artery,
4) Subscapular artery.
5) Anterior circumflex humeral artery.
6) Posterior circumflex humeral artery.
[Ref- B. D. Chaurasia / 7th / 50-55]

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 Axillary Vein.
Q. Write short note on:
Answer
Axillary vein:
of the basilic vein.
Origin: The axillary vein is the continuation
by the venae comitances
of the brachial artery a little above the lo er
Course: The axillary vein is joined axillary artery.
the medial side of the
border of the teres major. It lies on vein.
Termination; At the outer border of the
first rib it becomes the subclavian
corresponding to the branches of the axillary artery, it receives th
Tributaries: In addition to the tributaries
cephalic vein in its upper part.
[Ref- B. D. Chaurasia / 7th / 55]

Q. Draw and label brachial plexus. [DU-19M,18/17M,15N/M,14Ju,13J,12J,08J,06J,05Ju/J, CU-

SUST-19N/M,18/17N,17M,16M, 15N/J, 14J, 13J,
19M. 1 8/1 7N, 1 5Ju/N/J, 1 3Ju, 1 1 J, 1 OJu, 09Ju,08J,
12Ju,I 1 Ju,l I/I0/09J,08J,07J,06J, RU-19N,17N,16N,15N/J,14J,1 1 J, 09J,08J]
Q. Give the formation of brachial plexus. [SUST-05Ju]
Q. Write about posterior cord of brachial plexus. [SUST-18MJ4J]
Q. Give the formation of different components of brachial plexus. [SUST-13Ju]
Answer
Brachial plexus:
It is a nerve plexus situated in the root of the upper limb. It consists of roots, trunks, divisions cords and
branches.
A. Roots: It is formed by the anterior primary rami spinal, nerves C5,6,7,8 & T1 with contributions from
anterior primary rami of spinal nerves C4 & T2. . • >
d ’
: e iiiirif )n..
B. Trunks:
> Upper trunk: formed by C5 & C6 nerve roots.
> Middle trunk: formed by C7 nerve root.
> Lower trunk: formed by C8 & TI nerve roots.
C. Divisions: Each trunk is divided into ventral &
dorsal divisions.
D. Cords: Divisions join to form the cords.
> Lateral cord: formed by the union of ventral divisions of the upper &
> Medial cord: formed by the ventral division middle trunks.
lower trunk.
> Posterior cord: formed by the union of dorsalofdivisions of all the three trunks.

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Chapter-07: Superior extremity 901

Suprascapular nerve
Dorsal scapular nerve
Branch to phrenic

Muscular branches
Long thoracic nerve

Muscular branches
Musculocutaneous
nerve Upper subscapular nerve
Nerve to Latissimus Dorsi
Axillary nerve
Lower subscapular nerve
Medial Pectoral nerve
Medial cutaneous nerve of arm
Median Medial cutaneous nerve of forearm
nerve Radial Ulnar
nerve nerve
Figure: The Right Brachial Plexus

E. Branches of brachial plexus:

1. Branches of the Roots: v u; >
a) Nerve to serratus anterior (long thoracic nerve C5,6,7)
b) Nerve to rhomboideus (dorsal scapular nerve C5)
2. Branches of the Trunks:
a) Suprascapular nerve (C5, 6)
b) Nerve to subclavius (C5, 6)
3. Branches of The Cords:
I. Branches of Lateral Cord:
a) Lateral pectoral (C5-C7)
b) Musculocutaneous (C5-C7)
c) Lateral root of median (C5-C7)
IL Branches of Medial Cord:
a) Medial pectoral (C8, Tl).
b) Medial cutaneous nerve of arm (C8, Tl). ,
?
c) Medial cutaneous nerve of forearm (C8, Tl ).
d) Ulnar (C7,C8,T1)- C7 fibres reach by a communicating branch from lateral root
of median nerve.
e) Medial root of median (C8, Tl).
III. Branches of Posterior Cord;
a) Upper subscapular (C5, C6)
b) Nerve to latissimus dorsi (thoracodorsal) (C6, C7, C8)
c) Lower subscapular (C5, C6)
d) Axillary (circumflex) (C5, C6)
e) Radial (C5-C8, Tl)
]Ref- B. D. Chaurasia / 7 / 56-58]

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 _ FAVOUR ANATOMY FOR WRITTEN (SAP, MCQ) A V!Va
902
median, radial, ulnar and musculocutaneous nerves.
Q. Give the root values of axillary,
Answer
The root values of axillary,
... «<«.1
median, rad
— ulnnrund musculocutaneous nerves:
Axillary nen e; C5,6
Median nerve; C5-C8, Tl
Radial nen e: C5-C8, Tl
Ulnar nen e: C7.8, 1 1
Musculocutaneous nen e: C5-C7
|Ref- B. D. Chaurasia / 6,h / 57-58]

£ 05Ju]
CU-i 9M, 1 8M, i 7M.08J, SUST-07J, RU-

Answer
Pre-fixed & post-fixed types of brachial plexus: . c . , ,„„ o
The roots of the brachial plexus are formed by the anterior primary rami of spinal nerves C5,6,7,8 & Tl
with contributions from the anterior primary rami of C4 & T2. The origin of the plexus may shift by one
segment upward or downward, resulting in a prefixed or postfixed plexus respectively.
> Pre -fixed plexus: Here the contribution by C4 is large & that from T2 is often absent.
> Post- fixed plexus: Here the contribution by Tl is large, T2 is always present, C4 is absent, C5 is
reduced in size.
[Ref- B. D. Chaurasia / 7th / 59]

Q. What is Erb’s point? [RU-08J]

Answer
Erb’s point: The region of the upper trunk of the brachial plexus is called Erb’s point. In this region, C5 and
C6 roots join to form upper trunk, suprascapular and nerve to subclavius are given and ventral
and dorsal
divisions of upper trunk start.
(Ref- B. D. Chaurasia / 7th / 59]

Figure: Erb’s point.

O wit' P!"Sy? [DU-'

Q- What is Erb s paralysis? ID8M-
U-06
™5M, I 2J,08J, RU-09J SUST 08 n
J 05 In CT I 1 om 1 , L, J]
Q. Write short note on: Erb’s
palsy. [DU-07J]' ’18M’15J>13/09Ju, SUST-16M]
Q. Explain on anatomical background-
Ininrv tn .
. adducted & medial rotated drm and
Answer Ln ei^
dnd tended and pronated ?f„b™hial
P,e™ causes
forearm. [CU-12Ju]
Erb’s palsy: . , j<r

to the opposite side & depress^nTfdX from excessive displacement of the head
Site of injury:
The region of the upper trunk of
to the upper trunk causes Erb’s
the brachial plexus is r m s point.
paralysis. ' Six nerves meet here. Injury

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Chapter-07: Superior extremity - 903
Causes of injury:
Undue separation of the head from the shoulder, which is commonly encountered in:
1) Birth injury
2) Fall on the shoulder and
3) During anaesthesia.
Nerve roots involved: Mainly C5 and partly C6.
Muscles paralysed:
1. Mainly biceps, deltoid brachialis and brachioradialis.
2. Partly supraspinatus, infraspinatus and supinator.
Deformity (position of the limb):
• Arm: Hangs by the side; it is adducted and medially rotated.
• Forearm: Extended and pronated.
The deformity is known as ‘policeman's tip hand’ or ‘porter's tip hand’.
Disability; The following movements are lost:
1 . Abduction and lateral rotation of the arm (shoulder).
2. Flexion and supination of the forearm.
3. Biceps and supinator jerks are lost.
4. Sensations are lost over a small area over the lower part of the deltoid.
[Ref- B. D. Chaurasia / 7,h 1 59|

Q. What is the effect of lower trunk compression?

Q. Write short note on: Klumpe’s paralysis.
Answer
Effect of lower trunk compression; Lower trunk compression causes Klumpe’s paralysis.
Cause of injury; Undue abduction of the arm, as in catching something with the hands after a fall from a
height, or sometimes in birth injury. ; . L ,
,

Nerve roots involved: Mainly T1 and partly C8. :

Muscles paralysed:
1) Intrinsic muscles of the hand (Tl).
2) Ulnar flexors of the wrist and fingers (C8).
Deformity (position of the hand); Claw hand is due to the unopposed action of the long flexors and extensors
of the fingers. In a claw hand, there is hyperextension at the metacarpo-phalangeal joints and flexion at the
interphalangeal joints.
Disability:
I ) Claw hand.
2) Cutaneous anaesthesia and analgesia In a narrow zone along the ulnar border of the forearm and
hand.
3) Horner's syndrome: Ptosis, miosis, anhydrosis, enophthalmos, and loss of ciliospinal reflex-may be
associated.
4) Vasomotor changes: The skin areas with sensory loss are warmer due to arteriolar dilation. It is also
drier due to the absence of sweating as there is loss of sympathetic activity.
5) Tropic changes: Long-standing case of paralysis leads to dry and scaly skin. The nails crack easily with
atrophy of the pulp of fingers.
|Ref- B. D. Chaurasia /
7,h/ 59J

Q. What is the effect of lesion of long thoracic nerve? [SUST-1 IJu]

Answer
Ibe effect of lesion of long thoracic nerve: Paralysis of serratus anterior.

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 MC
WWVOM ANA TOMY FOR WRITTEN
(SA
904
The back
muscles. Give their nerve supply. [RU-14Ju,06J]
Q. Mention the vertebro-scapuLu muscics.
*1

Answer
column. The muscles are:
which conncct lhe upper |imb wilh the vertebral
1. Trapezius.
2. Latissimus dorsi.
3. Levator scapulae.
4. Rhomboideus major.
5. Rhomboideus minor.
i-sca m
Origin, msern )n nerve supply unu <1

Muscles Origin -Insertion : WS Nerve supply < '

Actions" / --..
Trapezius 1 . Medial l/3rd of a. Upper fibres: Into 1. Spinal part of 1 . Upper fibres elevate
superior nuchal the posterior border accessory nerve is the scapula, as in
line. of lateral 1 /3rd of motor. shrugging.
2. External occipital clavicle. 2. Branches from 2. Middle fibres retract
protuberance. b. Middle fibres: Into C3,4 are the scapula.
3.Ligamentum the medial margin of proprioceptive. 3. Upper & lower
nuchae. the acromion & fibres are important in
4.C7-T12 vertebral upper lip of the crest abduction of the arm
spines. of spine of scapula. beyond 90°.
c. Lower fibres: On the 4. It steadies the
deltoid tubercle at scapula.
the medial end of the
spine, with a bursa
intervening.
Latissimus I. Posterior l/3'd of 1 . Into the floor of the Nerve to latissimus 1 . Adduction,
dorsi the outer lip of iliac intertubercular dorsi (C6, 7, 8).
crest.
extension & medial
sulcus. rotation of the shoulder
2. Posterior layer of
lumbar fascia. as in swimming,
3. Spines of T7 to climbing.
T12. 2. Helps in violent
4. Lower four ribs. expiratory effort (e.g.
5. Inferior angle of coughing, sneezing).
the scapula. 3. Holds inferior angle
1. Iransverse Into the superior angle 1 . A
scapulae processes of branch from
& upper part of medial nerve to 1. Helps in elevation
i 21,2.
border (upto triangular rhomboideus of scapula.
L Posterior tubercles area) of the scapula. (C5) 2. Steadies the
c)f transverse 2. C3, 4. scapula during
Eirocesses ofC3.4. mo vements of the
. Lower part of
the triangular Dorsal scapular
Base of arm.
minor ] gamentum
nuchae. irea at the root of the (C5). nerve Retract the scapula &
2. Spines ofC7 & T1 L;P| ne of steady it.
the scapula.
. Spines of T-2,3,4,5. IMedial
major border of the Dorsal
2. Supraspinous capula below the root (C5). scapular nerve Retract the scapula &
li gaments. f )fthe spine. steady it.

|Ref- B. D. Chaurasia / 7,h / 65]

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 Chapter-07: Superior extremity 905

Figure: Vertebro-scapular muscles, triangle of auscultation, triangle of Petit.

Q. Write short note on: Triangle of Auscultation.

Q. What is triangle of auscultation? [RU-1 1 Ju]
Answer
Triangle of Auscultation:
This is the only part of the back which is not covered with muscles. Respiratory sounds heard through a
stethoscope are said to be better heard over this triangle than elsewhere on the back.
Boundary:
• Medially: by the lateral border of the trapezius.
• Laterally: by the medial border of the scapula.
• Inferiorly: by the upper border of the latissimus dorsi.
• Floor: by the seventh rib, sixth and seventh intercostal spaces, and the rhomboideus major.
Importance: , C ’ '

1. This is the only part of the back which is not covered with muscles. Respiratory sounds heard
through a stethoscope are said to be better heard over this triangle than elsewhere on the back.
2. On the left side, the cardiac orifice of the stomach lies deep to the triangle, and in days before X-
rays were discovered the sounds of swallowed liquids were auscultated over this triangle.

[Ref- B. D. Chaurasia / 7,h / 67J

Q. Write short not on: Lumbar triangle of Petit.
Answer
Lumbar triangle of Petit:
Boundary:
• Medially: by the lateral border of the latissimus dorsi.
• Laterally: by the posterior border of the external oblique muscle of the abdomen.
• Inferiorly: by the iliac crest.
Importance: The occasional hernia at this site is called lumbar hernia.
|Ref- B. D. Chaurasia / 7th / 67[

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 906 ENDEAVOUR ANATOMY FOR WRFTTENJ.SA&MCQ) & VIVa
Cutaneous nerves & Dermatomes
SUS T-19M, 1 8M, 15M, 1 3/1 2Ju,
Q. What is dermatome? [RU-18M. 16N. 14Ju,l2Ju,IOJu,O9Ju,O8Ju,

Q. Define dermatome? [DU-17N.16M. 15JJ4J, J3Ju,

CU-I3J, RU-l3Ju; SUST-I4J]
0 Draw and label dermatome of upper limb with
axial line. [DU-I8N, 16M, 15J, 14J, 13Ju,08Ju,
07.lu.05M. CLM9M.18/l7/l6M.15N/M,l4J,l2Ju,l 1 Ju, I 1 J, 1 0Ju,08J,05J, RU-14Ju, 07J, SUST-
19M.ISN/MJ7N.15M.14.I.12.IU, 1 1 Ju.08J.07J]
Q. Draw and label the dermatome of ventral surface of right upper limb. [RU-I6M]
Q. Draw and label dermatome of right upper limb. [RU-1 8M, 1 7M, 1 5M, 1 3Ju, 1 2Ju,09Ju,08Ju, CU-
15Ju.14Ju.13J]
Answer
Dermatome: The area of skin supplied by a single spinal nerve is called a dermatome. . .

Q. What is axial line?

Answer
[DU-18N,13Ju] Mention the axial lines of upper
limb. [RU-09Ju,08Ju]
Axial line. The line along which the
each other, and across which the central dermatomes are buried
overlapping of the dermatomes is (missing) and distant dermatomes adjoin
Axial lines of upper limb: There minimal is called the axial line.
1 • The,anterior axial Une: It
are two axial lines: anterior and posterior axial line
extends
and along the front of the limb as from the sternal angle (of Louis) across the
far below as the wrist. second costal cartilage
2. The posterior axial Une: it
is believed to commence
curve across the scapula and then passes from the 7,h cervical spine, makes a gentle convex
down along the back of arm as far as the elbow.
|Ref- BDChaurasia/7'"/83l

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Chapter-07: Superior extremity -■
..
907
Q. What is preaxial and postaxial border?
Answer
preaxial and postaxial border: Each limb bud has a cephalic and caudal border, known as preaxial and
postaxial borders, respectively. In the upper limb, the thumb and radius lie along the preaxial border, and the
little finger and ulna along the postaxial border.
I Ref- B. D. Chaurasia /7"’ / 80]
Q. Give the clinical importance of dermatome of upper limb. [SUST-1 1 Ju,07J]
Answer
Clinical importance of dermatome of upper limb: In cases of paraplegia, the level of the spinal lesion can be
determined with the knowledge of dermatomes. The upper limit of sensory loss indicates the level of lesion.
|Ref- B. D. Chaurasia /7th /81 1

Venous drainage of upper limb

Q. Give the mode/ plan of venous drainage of upper limb. [DU-19N,17N,16N,15M, CU-18M,06Ju,
RU-19N,15Ju,l 1J, 08Ju]
Q. Write short note on: superficial veins of upper limb. [SUST-1 8M]
Q. Draw and label the superficial venous drainage of upper limb. [RU-1 5J, 1 3 J]
Answer
Venous drainage of upper limb: The venous drainage of upper limb is described below -
• Dorsal venous arch: It lies on the dorsum of the hand.
Afferent (tributaries):
1. Three dorsal metacarpal veins.
2. A dorsal digital vein from the medial side of the little finger.
3. A dorsal digital vein from the radial side of the index finger.
•4..Two dorsal digital veins from the thumb.
5. Most of the blood from the palm through veins passing around the margins of the hand &
also by perforating veins passing through the interosseous space.
Efferent: Cephalic & basilic veins after draining the dorsum of the hand & fingers.

• Cephalic vein: It is the pre-axial vein of the upper limb. It begins from the lateral end of the dorsal
venous arch. It terminates into the axillary vein.
• Basilic vein: It is the postaxial vein of the upper limb. It begins from the medial end of the dorsal
venous arch and drains into axillary vein. ,

* Median cubital vein: It is a large communicating vein, which shunts blood from the cephalic vein to
the basilic vein. It begins from the cephalic vein 2.5 cm below the bend of the elbow, runs obliquely
upwards and medially and ends in the basilic vein 2.5 cm above
the medial epicondyle. It is ideal for
intravenous injection.
Median vein of the forearm: It begins from the palmar venous network and ends in anyone of the
veins in front of the elbow. Sometimes
it divides into median cephalic & median basilic veins which
join the cephalic & basilic veins
respectively.

’Mt uflj . i '1‘li Nli

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"

Q. What is dorsal venous arch? Give its formation.

Q. Write short note on: Dorsal venous arch.
Answer
Dorsal venous arch:
The dorsal digital veins from the adjacent sides of
the fingers join in the interdigital clefts to form three dorsal
metacarpal veins which unite with each other and form a
dorsal venous network proximal to the metacarpal heads
known as dorsal venous arch.
• Its afferents (tributaries) include:
1) Three dorsal metacarpal veins.
'
2) A dorsal digital vein from medial side of the
little finger.
3) A dorsal digital vein from the radial side of
the index finger.
4) Two dorsal digital veins from the thumb.
5) Most of the blood from the palm through
veins passing around the margins of the
hand & also by perforating veins passing
through the interosseous space.
• Its efferents are:
1) Cephalic vein.
2) Basilic vein.
[Ref- B. D. Chaurasia/ 7,h /83]

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Chapter-07: Superior extremity 909
Q. Write briefly on: Formation, course & supply of cephalic vein. [DU-10J]
Q. Write short note on: Cephalic vein. [RU-I5M,I4.J]
Q. Give the formation, course & termination of cephalic vein. Write down the importance of
cephalic vein. [RU-05.1]
Answer
Cephalic vein:
Formation: It begins from the lateral end of the dorsal venous arch.
Course:
> It runs upwards through the roof of the anatomical snuffbox.
> It winds round the lateral border of the distal part of the forearm.
> Then it continues upwards in front of the elbow & along the lateral border of the biceps brachii.
fascia at the lower border of the pectoralis major muscle.
> It pierces the deep deltopectoral
> Then it runs in the groove upto the infraclavicular fossa, where it pierces the clavipectoral
fascia.
> At the elbow, the greater part of its blood is drained into the basilic vein through the median cubital
vein & partly also into the deep veins through the perforator veins.
Termination: It terminates into axillary vein.
Applied anatomy:
The cephalic vein frequently communicates with the external jugular vein by means of a small vein
which crosses in front of the clavicle. This vessels becomes considerably enlarged in cases of excision of the
breast for carcinoma, in which portion of axillary vein is also excised as it offers an efficient channel for venous
return from the limb.
[Ref- A.K Datta /3rd /26]

Q. Write short note on: Median cubital vein. [SUST-19M,15Ju,13J,l 1 J, CU-19N,15N]

Q. Give the clinical importance of median cubital vein. [DU-19N,17N,16N,14J,06J, CU-18N,16M,
15J,13Ju,10Ju, SUST-17M,15N,14J, 07J, RU-18M,15J,1 1 J, 05 JI
Q. Why median cubital vein preferred clinically. [CU-17M,
RU-13J] Basilic vein
Answer
Median cubital vein:
Median cubital
It is a large communicating vein, which shunts blood from the vein
cephalic vein to the basilic vein.
Accessory
Course: It begins from the cephalic vein 2.5 cm below the bend of the
elbow, runs obliquely upward and medially and ends in the basilic vein cephalic vein
2.5 cm above the medial epicondyle. - Median vein
Clinical importance: of forearm
The median cubital vein is the vein of choice for-
1. Intravenous injections.
2. Withdrawing blood from donors.
3. Blood transfusion.
4. Cardiac catheterization.
Figure: Median cubital vein

[Ref- B. D. Chaurasia / 7th / 84 + A. K. Datta / 3rd / 27|

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 _ endEA yoURA^TOMY^^
is<(,logically-
. „v/ 1.hist y Antecubital vein is preferred for site of
embryologically/ log
O Explain anatomically/
IV blood collection. [DU-I6M.U.
u, ( . „
embryologically/ h.stologicany Mc{iian cubital
, vein is preferred for
Q. Explain anatomically/
intravenous route. |DU-08.l] infusion. [DU-18N, lOJu, RU-08J]
cubital vein is the choice flot intravenous
Q. Why median

Median cubital vein is the choice for vein oi injection or site of intravenous (IV) blood
The median cubital vein is the
cnoiuu

collection, for three peculiarities of the vein:

1. It is superficial.

1 XSS
needle.
are fixed by the perforators and do not slip away during piercing by

[Ref- B. D. Chaurasia / 7th / 84 + A. K. Datta / 3rd / 27|

Q. What is venae comitantes? Give its function.

Answer
Venae comitantes: .
Medium sized deep arteries are often accompanied by two veins, one on each side is called venae comitantes.
Functions:
1 . They allow counter flow exchange of heat from artery to vein.
2. It helps in venous return.

Lymphatic drainage of upper limb * ‘

Q. Describe the lymphatic drainage of the upper limb.

Answer
Lymphatic drainage of upper limb:
Lymph nodes: The main lymph nodes of the
upper limb are the axillary lymph nodes, which - Lateral axillary
are scattered in the flbro-fatty tissue of the
axilla. They are divided into five groups: Supraclavicular
1 . Anterior or pectoral group
2. Posterior or subscapular group Apical
3.
3 Lateral or brachial group Anterior axillary
4. ' Central group and r®
5. • Apical group.
Centra/biliary:-
Other lymph nodes of the upper limb
I- 'Hie infraclavicular nodes
are: —
SI
Posterior axillary
2. Deltopectoral node
3. Superficial cubital or
supratrochlear nodes
Deltopectoral
4. A few other deep lymph
nodes. Supratrochlear
Areaof drainage of
A- Axillary lymph
chief lymph no(lev Figure: Lymphatic drainage of Upper limb
nodes:
from the major part of the
breast™^ ^°m UP^er anterior wall of the trunk &

the breast0^1
from the axillary tail1 of ^°ni Pos^er*01 wa" °F >he upper half of the trunk and
lymphatics accompanying
the cephahcvein6 W'10'e uPPer ^In'3 except the part drained by the

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Chapter-07: Superior extremity - 911
4) Central group: Receive lymph from the preceding groups.
5) Apical group: 1 hey receive lymphatics from upper and outer quadrant of the parenchyma of
the breast and the other groups of the axillary lymph nodes.
B. Other nodes:
1 ) infraclavicular nodes: They drain the upper part of the breast, and the thumb with its web.
2) Dcltopcctoral node: It lies in the dcltopectoral group along the cephalic vein & drains the
similar structures.
3) Superficial cubital nodes: Drain the ulnar side of the hand & forearm.
Lymphatics:
A. Superficial Lymphatics: Superficial lymphatics are much more numerous than the deep lymphatics.
They collect lymph from the skin and subcutaneous tissues. Most of them ultimately drain into the
axillary nodes, except for:
1) A few vessels from the medial side of the forearm which drain into the superficial cubital
nodes.
2) A few vessels from the lateral side of the forearm which drain into the deltopectoral or
infraclavicular nodes.
B peep Lymphatics: They drain structures lying deep to the deep fascia. They run along the main blood
vessels of the limb, and end in the axillary nodes. Some of the lymph may pass through the deep lymph
nodes present along the axillary vein as mentioned above.
Clinical importance:
1. Inflammation of lymph vessels is known as lymphangitis. In acute lymphangitis, the vessels may be
seen through the skin as red, tender (painful to touch) streaks.
2. Inflammation of lymph nodes is called lymphadenitis. It may be acute or chronic. The nodes enlarge
and become palpable and painful.
3. Obstruction to lymph vessels can result in accumulation of tissue fluid in areas of drainage. This is
called lymphoedema. This may be caused by carcinoma, infection with some parasites like filaria, or
because of surgical removal of lymph nodes. Filariasis in lower limb leads to increase in its size called
as elephantiasis.
[Ref- B. D. Chaurasia / 7* / 60, 85-86)

The shoulder / scapular region t

Q. What are the muscles of scapular region?
Answer
Muscles of scapular region:
The muscles of the scapular region are-
1. The deltoid.
2. The supraspinatus.
3. The infraspinatus.
4. The teres minor.
5. The subscapularis.
6. The teres major.

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 Q-
WmS
tabulated
O Write in a loim ti n nc„e sapply and action
of deltoid. [DU-17M.16N.15Ju.

I4J]
The de Hold
hl)Wnlo«|c.[DU-07Ju,06Ju,05Ju,CU-18N,l5J,l3/IOJu,08J,06J,
W
0. Write short note on: RU-09Ju]
SUST-1 8M, 1 5J.O8.Iu,
Answer
The deltoid muscle:

^^The anterior border of the lateral one-third

the clavicle.
of

o The lateral border of the acromion.

Lower lip of the crest of the spine of
the
3’
scapula.
Insertion: The deltoid tuberosity of the humerus.
Nerve Supply: Axillary nerve (C5, C6).
Actions:
1 . The acromial fibres are powerful abductors of
the arm at the shoulder joint from 1 5°- 90°.
2. The anterior fibres are flexors and medial
rotators of the arm.
3. The posterior fibres are extensors and lateral
rotators of the arm.
Figure: Deldoid muscle.

[Ref- B.D. Chaurasia 1 7th 1 70,71[

Q. Which part of deltoid muscle is preferred for intramuscular injection and why? [DU- 1 5 J]
Q. Explain anatomically - Intramuscular injection is given preferably in
lower part of the
deltoid muscle. [DU-19N,12J,08Ju,07J]
Answer
Intramuscularinjection is given preferably in lower part
of the deltoid muscle-
is given £ T""T °f S°> any 1"^as^lar injection in the shoulder
X^iiZS ,0 inSerti°n to avoid to Axillary nerve and its
[Ref- B.D. Chaurasia / 7,h / 72|
attaChments of muscles of scapular region.
Answer
Scapular muscles: The muscles of the scapular
region
8 are the6
teres minor, the subscapularis, and the
teres major t0’d’ supraspinatus, the infraspinatus, the
Attachments of muscles of scapular region:
Muscle
Deltoid -
Please see above, -
'
Insertion into
Supraspinatus Please see above.
Medial two-thirds
fossa of the scapula orih^^i^ Upper impression of the greater
Infraspinatus
fossa of the scapula.
— tubercle of the humerus
Middle impression on the greater
Teres minor Upper two-thirds of the dorsal
surf^?
of the lateral border of the scapula
— tubercle of the humerus ’

Lowest impression on the greater

— tubercle of the humerus

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 Chapter-07; Superior extremity 913
| Muscle Origin from ' • Insertion into
Subsea puhir is Medial two-thirds of the subscapular Lesser tubercle of the humerus
fossa
Teres major Lower one-third of the dorsal surface Medial lip of the bicipital groove of
of lateral border and inferior angle of the humerus
1hc scapula

Suprascapular notch

Cut edge
of deltoid
Cut edge
of trapezius
minor
Surgical neck of humerus
Triangular Medial lip of
space intertubercular sulcus
Quadrangular space

Teres major interval

Long head, of
biceps brachii
Cut edge of
lateral head of
biceps brachii

Figure: Muscles of scapular region.

Nerve supply and actions of muscles of scapular region;
Muscle
Deltoid
Nerve supply
Please see above.
wM
Please see above.
Adons
Supraspinatus Suprascapular nerve (C5, C6) . The supraspinatus initiates abduction of the arm and
carries it up to 15°.
1. Along with other short scapular muscles it steadies
he head of the humerus during movements of the arm,
<>o that the latter
does not slip out of the glenoid cavity.
Infraspinatus Suprascapular nerve (C5, C6) . Lateral rotator of arm.
-• See supraspinatus.
Teres minor Axillary nerve (C5, C6) Same as infraspinatus.
Subscapularis Upper and lower subscapular Medial rotator and adductor of arm.
nerves
Teres major Lower subscapular nerve Same as subscapularis.

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 ENDEA. --
214 formed? [DU- 1 1 J] Give its importance.

Q. Write short note on: Mnneulotendmons

Acromion
Answer
Rotator cuff: ,
_ ,.„
by
Coracoacromial ligament
This is fibrous sheath formed the
blend with
four flattened tendons whichstrengthen it.
Coracoid process
capsule of shoulder joint & Subacromial bursa
Components: The muscles which
form the
cuff arise from the scapula and arc inserted Supraspinatus
tubercles of the
into the lesser and greater Subscapularis
humerus. They are-
1) Subscapularis. Infraspinatus
2) Supraspinatus.
3) Infraspinatus. Teres minor
4) Teres minor.
These tendons, while crossing the shoulder
Glenoid cavity
joint blend with each other and with capsule Glenoid labrum
of the joint and finally reach their points of
insertion. Sinovial fluid
Importance:
Capsule of
The rotator cuff gives strength to the shoulder joint
capsule all around except inferiorly where it
is dislocated usually. Figure: The musculotendinous (Rotator) cuff of shoulder
[Ref- B.D. Chaurasia / 7,h / 73, 74|
Q. Mention the origin, insertion, nerve supply and action of the muscles of musculotendinous
cuff/ rotator cuff. [SUST-05Ju, RU-15N, CU-15M]
Q. Give the nerve supply of structures forming rotator cuff. [DU-1 1 J, RU-1 6N]
Q. Give the origin, insertion, nerve supply and action of the supraspinatus muscle. [DU-10J]
Answer
Muscles of musculotendinous cuff / rotator cuff:
I) Subscapularis.
2) Supraspinatus.
3) Infraspinatus.
4) Teresminor. ’

Origin, insertion, nerve supply & action; Please see

above
Q. Write short note on: Subacromial bursa.
Answer
Subacromial bursa:
deltoid muscle^0"1'3' burSa °f the « below the eoracoacromial arch and the
Importance:

2) 11 protects the supraspinatus Undon^gainst friction with th shouWerioint-

facilitated by the presence of this bursa. passes under the acromion. This is

|Ref- B.D. Chaurasia / 7lh / 74|

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 i

Chapter-07: Superior extremity

915
Q. Give the formation and distribution of axillary nerve or circumflex nerve.
[SUST-O6J11]
Q. What are the effects of injury to the axillary nerve at the shoulder?
Answer
Axillary ncnc:
Axillary or circumflex nerve is called axillary nerve as it runs through the upper part of
axilla though it
does not supply any structure there. It is used to be called circumflex as it goes found the surgical neck of
humerus.
Origin:
It is a branch of posterior cord of the brachial plexus.
Root value:
Ventral rami of C5 & C6 segments of spinal cord.

Branches & distribution:

1 . Muscular branches: To the deltoid & the teres minor.
2. Cutaneous branch: upper lateral cutaneous nerve of arm to the skin over the lower half of the deltoid.
3. Articular branch: To the shoulder joint.
4. Vascular branch: Supplies the posterior circumflex humeral artery.
Effects of injury to the axillary nerve at the shoulder: The axillary nerve may be damaged by dislocation of
the shoulder or by the fracture of the surgical neck of the humerus. The effects are-
1 . Paralysis of deltoid muscle.
2. The rounded contour of the shoulder is lost.
3. Loss of the power of abduction at the shoulder. -i . :
4. Greater tubercle of the humerus becomes prominent.
5. There is sensory loss over the lower half of the deltoid.

- r: ! ;
[Ref- B.D. Chaurasia / 7th 1 75]

Q. Mention the clinical importance of axillary nerve. [SUST-13Ju]

Q. Explain anatomically- Why/how axillary nerve injury causes loss of abduction of shoulder
joint. [DU-1 1J]
Q. Explain on anatomical background- In fracture surgical neck of humerus, abduction of
shoulder is not possible. [CU-12Ju]
Answer L -
Axillary nerve injury causes loss of abduction of shoulder joint:
Injury to the axillary nerve due to fracture of the surgical neck of the humerus or by dislocation of the
shoulder results in paralysis of deltoid muscle with loss of the power of abduction of shoulder from 15°-90°.

Q. Where intramuscular injection is given in the upper limb usually and why?
Answer - > . .

Intramuscular injections are usually given into the deltoid in the upper limb. They should be given in
the lower half of the muscle to avoid injury to the axillary nerve.
Q. Give the steps of dissection of quadrangular and triangular spaces.
Mention their boundary
and contents. [RU-14Ju,06Ju]
Q. Write short note on: Quadrangular space.
[R.U-13J,08Ju]
Q. Give the boundaries & contents of triangular spaces.
How will you identify teres minor
muscle?
Answer
Steps of dissection of quadrangular & triangular spaces:
1) Skin incisions:
a) A longitudinal incision from the inferior angle of the scapula to the tip of the acromion.
b) Another incision from the tip of the acromion laterally to the arm about 2.5 inches.
2) Then the superficial & deep fasciae are separately reflected as that of skin.
3) Posterior border of deltoid is retracted upwards.

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 FNOFAVOUR ANATOMY FOR WRITTEN
(S^MCQ) & nyA
91«
Triceps are cleaned.
4) Then, lateral & medial margins of long head of
5) Upper margin of teres major is cleaned.
6) Lower margin of teres minor is cleaned.
are studied.
7) Then the contents of quadrangular & triangular spaces
Quadrangular space;
Boundaries: . .
minor, Subscapularis and the capsule of shoulder joint.
• Above: Teres
major.
• Relow: Upper border of teres
of humerus.
• Laterally: Surgical neck long head of triceps.
• Medially: Lateral border of
Contents: I
a) Axillary nerve.
b) Posterior circumflex humeral vessels.
Triangular space:
a) Upper Triangular Space:
Boundaries:
• Medial: Teres minor.
• Lateral: Long head of the triceps.
• Inferior: Teres major.
Contents: Circumflex scapular artery. It interrupts the origin of the teres minor and
infraspinous fossa for anastomosis with the suprascapular artery. reaches the
b) Lower Triangular Space:
Boundaries:
• Medial: Long head of the triceps.
• Lateral: Medial border of humerus.
• Superior: Teres major. '
? .

Contents; "
. .

i. Radial nerve.
ii. Profunda brachii vessels.
Identification of the teres minor muscle:
JhX^n"’' T* m“Scle?y
Which is a branch of axillary nerve,
which seeing its nerve supply-
The gang!ion is produced by local bear a pseudoganglion.
Because ,he nCTve >0 teres
thickening of connective tissue.

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 Chapter-07: Superior extremity - 917

Suprascapular foramen

Quadrangular- -Subscapularis
space Triangular space
Triangular -Teres major
interval

Long head of
biceps brack it

Latissimus dorsi

Figure: Quadrangular & triangular spaces.

Q. Describe the arterial anastomosis around the scapula.

Answer
Anastomosis around the body of the scapula:
The anastomosis occurs in the three fossae, subscapular, supraspinous and infraspinous. It is formed by:
1 . The suprascapular artery, a branch of the thyrocervical trunk;
2. The deep branch of the transverse cervical artery, another branch of the thyrocervical trunk;
3. The circumflex scapular artery, a branch of the subscapular artery which arises from the third
part of the axillary artery.
It is to be noted that, this is an anastomosis between the first part of the subclavian artery and the third
part of the axillary artery.
Anastomosis over the acromion process:
It is formed by:
I . The acromial branch of the thoracoacromial artery;
2. The acromial branch of the suprascapular artery; and
3. The acromial branch of the posterior circumflex humeral artery.
It is to be noted that, this also is an anastomosis between the first part of the subclavian artery and the
third part of the axillary artery.

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 a*
(SAQ, MCQ) &
918 ENDEA VOUR ANA TOMY FOR WRITTEN

The arm
Q. What arc the compartments of arm?
Compartments of the arm:
The ami is divided into two compartments
by extension of deep fascia which is called the medial and
lateral intermuscular septa. They are:
a) Anterior compartment.
b) Posterior compartment.

Q. Name the muscles of the arm with their origin, insertion, nerve supply & action. [DU-06Ju,
SUST-O6J11]
Q. Write in a tabulated form the origin, insertion, nerve supply & actions of biceps brachii. [DU-
"
!S/l5N,14Ju] ' •

Q. Give the origin, insertion, nerve supply & action of the following muscles.
a) Biceps brachii. [DU-12Ju,10J,06Ju,05Ju/J, SUST-15M,09J,06J, CU-I9M,17N,I6M,14J,13J
10Ju,05J]
b) Brachialis. [CU- 1 3J, 1 2Ju, 1 1 Ju, 1 0Ju,08J]
Q. Give the origin, insertion, nerve supply & action of the triceps brachii muscle. [DU-19M
1 6N/M, 1 5 J, 1 3 J, 1 1 Ju, 09Ju,07Ju]
Answer
Muscles of the arm;

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Chapter-07: Superior extremity
919
A. Muscles of the front of the arm:

Muscles Origin Insertion Nerve supply Action

Coracobrachialis Tip of the coracoid The middle 5 cm Musculo¬ 7lexes the forearm at the
process of scapula of the medial cutaneous nerve elbow joint.
with the short head of border of the (C5-C7).
biceps. humerus.
Biceps brachii Short head: From the Posterior rough Musculo¬ a) It is a strong
tip of the coracoid part of the radial cutaneous nerve supinator when the
process of scapula. tuberosity. (C5-C6). forearm is flexed.
Long head: From the All screwing
movements are done
supraglenoid tubercle
of the scapula & from with it.
b) Flexor of the elbow.
the glenoidal labrum.
c) The short head is a
flexor of the arm.
d) The long head
prevents upward
displacement of the
head of the
humerus.
e) It can be tested
against resistance.
Brachialis • Front of the lower • Ulnar tuberosity • Musculo¬ Flexes forearm at the
half of the humerus, • Rough anterior cutaneous nerve elbow joint.
including the surface of the is motor.
anteromedial & coronoid process • Radial nerve is
anterolateral of the ulna. proprioceptive.
surfaces and the
anterior border.
• Medial & lateral
intermuscular scpU.

Figure: Muscles of front of the arm.

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 ENDEAVOUR ANATOMY FOR WRITTEN (SAQ, MCQ) & yjy.

Muscles of the back of the arm:

Nerve . •
^^"1
Origin Insertion Action
Muscle supply - -- '

Triceps • Long head: From the Posterior part o r Radial a) Powerful extensor of
Brachii infraglcnoid tubercle of the the superior nerve. the elbow joint.
muscle scapula. surface of the b) Long head supports
olecranon the head of the
• Lateral heads: From an process. humerus in the
oblique ridge on the upper
pail of the posterior surface abducted position of
of the humerus, the arm.
corresponding to the lateral
lip of the radial (spiral)
groove.
• Medial head: From a large
triangular area on the
posterior surface of the
humerus below the radial
groove, as well as from the
medial and lateral
fibromuscular septa.
[Ref- BD Chaurasia / 7th / 99,100]

Lateral head of triceps brachii—

Radial groove of humerus W
—
Long head of triceps brachii
Medial head of triceps brachii.
W
o
— -

Lateral head of triceps

brachii -
Olecranon •

FigUre: Triceps
brachii muscle.

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Chapter-07: Superior extremity
921
ana,omica">'- W"y brachtalis is called composite / hybrM muscle?
Brachialis is called composite / hybrid muscle:
supply Ji?86 ufby h^11’31'5’
given
motor supp!y is given by musculocutaneous nerve and sensory or proprioceptive
radial nerve. So. due to having double nerve supply, brachialis is called composite hybrid
/ 7
muscle.

Q. Write short note on: Bicipital aponeurosis. [R.U-15N]

Answer
Bicipital aponeurosis: ;
It is an aponeurotic band given off from the
medial side of tendon of biceps at the level of the
bend of the elbow. It passes obliquely downwards &
medially across the brachial artery.
Biceps brachii
Importance of bicipital aponeurosis:
a. It separates the brachial artery from the
median cubital vein and protects the artery
from mistaken introduction of irritating drugs
which should have been injected into the Brachioradialis
vein. Bicipital
b. It encloses the median nerve and separates it
from ulnar artery. aponeurosis
- Pronator teres

Figure: Bicipital aponeurosis.

[Ref- B.D. Chaurasia / 7,h / 91, 92[

Q. Give the origin, extension, termination and branches of brachial artery.

Q. Write short note on: Brachial artery. [SUST-18M]
Answer
Brachial artery:
Origin:
Brachial artery is the continuation of the axillary artery. £
elbow, at the level
It extends from the lower border of the teres major muscle to a point in front of the
of the neck of the radius, just medial to the tendon of the biceps brachii.
Termination:
It terminates by dividing into radial and ulnar artery.
Branches:
1) Unnamed muscular branches.
2) The profunda brachii artery.
3) The superior ulnar collateral branch.
4) A nutrient artery to the humerus.
5) The inferior ulnar collateral (or supratrochlear) branch.
6) Two terminal branches, the radial and ulnar arteries.

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 (SAO, MCO)^^
FOR WRITTEN
ENDEAVOUR ANATOMY
922

Hillary artery

Anterior circumflex humeral

artery
artery
Anterior circumflex humeral

Profunda brachii artery

Nutrient artery
Brachial artery
Superior ulnar collateral artery
Radial collateral artery
Middle collateral artery
Inferior ulnar collateral artery
Interosseous recurrent artery
Radial recurrent artery
Anterior ulnar recurrent artery
Radial artery Posterior ulnar recurrent artery
Common interosseous artery
Posterior interosseous artery
Anterior interosseous artery
Ulnar artery

Figure: Brachial artery, its branches and anastomosis around elbow joint.
[Ref- B D Chaurasia / 7*h / 94,95|
Q. Explain why- Brachial artery is clinically important. [DU-1 lJu, 06Ju]
Answer
Clinical importance of arteries of upper limb:
• Brachial pulsations are felt or auscultated in front of elbow just medial to biceps tendon during
recording the blood pressure.
• This is a useful site at which to pass an arterial catheter for coronary angiography or cardiac
catheterization.
• Damage to or pressure on the brachial artery due to. fracture of the distal end of humerus or fractures of
the radius and ulna leading to Volkmann's ischemic contracture (in
and the extensor muscles reduced so that they undergo which the arterial flow to the flexor
ischemic necrosis).
|Ref- Gray / 4O‘h / 787 + Snell / 8th / 446, 483|

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Chapter-07: Superior extremity — 923

Q. Write down the arterial anastomosis around the elbow joint. [SUST-15Ju,08Ju, RU-06J]
q Draw and label the arterial anastomosis around the elbow joint.
Answer
Anastomosis around the elbow joint:
Anastomosis around the elbow joint links the brachial artery with the upper ends of the radial and ulnar
"

arteries.
Function: It supplies the ligaments and bones of the joint.
Subdivisions:
The anastomosis can be subdivided into the following parts:
Z /n front of the lateral epicondyle of the humerus: The anterior descending (radial collateral)
branch of the profunda brachii anastomose with the radial recurrent branch of the radial artery.
Z Behind the lateral epicondyle of the humerus’. The posterior descending branch of the
profunda brachii artery (above) anastomoses with the interosseous recurrent branch of the
posterior interosseous artery (below).
Z In front of the medial epicondyle of the humerus: The inferior ulnar collateral branch of the
brachial artery, and occasionally a branch from the superior ulnar collateral artery (above),
anastomoses with the anterior ulnar recurrent branch of the ulnar artery (below).
Z Behind the medial epicondyle of the humerus’. The superior ulnar collateral branch of the
brachial artery (above) anastomoses with the posterior ulnar recurrent branch of the ulnar
artery, and a branch from the inferior ulnar collateral artery (from the medial side).

Anterior
descending branch— ii — Brachial artery
Superior ulnar
collateral artery
Posterior Ci

descending branch—
Supratrochlear
artery
rl
fl

Radial Anterior ulnar

recurrent artery :
recurrent artery
Interosseous Posterior ulnar
recurrent artery recurrent artery
Posterior
interosseous artery
Radial artery . Ulnar artery

Figure: Anastomosis around elbow joint

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Q. Give the area of innervations by musculocutaneous nerve of brachial plexus. [CU-08J]
Q. Name the muscles supplied by the musculocutaneous nerve. [CU-09Ju]
Answer
Area of innervations by musculocutaneous nerve of brachial plexus:
1. Muscular branches: Coracobrachialis, long head of biceps brachii; short head of biceps brachii a nd
brachialis.
2. Cutaneous branches: Lateral side of forearm both on front and the back.
3. Articular branches: Elbow joint.

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Chapter-07: Superior extremity — 925

Q. Write short note on: Radial nerve. [DU-1 1 J]

Q. Describe the course, branches & distributions of radial nerve. [DU-17N,13Ju, SUST-llJu]
Answer
Radial nen e:
Radial nerve is the largest branch of the Lower part of posterior
posterior cord of the brachial plexus with a root cord or brachial plexus
value of C5-C8. 1 i. Axillary nerve Radial nerve
Long head and posterior
Branches & distribution: The radial nerve cutaneous nerve of arm
presents four types of branches- muscular, Upper lateral cutaneous Medial head
cutaneous, articular and vascular. nerve of arm
A. Branches in the axilla: Lateral hea
1 . A branch to the long head of
triceps.
2. A branch to the medial head of '
Medial head
triceps. Brachioradialis and
3. Posterior cutaneous nerve of the extensor carpi
carpt y
radialis longus If \
—* ^-Anconeus
arm: supplies the skin of the rY Brachialis
dorsal surface of the arm upto the Extensor carpi
olecranon process. radialis brevis
B. Branches in the spiral groove:
1 . Muscular branches: supply Superficial branch
lateral and medial heads of Deep branch
triceps.
2. Posterior cutaneous branch of
the forearm: supply the skin of
the dorsal surface of forearm as
far as the wrist.
3. Lower lateral cutaneous nerve of
the arm: supply the skin of the
lateral side of the lower half of the
arm.

Figure: Radial nerve.

C. Branches in the lower part of arm: These are all muscular branches and supply-
1. Brachioradialis.
2. Extensor carpi radialis longus.
3. Lateral part of the brachialis.
D- Superficial terminal branch: Subsequently it divides usually into five dorsal digital nerves to supply-
1 . The lateral two-thirds of the dorsum of hand and
2. The dorsal aspect of lateral three and a half of digits till distal interphalangeal joints.
E. Deep terminal branch:
• Th? short branches: supply the extensor digitorum, extensor digiti minimi and extensor carpi
' ulnaris.
2' The long branches: with lateral and medial divisions supply the abductor pollicis longus and
extensor pollicis brevis; extensor pollicis longus and extensor indicis.
|Ref- A.K. Datta / 3rd / 105-106 + B.D. Chaurasia / 7'" / 101 ]

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 e^eavour^at^ *
926
For more curiosity!
of distribution of , musc|es of arm and forearm, and the skin on the dorsal aspect of
Summery ,he d°re“m of ,he
,he ,a,eral ,wo ,hirds °f "ani
thc
of the posterior cord and passes downward
CoBSS > hPPins in the axilla as a continuation muscles of posterior wall of axilla.
SX£
...VP

part auxiliary artery i" front ofthe

teres major, medially by
space which is bounded above by the
. II to es the axilla throueh
the long head of triceps and
a Iriansular
laterally by the shaft of humerus.
, The nerve along with arteria profunda brachii
enters the spiral groove on the dorsal surface of the
and laterally along the
heads of the triceps, and run downwards
humerus between the long and medial of triceps.
groove in between the lateral and medial heads of lower arm
septum and inters the anterior compartment
• It pierces the lateral intermuscular about I cm lateral to biceps tendon, the nerve divides into
• On reaching the front of lateral epicondyle
superficial and deep terminal branches.
downward along the lateral side of forearm
• The superficial branch of radial nerve passes straight forearm. Subsequently it divides usually into
accompanied by radial artery in the upper two-thirds of
five dorsal digital nerves to supply the lateral two-thirds of the dorsum of hand
and the dorsal aspect of
lateral three and a half of digits till distal interphaiangeal joints.
• The deep branch appears in the posterior compartment of forearm, after passing between the superficial
and deep strata of fibers of supinator muscle. In the back of the forearm the nerve divides into three
short and two long branches. The long branches subdivide into lateral and medial divisions. Finally the
nerve ends in a terminal pseudo-ganglion at the back of the wrist and supplies the neighboring joints.]

Q. Give the applied anatomy of radial nerve.

Answer
Applied anatomy of radial nerve:
The radial nerve is very commonly damaged in the radial groove.
Common causes of injury of radial nerve:
1. Intramuscular injections in the arm (triceps).
2. Sleeping in an arm-chair with the limb hanging by the side of the chair
the pressure by a crutch (crutch paralysis).
(Saturday night palsy), or even
3. Fractures of the shaft of the humerus.
Effects of injury of radial nerve:
1 . Weakness or loss of power of extension at the wrist (wrist
2. Sensory loss over a narrow strip on the back of
drop)
hand. the’forearm & on the lateral side of the dorsum of the

[Ref- B.D. Chaurasia / 7th / 101[

Q. What is Saturday night palsy?
Answer
Saturday night palsy:
Compression of the radial nerve against
chair under drunken condition may the spiral groove by placing the
be associated outstretched arm on an arm¬
with temporary radial nerve palsy.
night palsy. Saturday
r J This is known as

[Ref- A.K. Datta/ 3rd /1061

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Chapter-07: Superior extremity -
Q. What is wrist drop? [CU-17N, I5M,14J,13J, 1 Uu, 10Ju,08J, SUST-19/18N 17M 15N 1 1 Ju 08J
07J, 06J. RU-17N,12Ju,09J,06J]
Q. Write short note on: Wrist drop? [SUST-08Ju]
Q. What do yon mean by wrist drop? [RU-l5Ju,13J]
Answer
Wrist drop:
It is a clinical condition characterized by inability to extend the
wrist joint and the fingers with flexion of wrist due to damage of the radial
nerve. Wrist drop, or flexion of the wrist, occurs as a result of the action of
the unopposed flexor muscles of the wrist.
Causes: The common causes are-
1 . Displacement of humerus.
2. Crutch pressing the axilla.
3. Fall on the arm.
4. Intramuscular injections in the arm (triceps).
5. Fractures of the shaft of the humerus.
6. Prolonged application of a tourniquet to the arm.
Disability: A patient with wrist drop is unable to flex the fingers strongly
for the purpose of firmly gripping an object with the wrist fully flexed. Figure: Wrist drop.
[Ref- Snell / 8th 1 537 + B.D. Chaurasia / 7,h I 1 03|

Q. Explain anatomically- Wrist drop is a consequence of radial nerve injury. [RU-19M, DU-
lOJu]
Q. Mention the effects of radial nerve injury at the radial groove of humerus. [DU- 15N]
Q. Explain developmentally/anatomically- Why radial nerve palsy leads to wrist drop? [DU-
17N, 14J]
Q. Explain anatomically- Why radial nerve injury causes wrist drop. [DU-09J]
Answer
Radial nerve injury causes wrist drop:
When the radial nerve in injured the long extensors of the wrist are paralyzed. Patient is unable to
extend the wrist joint. Wrist drop occurs as a result of action of the unopposed flexor muscles of the wrist. The
wrists are permanently in fully flexed position and fingers are unable to grip any object.
|Ref- Snell /8th/ 537 1

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 Ci

(SAO,
928 WEAVOVR ANATOMY FOR mUTTEN
Cubital fossa
and contents of cubital fossa. [DU-17M,12J,08Ju,06J
Q. Give the steps of dissection, boundaries ’ ’
RU-18M, 1 7M, I4J,08Ju, SUST-15N,09Ju/J,07J,06Ju]
fossa with its content. [DU-14J, RU-15J]
Q. Mention the steps of dissection of cubital
Q. Draw and label boundary and contents of
cubital fossa. [CU-19N, DU-15M, SUST-14J]
Q. Mcntion/give the boundary and contents of the
cubital fossa. [DU-1 1 J, 10J,08Ju,06J’ CU 15\/i
13Ju. I U,09Ju, SUST-18N, I7M, 15J, 14Ju, 13J, 1 IJ, RU-13J]
Answer
Cubital fossa: Cubital fossa is a triangular hollow situated on
the front of the elbow.
Steps of dissection:
Skin incision:
a. A transverse incision in front of the elbow joint
connecting the two epicondyles of humerus. Base of
b. Another transverse incision at the junction of "cubital fossa
upper 1 /3 rd & lower 2/3 rds of the front of the
forearm. Cubital fossa
c. A vertical incision connecting the midpoints of Pronator teres
first & second incisions.
2. Then the superficial fascia is reflected by preserving Brachioradialis
the cutaneous structures.
The lower end of bicipital aponeurosis is separated
from deep fascia & reflects upwards. Apex of
4. Then the deep fascia is reflected as that of skin. cubital fossa
5. Then the contents of the cubital fossa are studied.
Boundaries: Figure: Boundary of cubital fossa
Apex: It is directed downwards & is formed by
the
meeting point of the brachioradialis & pronator
teres.
2. Base: It is directed upwards and is formed by an
Biceps brachii
imaginary line joining the two epicondyles of
humerus. Radial nerve
3. Medially: Lateral border of pronator teres.
4. Laterally: Medial border of the
Brachial artery
5. Root: By-
brachioradialis.
Median nerve
•
Skin.
•
Superficial fascia.
X Brachioradialis
• Deep fascia.
• Bicipital aponeurosis. Pronator teres
6. Floor: It is formed by brachialis
& supinator muscles.
Contents: aponeurosis
Median nerve.
Termination of the brachial artery. Figure: Contents of cubital fossa.
> The beginning of the radial & ulnar
arteries.
> The tendon of the biceps.
> The radial nerve.
> Venae comitances of arteries.
> Fat.

[Ref- B.D. Chaurasia / 7,h / 97,991

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 •uuuamfaiim^

Chapter-07: Superior extremity

929
"
Q^e im|>°r‘"nCC "Pl’,ic‘l “n”,omy »f
' cubital fossa. [suST-OSJo]
Applied anatamy oXcubltal fossa: The cubital fossa is important for the following
VC'" IS ",C V0'n °f Ch°iK fM reasons -
’• blood and cardiac
L
SC“ ^^118 the braChii"
c. In fracture of the elbow the anatomy of the cubital fossa is useful.
in f™"‘ of ‘he elbow in the

[Ref- B.D. Chaurasia / 7,h / 97-99|

Forearm & hand

Front of the forearm and Hand
Q. What are the components of the front of the forearm?
Answer
Components of the front of the forearm:
The front of the forearm presents the following components for study.
1 . Eight muscles: five superficial and three deep.
2. Two arteries: radial and ulnar.
3. Three nerves: median, ulnar and radial.

Q. Name the muscles of the front of the forearm with their nerve supply & action. [SUST-07Ju]: :
? '■ ;
Answer ’ '

Muscles of the front of the forearm with their nerve supply & action:
The muscles of the front of the forearm may be divided into superficial and deep groups.
Superficial muscles:
There are 5 muscles in the superficial group. These are-
Muscles Nerves. .

Median nerve
- Action 1 --
1. Pronator teres • It is the main pronator of forearm.
• It also flexes the elbow.
2. Flexor carpi radialis Median nerve • Flexor and abductor of the wrist
3. Palmaris longus Median nerve • It flexes the wrist & makes the palmar aponeurosis
tense
4. Flexor carpi ulnaris Ulnar nerve • Flexor of the wrist.
• Adductor of the wrist.
• Fixes the pisiform bone during contraction of the
hypothenar muscles;
5. Flexor digitorum Median nerve • Main flexor of the proximal interphalangeal joints.
superficialis • It may also flex the metacarpophalangeal & wrist
joints. . -
—

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 (SAQ, MCQ) & Viy^
ANATOMY FOR WRITTEN
ENDEAVOUR
Deep muscles; deep group. 1hese arc-
There arc 3 muscles in the Action
] Nerve supply Flexor of distal phalanges.
Muscles
half by ulnar nerve.
•
/. Flexor digitoruni • Medial half • It is the chief gripping muscle.
by anterior interosseous
profundus • Lateralof median nerve.
branch
interosseous branch of median • Flexor of distal phalanx oTthe
2. Flexor pollids • Anterior thumb.
nerve. Superficial fibers pronate the
longus
Anterior interosseous branch of median •
1 S. Pronator quadratus • forearm.
nerve. Deep fibers bind the lower ends
•
of radius and ulna.
{Ref- BD Chaurasia / 7,h / 107-108)

® A FHumeral head Mik1 1“ of .. , head

.

(Ro Hcu™ral
Ulnar artery pronator teres Ulnar head
.
1
/
i
Radial artery
Pronator teres
—Flexor carpi
mdialis
।

^rnaris lonaus 7- Mmg

Hexor carpi
OlFlh®l
radialis
If K -Sl^
'

11
r-<
fefeMl'f
carpi ulnaris U J W
।

1
/ 1ri /Ei/w
if P F-T-/ W

RWo/ 1
1 11 1
1

/w.

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 Chapter-07:

Figure: Deep muscles of anterior compartment of forearm.

Q. Mention the flexor of the elbow joint with their origin, insertion and nerve supply. [RU-1 1 Ju]
Q. Mention the insertion, nerve supply and actions of flexor digitorum superficialis. [CU-15Ju,
12Ju]
Q. Give the origin and insertion, nerve supply and actions of flexor digitorum profundus. [DU-
1 Uu, CU-14J, I3J,1 Uu, SUST-14Ju]
Q. Give the origin and insertion of the muscles of the front of the forearm.
Answer : '
- -
\
Attachment of the muscles of the front of the forearm/ flexor of forearm:
Superficial muscles:

Muscles . r:. Origin

1. Pronator teres 1 . Humeral head: from the medial Middle one-third of the lateral
epicondyle of the humerus (common surface of the shaft of the
flexor origin). radius.
2. Ulnar head or deep head: from the
medial margin of the coronoid process of . i
.
the ulna.
2. Flexor carpi radialis From the medial epicondyle of the Into palmar surface of the
humerus (common flexor origin). bases of the second and third
metacarpal bones. s ,

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 yOURANATOM^F^^
932 — — ——— —
T
'
tt-”-
Origin
~ ~~
'■ 1
; . .
Insertion-
.
•

,'■ 1
?

Muscles Distal half of flexor

3. Paimaris longus Medial epicondyle of the humeius retinaculum and the apex of the
(common flexor origin). palmar aponeurosis.
4, Flexor carpi ulnaris 1 Humeral head from the medial the pisiform bone.
epicondyle of the humerus (common
flexor origin). .
2. Ulnar head from the medial margin or
the olecranon and by an aponeurosis
from the posterior border of the ulna.
1. Humeroulnar head: from the medial The muscle ends in four tendons,
5. Flexor digitorum one each for the medial four
superflcialis epicondyle of the humerus, the ulnar
collateral ligament, and a tubercle on the digits. Opposite the proximal
medial border of the coronoid process of phalanx the tendon for each digit
ulna. splits into medial and lateral
2. The radial head: arises from the slips which are inserted on the
anterior border of the radius up to the corresponding sides of the
insertion of the pronator teres. middle phalanx.
3. Some fibres arise from fibrous arch
passing from the ulna to the radius and
connecting the two heads. The median
nerve and the ulnar artery pass deep to
this arch.
Deep muscles:

1. Flexor digitorum i.
Upper three-fourths of the anterior and
profundus medial surface of the shaft of ulna.
> The muscle forms 4 tendons
for the media 4 digits which
ii. Upper three-fourths of the posterior enter the palm by passing deep
border of ulna. to the flexor retinaculum.
iii. Medial surface of the olecranon and > Opposite the proximal phalanx
coronoid processes of ulna. of the corresponding digit the
iv. Adjoining part of the anterior surface
tendon perforates the tendon
of the interosseous membrane.
of the flexor digitorum
superficialis.
'
? •
’
• ( '• . , •
Each tendon is inserted on the
palmar surface of the base of
2. Flexor pollicis longus Upper three-fourths of the anterior
surface ofthe shaft of radius. •
• The tendon enters the palm by
ii. Adjoining part of the anterior passing deep to the flexor . /
surface retinaculum.
ofthe interosseous membrane.
• It is inserted into the palmar
surface of the distal phalanx oi
3. Pronator quadratus Oblique ridge on the lower
one-fourth
anterior surface ofthe shaft of ulna, of Superficial fibres into the
the area medial to it. and lower one-fourth of the
anterior surface and the
anterior border of the radius.
Deep fibres into the triangular
area above the ulnar notchy .
z [Ref- BD Chaurasia / 7th / 107-108J
Nerve supply: Please see above.

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 Chapter-07: Superior extremity
— 933

Answer^ ”°tC

Please see above.

Musc,cs’ bIood vcssds and nerves of forearm. [SUST-15N]

Answe^*1'11 ana^om*ca"y- Why flexor digitorum profundus is called composite/ hybrid muscle?
Flexor digitorum profundus is called composite/ hybrid muscle:
. .Fl.^Ordlg’t>°™m profundus is a muscle of deep group of front or anterior compartment of forearm. Its
medial halt is supplied by ulnar nerve and lateral half is supplied by median nerve.
So, due to having double nerve supply, flexor digitorum profundus
is called composite / hybrid muscle.
Q. Explain double nerve supply of a muscle of upper limb. [RU-1 1 Ju]
Answer
Double nerve supply of a muscle of upper limb:
In the upper limb there are two muscles- brachialis and flexor digitorum profundus having double nerve
supply.
In case of brachialis, motor supply is given by musculocutaneous nerve and sensory or proprioceptive
supply is given by radial nerve. On the other hand, medial half of flexor digitorum profundus is supplied by
ulnar nerve and lateral half is supplied by median nerve.
So, due to having double nerve supply, brachialis and flexor digitorum profundus are called composite /
hybrid muscle.

Q. Give the origin, course, termination and clinical importance of radial artery. [DU-12Ju, RU-
15N, SUST-16M]
Q. Give the commencement, termination and clinical importance of radial artery. [RU-07Ju,05J,
SUST-06Ju/J]
Q. Explain - Radial artery is clinically important. [DU-18M,17M,15J]
Q. Write short note on: Radial artery. [DU-06J, SUST-15Ju,O5Ju, RU-1 1 Ju]
Answer
Radial artery; It is the smaller terminal branch of the brachial artery in the cubital fossa.

• It begins in the cubital fossa about 1 cm below the bend of elbow opposite the neck of the radius.
• Then it runs downwards along the radial side of the forearm with a lateral convexity from its origin to
the wrist.
• It leaves the forearm by turning posteriorly and entering the anatomical snuff box to reach
• The proximal end of the first interosseous space.
• In the hand, it passes between the two heads of the first dorsal interosseous muscle and between the two
heads of adductor pollicis it anastomoses with the deep branch of the ulnar artery & form the deep
palmar arch.
Branches:
1 . Radial recurrent artery
2. Muscular branches
3. Palmar carpal branch
4. Dorsal carpal branch
5. Superficial palmar branch
6. First dorsal metacarpal artery
7. Arteria princeps pollicis
8. Arteria radialis indicis
Clinical importance:

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934
of „
Biceps firachii
Brachial artery
Ulnar artery

Radial artery

Tendon of flexor
carpi radialis

Figure: Arteries of front of the forearm.

|Ref- B.D. Chaurasia / 7th / 1 1 1 »1 12 + A.K.
Datta /3rd /72]

Q. Mention the site where we feel the radial pulse? [RU-1 7M,
14J,05 J]
Answer
Site where we feel the radial pulse:
The radial pulse is most easily felt on the ventral aspect of the
wrist in the interval between the tendon of flexor carpi radialis medially
and the lateral aspect of the distal third of the radius.

Q. Explain anatomically/ developmentally- Radial artery is

preferred for examination of pulse. [DU-07Ju]
Answer
Radial artery is preferred for examination of pulse:
Arterial pulse can be best felt when there is any hard structure
lying behind that artery. The radial artery is preferred for feeling the
(arterial) pulse at the wrist

Figure: Radial pulse.

]Ref- B.D. Chaurasia / 7,h / 135]

Q. Explain anatomically/ developmentally- Radial pulse
is better to palpate in front of wrist.
[RU-12JU]
Answer
Radial pulse is better to palpate in front of wrist:
The radial pulse is most easily felt in front of the wrist
because-
Presence of radial artery in the interval between the .
the lateral aspect of the distal third of the radius tendon of flexor carpi radialis medially an
Presence of the flat radius behind the artery. / J
'
’ nur . f
'
•-’j''
• '] =" 1
•• • ••
•

I Ref- B.D. Chaurasia / 7th / 1351

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 Chapter-07: Superior extremity 935
Q. Give the sites of feeling of arterial pulsation in the body.
Answer
Sites of feeling of arterial pulsation in the body:
1. Radial artery
2. Brachial artery
3. Common carotid artery.
4. Femoral artery
5. Popliteal artery
6. Anterior tibial artery
7. Posterior tibial artery
8. Arteria dorsalis pedis

Q. Give the clinical importance of clinically important arteries of upper limb. [DU-10J]
Answer
Clinically important arteries of upper limb:
1. Axillary artery
2. Brachial artery
3. Radial artery
Clinical importance:
Axillary artery:
• In order to check bleeding from the distal part of the limb, the artery can be compressed in the lower
part of the lateral wall of the axilla.
• The artery is felt during brachial plexus nerve block as the axillary sheath encloses the axillary
vessels and the brachial plexus.
• Axillary artery is the 2nd most common artery of the body to be lacerated by violent movements.
Brachial artery:
• Brachial pulsations are felt or auscultated in front of elbow just medial to biceps tendon during
recording the blood pressure.
• This is a useful site at which to pass an arterial catheter for coronary angiography or cardiac
catheterization.
• Damage to or pressure on the brachial artery due to fracture of the distal end of humerus or fractures
of the radius and ulna leading to Volkmann’s ischemic contracture (in which the arterial flow to
the flexor and the extensor muscles reduced so that they undergo ischemic necrosis).
Radial artery: "

• This is the most accessible pulse for palpation. : '

;
.
• This is the most useful and commonly used site for cannulation of an artery for blood pressure
monitoring and arterial blood sampling.
|Ref- Gray 1 40,h / 787 + Snell / 8,h / 446, 483|
> . ' •
. • • •

Q. Write short note on: Ulnar artery.

Answer
Ulnar artery:
It is the largest terminal branch of the brachial artery which begins from the cubital fossa.
Branches:
1 . The anterior and posterior ulnar recurrent arteries.
2. The common interosseous artery.
3. The anterior interosseous artery.
4. Muscular branches.
5. Palmar and dorsal carpal branches.

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 WRIT‘S
936
FLAVOUR ANATOMYFOR ]
& supply of median nerve. [D
Q. Write briefly on root value, course of median nerve.
Q. Give the formation, course & distribution
note on: Median nerve.
[SUST-1 8M]
Q. Write short
Answer
the main nerve of the forearm.
Median nen e; Median nerve is
of spinal cord.
Root value; Ventral rami ofC5-C8, Tl segments
axilla.
Course:
the medial & lateral cords of the brachial plexus in the
part, it is lateral
• Median nerve arises the brachial artery throughout its course in the arm. In the upperside;
from
and remains
• It is closely related to to the medial
arm, it crosses the artery from lateral
to the artery; in the middle of the
t.. medial side of the artery upto the
elbow.
on the
' ।
It appears in the cubital fossa beneath
the bicipital aponeurosis and enters the
forearm by passing between the two Medial root
heads of pronator teres, then deep to the Lateral root-
fibrous arch of flexor digitorum
superficialis and runs deep to this Median nerve
muscle on the surface of the flexor
digitorum profundus.
• Lastly it is placed deep to the palmaris
longus to enter pahn under the flexor Tendon of Elbow joint
retinaculum through the carpal tunnel. biceps brachii - Pronator teres
• Immediately below the retinaculum the
nerve divides into lateral & medial
Anterior nf.
divisions. The lateral division gives off a
muscular branch to the thenar muscles,
interosseous ' Branches to flexor
carpi radialis,
nerve
and three digital branches for the lateral palmaris longus
one and half digits including the thumb. and flexor digitorum
The medial division divides into two superficialis
common digital branches for the Palmar
second and third interdigital clefts, cutaneous For muscles of
supplying the adjoining sides of the branch o thenar eminence
index, middle and ring fingers.
Digital nerve I
Branches & distribution;
A. Muscular branches;
In the arm: Nerve to the
pronator teres above the elbow. Figure: Median nerve.
• In the forearm: Supplies all flexor muscles of the forearm,
except flexor carpi ulnaris and
medial half of flexor digitorum profundus.
• In the hand: It supplies five intrinsic muscles- three thenar
flexor pollicis brevis, opponens pollicis) and first & muscles (abductor pollicis brevis,
second lumbricals.
B. Cutaneous branches:
• In the forearm: The palmar cutaneous branch supplies
adjacent part of thenar eminence. the central part of the palm and the
• In the hand: Palmar digital nerves supplies the palmar
digits with their nail beds and also the skin over the lateral three and a half
dorsal
middle and terminal phalanges of the other skin over the terminal phalanx of the thumb and
fingers.
C. Articular branches: To the elbow, superior
and inferior radio-ulnar and
D. Vascular branches: Supply the axillary, wrist joints.
brachial, radial & ulnar arteries.
[Ref- A.K. Datta / 3rd / 101,
102 + B.D. Chaurasia / 7th / 113,114,1281

I
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 Chapter-07: Superior extremity - 937
Q. Mention the clinical condition arising by median nerve injury.
Answer
Clinical conditions arising by median nerve injury:
1. Median nerve initiry above the level of elbow: It may happen in supracondylar fracture of humerus-
v' The flexor pollicis longus and lateral half of flexor digitorum profundus are paralyzed. The patient
is unable to bend the terminal phalanx of the thumb and index finger.
The forearm is kept in a supine position due to paralysis of the pronators.
The hand is adducted due to paralysis of the flexor carpi radialis, and flexion at the wrist is week.
Z The hand is adducted due to paralysis of the flexor carpi radialis, and flexion at the wrist is week.
Flexion at the interphalangeal joints of the index and middle fingers is lost so that the index (and to
a lesser extent) the middle fingers tend to remain straight while making a fist. This is called
pointing index finger occurs due to paralysis of long flexors of the digit.
/ Ape thumb deformity is present due to paralysis of the thenar muscles.
/ Sensory loss in the hand corresponding to its area of distribution.
/ Vasomotor and trophic changes: The skin on lateral three and a half digit is warm, dry and acaly.
/ The nails get cracked easily.

2. Median nerve injury at the wrist: This is a common occurrence & is characterized by the following signs-
Inability to oppose the thumb.
/ The patient is unable to pick up a pin with the thumb and index finger.
/ Ape-like deformity of hand de to paralysis of the short muscles of the hand.
/ The patient is unable to touch with his thumb a pen held in front of the palm.
Partial claw-hand and lagging behind of index and middle fingers in making the fist due to paralysis
of first and second lumbrical muscles.
Sensory loss corresponds to distribution of the median nerve in the hand.

Q. Why median nerve is called the labourer’s nerve?

Answer
Median nerve is called the labourer’s nerve:
Median nerve supplies most of the long flexor muscles of front / anterior compartment of the forearm.
These muscles control gross movements of the hand. These movements are used by the labourer. For these
reason, median nerve is called labourer’s nerve.
[Ref- B.D. Chaurasia / 7th / 129[
i r: JR ,1’ 1 7_ j 7 ;
'
' '
•
.

Q. Explain anatomically/ developmentally- Median nerve lesions are more disabling than ulnar
nerve lesions. . v
Answer
Median nerve lesions are more disabling than ulnar nerve lesion:
Median nerve lesions are more disabling than ulnar nerve lesions due to the inability to oppose the
thumb, so that the gripping action of the thumb is totally lost.
[Ref- B.D. Chaurasia / 7th / 129|

to ? n . •
'
. 1

ni ritod . .>.7

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 (SAQ, MCQ) &
938 ENDEA VOUR ANA TOMY FOR WRITTEN
the carpal tunnel. [SUST-18N,14Ju,14J,12Ju]
Q. Give the formation and structures within
structures passing through the tunnel. [DU-19M’
Q. How carpal tunnel is formed? Name the
1 9M, 1 5Ju, 1 1 Ju, SUST- 1 7N, 1 6M, 1 1 Ju]
Q. What is carpal tunnel? [SUST-15J]
Q. Write short note on: Carpal tunnel.
[SUST-18M,16N,15N, CU-15M]
Answer
Formation of carpal tunnel; concavity of carpal bones & thus converts the
The flexor retinaculum bridges over the anterior
concavity into a tunnel, called carpal tunnel.
to lateral -
Structures passim through this tunnel: From medial
1. Median nerve.
2. Tendon of flexor digitorum superficialis.
3. Tendons of flexor digitorum profundus.
4. Tendons of flexor pollicis longus.
5. Tendons of flexor carpi radialis.
[Ref- A.K. Datta / 3rd / 19]

Figure: Carpal tunnel.

Q. What is carpal tunnel syndrome? [DU-13Ju,
RU-09Ju,07J, SUST- 1 6M, 14Ju, 14J, 12Ju, 1 Uu, 09J,
07Ju, 06Ju/J, CU-17M,15N,1 1 Ju]
Q. Explain from your knowledge of
anatomy: median nerve compression leads to carpal tunnel
syndrome. [DU-16N,15Ju]
Q. Write short note on: Carpal
tunnel syndrome. [RU-1 8M,17M,13/10Ju, SUST-15N/J,UJ, CU-
19N,16M, 14Ju,14J] : ;

Answer : '
Carpal tunnel syndrome: '

The motor, sensory, vasomotor and

nerve in the carpal tunnel constitute the trophic symptoms in the hand caused by compression of the n
carpal tunnel syndrome.
Age & sex:
It occurs both in males and I
females between the age of 25 and 70.
Clinical features:
1. Motor changes:
• Ape-like thumb deformity.
• Loss of opposition of thumb.
• Index and middle fingers lag behind
while making the fist.

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Chapter-07: Superior extremity
—
2. Sensory changes: Loss of sensations on
939

lateral three and a half digits including the

nail beds and distal phalanges on dorsum of
hand.
3. Vasomotor changes: The skin areas with
sensory loss are wanner and drier.
4. Trophic changes:
• Long-standing cases of paralysis
lead to dry and scaly skin.
• The nails crack easily with
atrophy of the pulp of fingers.
Patient’s complaints:
Intermittent attacks of pain in the
distribution of the median nerve on one or both
sides. The attacks frequently occur at night. Pain
may be referred proximally to the forearm and arm. Figure: Carpal tunnel syndrome.

[Ref- A.K. Datta / 3rd / 103 + BD Chaurasia I 1* 1 130[

Q. Write short note on: Ulnar nerve. [DU-06 Ju]

Answer
Ulnar nerve: The ulnar nerve is formed in the axilla as a continuation of medial cord of brachial plexus.
Root value: Ventral rami of C8 and Ti segments of spinal cord. Often it receives a contribution from C7
through the lateral root of median nerve.
Branches & distribution:
A. Muscular branches:
• In the forearm: To the flexor carpi ulnaris and medial half of flexor digitorum profundus.
• In the hand: All intrinsic muscles of the hand, except the three thenar muscles and first & second
lumbricals.
B. Cutaneous branches:
• In the forearm:
1. A palmar cutaneous branch supplies the skin of the medial aspect of the palm.
2. A dorsal cutaneous branch supplies the dorsal aspect of the medial one and a half of the
fingers, excluding the distal two phalanges of the ring finger and terminal phalanx only of
the little finger.
• In the palm: The digital branches supply the palmer aspect of the medial one and a half of fingers as
well as dorsal surfaces of the middle and terminal phalanges of ring finger and only the terminal
phalanx of the little finger.
C. Articular branches: To the elbow, intercarpal and carpometacarpal joints.
D. Vascular branches: It provides vasomotor twigs to axillary, brachial, ulnar arteries and deep palmer arch.
[Ref- A.K Datta / 3"* / 103, 104 + B.D. Chaurasia / 7,h / 1 14,1 15, 1 27[

Q. Why the ulnar nerve is called musician’s nerve? i (

1

Answer
Ulnar nerve is called musician’s nerve:
The ulnar nerve is often called the musician’s nerve because it controls fine movements of the fingers
through its extensive motor distribution to the short muscles of the hand.
[Ref- B.D. Chaurasia / 7'" / 79]

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 940 endeavour ANATOMY
ul
Q. Mention the common sites of
<

Answer
Common sites of ulnar ncrvcjnjupL flexor carpi
between two heads of ulnaris

3) AUthe wistTnfront of the flexor retinaculum. [Ref- B.D. Chaurasia / 7th / 127]
of shaft of the
arc the nerves likely to be injured by fracture of ends & middle
Q. What
humerus?
Answer
Nen es that likely to be inured b fracture of
humerus:
1 . Upper end (at the surgical neck): Axillary nerve.
2. Middle of shaft (at the radial groove): Radial nerve.
3. Lower end (behind the medial epicondyle): Ulnar nerve.
[Ref- B.D. Chaurasia / 7th / 17j

Q. What is claw hand? [SUST-19M,17N,15J,13J,12Ju,09Ju/J, CU-17N]

Q. What is ulnar nerve palsy? [CU-1 5Ju, 14J]
Q. Write short note on: Claw hand. [RU-06Ju]
Answer
Claw hand:
Claw hand is a condition seen in ulnar nerve injury
in which the medial two fingers are extended at the
metacarpophalangeal joints and partially flexed at the
interphalangeal joints. True claw-hand involving all the
fingers is produced by a combined lesion of the ulnar and
median nerve.
Signs of claw hand:
A. Motor: Paralysis of the intrinsic muscles of the hand
and hyperextension of the metacarpophalangeal
joints and flexion at the interphalangeal joints.
B. Sensory loss: Over the medial one-third of the palm
and the little finger & ulnar half of the ring finger
including their nail beds.
c. .^mornr^/r^fcr^nyrrThe skin areas with sensory loss
are wanner and drier.
Causes;
1) Klumpke’s paralysis. . . .
2) Lesion of the medial cord of the brachial plexus.
3) Lesion of the ulnar nerve.
4) A combined lesion of the ulnar and median
nerves.
[Ref- A.K. Datta /3^/104
+ B.D. Chaurasia / 7th / 130-I3H
Q. Exp'al" anatomically- Uinar nerve

Ulnar nerve injury causes claw hand:

Injury of ulnar nerve causes paralysis
injury causes daw hand.

of lumhrimu •
[DU-llJu, 09Ju] '
-
metacarpophalangeal
knlwnas aid flJ"
Angers. As a
result hyperextension of the *
joints mUScles of and
5 fingers occur. This produces a deformity
claw hand * interPha,angeal Joints of the 4,h and

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Chapter-07: Superior extremity 941
Q. Explain anatomically- How median nerve palsy causes claw hand. [DU-05Ju]
Answer
Median nerve palsy causes claw hand: Median nerve supplies five muscles of the hand -
• Abductor pollicis brevis
• Flexor pollicis brevis
• Opponens pollicis
• First and second himbricals
Median nerve palsy causes hvpercxtension of the metacarpophalangeal joints and flexion at the
interphalangeal joints of the lsl, 2nd and 3rd fingers which causes complete claw-hand in addition with ulnar
nerve palsy.
Q. What will happen if ulnar nerve is damaged in forearm? [RU-O8J11]
Q. What will be the effect when ulnar nerve is compressed against medial epicondyle? [DU-13J]
Q. Mention the effect of injury to ulnar nerve behind the medial epicondyle of humerus. [DU-
053]
Answer
Effect of injury to ulnar nerve behind the medial
epicondyle of humerus:
The common site of compression or division of the ulnar
nerve is: behind the medial epicondyle of the humerus
producing cubital tunnel syndrome the manifestations of
which are as follows-
1 . On attempting to flex the wrist, the hand is abducted
due to unopposed action of flexor carpi radialis.
2. Medial four fingers cannot be abducted and adducted
due to paralysis of dorsal or palmer interossei
3. Claw hand is produced.
4. The thumb cannot be adducted due to paralysis of
adductor pollicis. Palmar aspect Dorsal aspect
5. There is wasting of hypothenar muscles, and loss of
sensation of the medial one and a half of digits and Figure: Area of sensory loss in ulnar
the adjoining medial side of the hand. nerve injury.

[Ref- A.K. Datta /3rd /104]

Q. What are the nerves likely to be injured by fracture of ends & middle of shaft of the
humerus?
Answer
Nerves that likely to be injured by fracture of humerus: At the-
• Upper end (at the surgical neck): Axillary nerve.
• Middle of shaft (at the radial groove): Radial nerve.
• Lower end (behind the medial epicondyle); Ulnar nerve.
|Ref- B.D. Chaurasia / 7th / 17]

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 (SAQ,
FOR WRITTEN
942 - ENDEAVOUR ANATOMY CU-06Ju,05J]
[SUST-18M, RU-19MJ6M,
Q. Write short note on: Palmar aponeurosis.
Answer

’’"""‘^^^ned
of the palm.
deep fascia 0™e central par. Pharis /0Hq°
tendon
Flexor
Shape: It is triangular in shape.
retinaculum
Features: Palmar
• It has an apex & a base. aponeurosis
• Apex is proximal & blends with the flexor
retinaculum & is continuous with the tendon of the
palmaris longus. Trensverse
fibres
• Base is directed distally. It divides into four slips
opposite the heads of the metacarpals of the medial Digital vess«(
four digits. Each slip divides into two parts which and r«rv4S
are continuous with the fibrous flexor sheaths.
• Extensions pass to the deep transverse metacarpal
ligament, the capsule of the metacarpophalangeal
joints and the sides of the base of the proximal
phalanx.
Fibrous flexor
sheath
Morphology;
Phylogenetically, the palmar aponeurosis represents
the degenerated tendon of the palmaris longus.
Functions:
figure: Palmar aponeurosis
• fixes the skin of the palm & thus improves the grip.
• It also protects the underlying tendons, vessels & nerves.
It provides origin to the palmaris brevis from its
apex for stronger grip on the ulnar side.
Applied anatomy;

in “f the aponeurosis results

(Ref- B.D. Chaurasia / 7,h /

1 1 7 + A.K. Datta / 3rd /87|

Ulnar nerve

Ulnar vein
Palmar
of ulnar cutaneous branch
nerve
Tendon of pulmaris (oa^ms
Hypothener muscle
Pulmar cutaneous
of median nerve branch
I
Thener muscle
Tendon of flexor 4-
digitorum
super
\ wM - Tendon
carpi
of flexor
radialis
Tendons of flexor Tendon of flexor
digitorum profundus pollicis longus
Median nerve

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Chapter-07: Superior extremity 943
Q. Write short note on: Flexor retinaculum. [DU-12J,09J, RU-13J]
Q. What is flexor retinaculum? Name the structures behind and in front of it. [SUST-15Ju,07J]
Q. How flexor retinaculum is formed and what structures pass behind it? [RU-14J]
Q. Write briefly on: Flexor retinaculum of hand. [DU-14J]
Q. Name the structures passing deep to the flexor retinaculum. [SUST-08J]
Answer
Flexor retinaculum:
It is a strong fibrous band which bridges the anterior concavity of carpal and converts it into a tunnel,
the carpal tunnel.
Attachment:
Medially:
1. Pisiform bone
2. Hook of the hamate
Laterally:
1 . Tubercle of scaphoid &
2. The crest of the trapezium.
The upper border of the retinaculum is continuous with deep fascia of forearm and lower border is
attached to the palmer aponeurosis.

Relations:
Structures passing superficial to the flexor retinaculum:
• Tendon of the palmaris longus
• Palmar cutaneous branch of median
nerve
—Radial bursa
• Palmar cutaneous branch of ulnar Ulnar bursa
nerve
• Ulnar vessels ;
• Ulnar nerve
Structures passing deep to the flexor
retinaculum: Digital synovial
• Median nerve sheath
• Tendons of flexor digitorum
superficialis i......
• Tendons of flexor digitorum
profundus
• Tendon of flexor pollicis longus
• Ulnar bursa
• Radial bursa.
Importance:
Compression of median nerve below the retinaculum produce a syndrome called carpal tunnel
syndrome.
[Ref- B.D. Chaurasia / 7'h/116]

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 FNDEA VOUR-
944

Figure: Flexor retinaculum.

Q. Name the intrinsic muscles of hand with their nerve supply. [SUST-17M, CU-06Ju]
Q. Give the nerve supply of lumbricals and interossei muscles of hand. [SUST-12Ju]
Q. Name the muscles of palm with their nerve supply. [DU-09J]
Q. Write short note on: Intrinsic muscles of the hand.
Answer
Short muscles of hand with their nerve supply & action: There are 20 muscles in the hand as follows -

A. Thenar muscles
1. Abductor pollicis brevis Median nerve (C8, Tl)
2. Flexor pollicis brevis Median nerve and a ramus of deep branch of ulnar
nerve.
3. Opponens pollicis Median nerve (C8, Til
4. Adductor pollicis Deep branch of ulnar nerve (C8, Tl )
B. Hypothenar muscles
1 Palmaris brevis ; Superficial branch of ulnar nerve (C8, Tl)
Deep branch of ulnar nerve (C8, Tl)
3. Flexor digiti minimi Deep branch of ulnar nerve (C8, Tl)
4. Opponens digiti minimi Deep branch of ulnar nerve (C8, T 1)
C. Four lumbricals
*
Id 2"dt|lumbncals
& by the median nerve (C8, Tl)
• 3 and 4 ' lumbricals by the deep branch of ulnar
nerve (C8, Tl)
D. Four palmer interossei
Deep branch of ulnar nerve (C8, )
E. Four dorsal interossei Tl
^eeP branch of ulnar nerve (C8, Tl)

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 Chapter-07: Superior extremity - -■
945
Q. Write in brief about the actions of lumbricals muscles. [DU-12J, RU-1 IJu, SUST-l2Ju]
Answer
Actions of hunbricals muscles:
Flexion of the metacarpophalangeal joint and extension of the intcrphalangeal joins of the digit into
which they arc inserted.

Q. Give the origin, insertion and nerve supply of hunbricals muscles. [DU-19M,17M 15M/Ju I2J
CU-1 1 Ju]
Answer
Origin of lumbricals muscles: They arise from tendons of flexor digitorum profundus:
• First hunbricals: Lateral side of tendon of flexor digitorum profundus of 2nd digit.
• Second himbricals: Lateral side of same tendon of 3rd digit.
• Thin! hunbricals: Adjacent sides of same tendons of 3rd and 4th digit.
• Fourth lumbricals: Adjacent sides of same tendons of 4th and 5th digit.
Insertion of himbricals muscles:
The tendons of the first, second, third and fourth lumbricals pass backwards on the radial side of the
second, third, fourth and fifth metacarpophalangeal joints respectively. They are inserted into the dorsal digital
expansions of the corresponding digits.
Nene Supply:
• The first and second lumblicals by the median nerve (C8, Tl).
• The third and fourth lumbricals by the deep branch of the ulnar nerve (C8, Tl).
Q. Write short note on: Thenar eminence. [RU-11 J]
Answer
Thenar eminence:
The thenar eminence refers to the group of muscles on the
palm of the human hand at the base of the thumb.
Muscles of thenar eminence:
The following muscles are considered part of the thenar
eminence:
1. Abductor pollicis brevis: It abducts the thumb. This
muscle is the most proximal of the thenar group.
2. Flexor pollicis brevis: It lies next to the abductor, will flex
the thumb, curling it up in the palm.
3. Opponens pollicis: It lies deep to abductor pollicis brevis.
4. Adductor pollicis. It lies deeper and more distal to flexor
pollicis brevis. Figure: Thenar eminence.

Q. Write short note on: Dupuytren’s contracture.

Answer
Dupuytren’s contracture:
It is a clinical condition which is characterized by
thickening and contraction of the aponeurosis due to inflammation
of palmer aponeurosis. As a result, the proximal phalanx and later
the middle phalanx become flexed and cannot be straightened.
The terminal phalanx remains unaffected. The ring finger is most
commonly involved.
|Ref- B.D Chaurasia / 7,h /118)

Figure: Dupuytren’s’ contracture

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 MC
946 VOURANATOMY£^^
6N,08Ju,05J, R
Q. Write short note on: Anatomical snuff box. [DU- 1
Answer
Anatomical snuff box:
the
It is a triangular depression on the radial side of
wrist and becomes visible when the thumb is fully
extended.
Boundaries:
• Laterally: Tendons of abductor pollicis longus &
extensor pollicis brevis.
• Medially: Tendon of extensor pollicis longus.
• Roof: It is formed by skin & fasciae.
• Floor: It is formed by styloid process of radius,
scaphoid, trapezium and the base of the first Extensor pollicis lo^
metacarpal bone.
Branch of radial nerve
Content: Extensor pollicis bravis
• Radial artery. Radial artery
• Proximal part of the 1st dorsal metacarpal artery.
Cephalic vein

Figure: Anatomical snuffbox.

(Ref- A.K. Datta / 3rd / 82 + BD Chaurasia / 7,h / 136]

First dorsal
interosseous muscle

Radial artery

Anatomical snuff box Radial artery

Extensor pollicis longus Extensor pollicis bravis

Cephalic vein Abductor pollicis longus
Figure: Anatomical
snuffbox.

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Chapter-07: Superior extremity 947
Q. Write short note on: Palmar arch. [RU-09J]
Q. How the palmar arches arc formed? [DU-12Ju]
Q. Write short note on: Superficial palmar arch. [DU-19M,09Ju, RU-16M,15J,13J]
Q. Write short note on: Deep palmar arch.
Answer
Palmar arch:
Branches of the terminal parts of the ulnar and radial arteries unite and form anastomotic channels
called superficial and deep palmar arches.
the
Superficial palmar arch: It is an important anastomosis between the ulnar & radial arteries.
Formation:
It is formed as the direct continuation of the ulnar artery beyond the flexor retinaculum. On the
lateral side, it is completed by one of the following branches of the radial artery:
1 . Superficial palmar branch
2. The radialis indicis
3. The princeps pollicis.
Branches: Four palmar digital arteries which supply the medial three and a half fingers.
Deep palmar arch:
It is an important anastomosis between the radial & ulnar arteries, which is situated deep to the long
flexor tendons in the palm.
Formation:
It is formed by direct continuation of the radial artery beyond the gap between the two heads of
the adductor pollicis & is completed at the base of the fifth metacarpal bone by the deep branch of the
ulnar artery.
Branches:
• Three palmar metacarpal arteries
• Three perforating arteries.
• Recurrent branch.
{Ref- B.D. Chaurasia / 7th / 123-124]

Deep branch of

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 948 £7VZ>£/1 Kuun zi/

Back of the forearm andJHand

with their nerve supply & action. [SUST-07J]
Q. Name the muscles of the back of the forearm
Q. Name the muscles present in extensor
compartment of the forearm with their nerve supply
[RU-09J]
Answer
Muscles of the back of the forearm:
Superficial muscles: There arc 7 superficial muscles in the back of
the forearm —

, Nerve supply Action

Muscles
I, Anconeus Radial nerve (C7, C8, Tl) Weak extensor of the elbow.
2. Brachioradialis Radial nerve (C5, C6, C7) • Flexor of forearm, especially in the
midprone position.
• It pronates the fully supinated forearm &
supinates the fully pronated forearm.
I J. Extensor carpi Radial nerve (C6, C7) • Extensor of wrist.
radialis longus • Abductor of the wrist.
• Assists movements of the digits by fixing the
wrist.
• 4. Extensor carpi Posterior interosseous nerve Same as extensor carpi radialis longus.
radialis brevis (C7, C8)
5. Extensor digitorum Posterior interosseous nerve Extensor of interphalangeal,
(C7,C8) metacarpophalangeal & wrist joints.
6. Extensor digiti Posterior interosseous nerve Extensor of the little finger at the
minimi (C7, C8) interphalangeal & metacarpophalangeal joints
7. Extensor carpi Posterior interosseous nerve
ulnaris (C7, C8)
• Extensor of the wrist.
• Adductor of the hand.
• Fixes the wrist during forceful movements o
the hand.
-- "

Extensor carpi
Brachioradialis - Anconeus radialis longus
Extensor carpi
Extensor radialis bravis
digiti ulnaris
Extensor
digiti minimi

Extensor
retinaculum

Figure: Superficial
muscles
of back of the forearm.

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Chapter-07: Superior extremity
Deep muscles:
Muscles Nerve supply Action
1. Supinator I ostciiot intci osseous nerve Supination of the forearm.
2. Abductor pollicis longus Posterior interosseous nerve Abduction and extension of the thumb at
the carpometacarpal joint
3, Extensor pollicis longus Posterior interosseous nerve Extension at all joints of the thumb.
4. Extensor pollicis brevis Posterior interosseous nerve Extends the proximal phalanx and
metacarpal of the thumb.
5. Extensor indicis Posterior interosseous nerve Extension of the index finger
|Ref- B.D. Chaurasia / 7,h / 126-127]

Q. Name the muscles of the back of the forearm with their attachment.
Q. Give the attachment of supinator muscle. [RU-15M]
Answer
Attachment of the muscles of the back of the forearm:
Superficial muscles: There are 7 superficial muscles in the back of the forearm —
.. Inser,^
/. Anconeus Posterior aspect of lateral 1 . Lateral aspect of olecranon process of ulna.
epicondyle of the humerus. 2. Upper one-fourth of the posterior surface of
ulna.
2. Brachioradialis 1 . Upper two-thirds of lateral Lateral side of radius just above the styloid
supracondylar ridge of process.
humerus.
2. Lateral intermuscular septum.
3. Extensor carpi 1 . Lower one-third of the lateral Dorsum of base of the second metacarpal bone.
radialis longus supracondylar ridge of the
humerus.
2. Some fibres arise from the
common extensor origin. A ; ...
3. Some fibres from the lateral
intermuscular septum.
4. Extensor carpi 1 . Common extensor origin. Dorsal aspect of bases of second and third
radialis brevis 2. Radial collateral ligament of metacarpal bones.
elbow.
5. Extensor Common extensor origin. The muscle ends in a tendon which splits into four
digitorum parts, one for each digit other than the thumb. Over
the proximal phalanx the tendon for each digit
divides into three slips- one intermediate and two
collateral. The intermediate slip is inserted into theThe
dorsal aspect of the base of the middle phalanx. dorsal
collateral slips reunite to be inserted into the
aspect of the base of the distal phalanx.
The tendon joins the tendon of the through
extensoi
6. Extensor digiti Common extensor origin. digit. It is inserted
minimi digitorum for the fifth
the dorsal digital expansion into the dorsalbase of
aspect
and the
of the base of the middle phalanx,
the distal phalanx.
bone.
7. Extensor carpi Common extensor origin. Medial side of the base of the fifth metacarpal
- ulnaris I Posterior border of the ulna

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 950
Deep muscles: Insertion
j Muscles 1 ' '
Upper one-third of the lateral surfaceof^
1 /. Supinator | 1. Lateral epicondyle of humerus.
the radius.
2. Radial collateral ligament of
elbowjoint.
3. Annular ligament.
4. Supinator crests of the ulna,
and the
posterior part of the triangular area in
front of it. _
surfaces of The tendon usually splits into two parts^
2. Abductor pollici i' Upper parts of the posterior part is attached to the lateral side of the base
longus the ulna and the radius, and from the
interosseous membrane. of the first metacarpal, and the other part is
attached to the trapezium. Further fasciculi
may become continuous with the opponens
pollicis, or with the abductor pollicis brevis
3. Extensor pollicis Posterior surface of the ulna (below the Base of distal phalanx of the thumb (dorsaT
longus origin of the abductor pollicis longus); aspect).
and from the interosseous membrane.
4. Extensor pollicis Posterior surface of the radius below the Dorsal surface of the base of the proximaT~
brevis origin of the abductor pollicis longus; phalanx of the thumb.
and from the interosseous membrane.
5. Extensor indicis Posterior surface of the ulna below the The tendon joins the ulnar side of the tender
origin of the extensor pollicis longus. of the extensor digitorum for the index
and from the interosseous membrane. finger.
[Ref- B.D. Chaurasia / 6th/ 138]

Supinator Supinator
(deep head} (superficial head)

Interosseous
membrane
Extensor Abductor
pollicis pollicis longus
longus
Extensor Extensor
indicis pollicis brevis

Figure: Deep
muscles of
back of the forearm

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 Chapter-07: Superior extremity
951
Q. Write short note on: Extensor retinaculum. [RU-15M1
Answer 1 J
Extensor retinaculum:

tendons 'in pla^br°US °" “ °f ,hC Wisl formcd b* thickening of deep fascia holding the extensor

Attachment:
Laterally: 1 o the lower part of the anterior
border of the radius
Medially: To the-
1 . Styloid process of ulna
2. Triquetral &
3. Pisiform bones.
Compartments. Six osteofascial compartments are formed on the back of the wrist. The structures passing
through each compartment, from lateral to the medial side, are listed below:
Compartment Al f
I • Abductor pollicis longus
• Extensor pollicis brevis
II • Extensor carpi radialis longus
• Extensor carpi radialis brevis
III • Extensor pollicis longus
IV • Extensor digitorum
• Extensor indicis
• Posterior interosseous nerve
• Anterior interosseous artery
V • Extensor digiti minimi
VI • Extensor carpi ulnaris
[Ref- B.D. Chaurasia / 7th / 135|

Extensor indicus •
Extensor digitatum-
Posterior interosseus nerve _
Anterior interosseus arterg _ Extensor pollicis longus
Extensor carpi radialis brevis
Extensor digiti minimi
— Extensor carpi radialis longus
Extensor carpi ulnaris -— Extensor pollicis brevis
Abductor pollicis longus
Radius
Ulna

Figure: Structures passing through extensor retinaculum.

Q. Write short note on: Dorsal digital expansion.

covering the
Dorsal digital expansion: It is an aponeurotic extension of the tendon of the extensor digitorum
dorsum of the proximal phalanx.
Shape: It is triangular in shape.

Location: On the dorsal aspect of the proximal phalanx & the metacarpophalangeal joint.
[Ref- BD Chaurasia7 7,h / 139]

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 952 —= impor c' [
Q. What is pulp space

phalanx.
f nt
Formation: Il is composed of subcutaneous
arranged in tight compartments formed by fibrous
septa which pass from the skin to the
periosteum of
the terminal phalanx.
Contents: Subcutaneous fat.
Clinical importance: Infection of this space is
known as whitlow. The rising tension in the space
gives rise to severe throbbing pain. Infections in the
pulp space (whitlow) can be drained by a lateral
incision which opens all compartments and avoids Figure: Pulp space of finger
damage to the tactile tissue in front of the finger.
If neglected, a whitlow may lead to necrosis of the distal four-fifths of the terminal phalanx due to
occlusion of the vessels by the tension. The proximal one-fifth (epiphysis) escapes because its artery does not
traverse the fibrous septa.

|Ref- BD Chau rasia / 7th /132]

Bones & Joints

Q. Write short note on: Pectoral girdle.
Answer .
’

Pectoral girdle: Pectoral or shoulder girdle connects the bones of the upper iimb with axial skeleton. The girdle
consists of scapula and clavicle on each side.
Connections:
ted ,h5 acromioclavicular joint
and by strong coraco-clavicular
ligaments, it articulates with the humeral head at the gleno-humeral (shoulder) joint
*
t'?°n a*
canuage by strong costoclavicular ligament.
the joint and is attach^ to the first costal

Movements of the shoulder girdle: / '

. . v . > . .. . ..-a,
« always associated with the move,nchl^^
below),

|Rcf- B.D. Chaurasia / 7,h / 1^1

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 Chapter-07: Superior extremity
953
Q. What arc the movements performed by scapula?
Answer
Movements performed by scapula;
Movements of the
scapula Muscles producing movements
I. Elevation Upper fibers of the trapezius & by the levator scapulae.
2. Depression Lower fibers of the serratus anterior and by the pcctoralis minor.
3.Protraction Serratus anterior and by the pcctoralis minor.
4.Retraction Rhomboideus; and by the middle fibers of the trapezius.
5. Forward rotation Upper fibers of the trapezius and by the lower fibers of the serratus anterior.
6. Backward rotation Levator scapulae and the rhomboideus.
|Ref- B.D. Chaurasia / 7th / 144-145]

Q. Write short note on: Clavicle. [RU-07Ju]

Answer Lateral
Clavicle: Medial
The clavicle is a modified long bone which transmit
the weight of the limb to the sternum. It is also called colar
bone and beauty bone in female.
Surface for articulation Surface for
Peculiarities of clavicle: with menubrium and articulation
1. It is the only long bone that lies horizontally. 1st costal cartilage with vnenubriunn and
2. It has no medullary cavity. 1st costal cartilage
3. It is the only long bone which ossifies in membrane
4. It is the only long bone which has two primary
centres of ossification.
5. It is the first bone to start ossification in the body
Conoid tubercle
and last to fuse. Figure: Clavicle.
6. It is subcutaneous throughout.
Presenting parts: The clavicle presents-
• Two ends: Sternal and acromial.
• A shaft: It is curved with the convexity in front in medial two-thirds and concavity, in front in lateral
one-third.
Functions of clavicle:
1 . It transmits the forces from upper limb to the axial skeleton.
2. It acts as a mobile strut for holding the upper limb free from the trunk so it may have maximum freedom
ofaction. : : - rii- . y
3. Concave posterior surface of the medial two-thirds of the clavicle protects the neurovascular structures
of the root of the neck.
4. It forms an important part of shoulder girdle and helps movements of the arm above shoulder.
|Ref- A.K. Datta / 3rd / 3-5 + BD Chaurasia / 7th / 6-12]

For more curiosity

Ossification of clavicle: , .
secondary
The clavicle is the first bone in the body to ossify. It ossifies from two primary centres and one

”7’ Primary centres: The two primary centres appear in the shaft between
the 5th and 6lh weeks of intra-

Wlth
•
“duri^-22 years. Occasionally
ce"tre for the medial end appearS during
there may be a secondary centre l5’1^
for the
yCarS’
acronnai end.

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 ^%’ffS.ly .he most usually
eomnmn bon.
takes place
outstretched hand. The fracture
at t j oW"
point.
1 9M]
Q. Why clavicle is a modified long bone? [DU-19N, CU
Answer
Clavicle is » modified long bone becnijse:
horizontally.
k It is the only long bone that lies
2. It has no medullary cavity.
3. It is the only long bone which ossifies in
membrane.
4. It is the only long bone which has two primary
centres of ossification.
5. It is subcutaneous throughout.

Q. Mention the joints formed by clnviclc. Mention their types. Why

clavicle is called modified
long bone? [SUST-07Ju]
Answer
Joints formed by clavicle with type:
1 . Sternoclavicular joint: Saddle type of synovial joint.
2. Acromioclavicular joint: Plane synovial joint.
Clavicle is called modified long bone:
Clavicle is called modified long bone, because it transmits forces or weight from the upper limb to the
axial skeleton.
[Ref- BD Chaurasia / 7th / 143,144 + A.K. Datta /3rd/ 3|

Q. Explain anatomically why- junction between medial 2/3rd and lateral l/3rd of the clavicular
shaft is the common site of fracture. [DU-18M]
Answer
Explanation:
The most common site of fracture of clavicle is the junction between medial 2/3rd and lateral 1/3"1 of the
clavicular shaft because it is the weakest point. It is usually fractured by an indirect violence due to a fall on the
outstretched hand including - automobile accidents, biking accidents (especially common in
horizontal falls on the shoulder joint, or contact sports such as football, rugby, hurling,
mountain biking),
or wrestling.
[Ref- BD Chaurasia / 7‘h / 8|
S" n“k»f « clinically important [DU-19M,I7M,IOJ)
O
V- Write short note on: Surgical neck of humerus. [RU-08J1 :
Answer J
Surgical neck of humerus:
ft is a constriction between the expanded upper end Greater
and cylindrical shaft of humerus. tubercle
BgJation:It is embraced posteriorly by the axillary nerve Superior
Anatomical facet
and posterior circumflex humeral vessels. neck ' Middle
Surgical facet
A fracture of surgical neck may involve the axillary neck
nerve with consequent paralysis of deltoid muscle. Inferior
facet
[Ref- A.K, Datta /3rd/ 10| Figure: Surgical neck of humerus.

•j

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 Chapter-07: Superior extremity - 955
Q. Mention the effect of fracture of surgical neck of humerus. [RU-1 1 J]
Answer
The effect of fracture of surgical neck of humerus:
Fracture of surgical neck of humerus may involve the axillary nerve which results in paralysis of deltoid
muscle.

Q. How shoulder joint is formed? Mention the factors maintaining the stability of the joint [DU-
15J.I2J.05Ju. SUST-15N/MJ3Js12Ju,l Uu,08Ju.06Ju,05Ju, CU-14/1 1 Ju]
Q. How stability of the shoulder joint is maintained? [I<U- 1 5 J, 1 4J, 1 3 J,09Ju, SUST-18M]
Answer
Formation of shoulder joint;
The shoulder joint is formed between the Acromion i
rounded head of the humerus and the shallow pear- Coracoacromial ligament I
shaped glenoid cavity of the scapula. The articular Coracoid process
surfaces are covered by hyaline articular cartilage, Subacromial bursa
and the glenoid cavity is deepened by the presence
of a fibrocartilaginous rim called the glenoid labrum. Supraspinatus
Type: Ball and socket type of synovial joint. Subscapularis
Factors maintaining stability of the joint; Infraspinatus
1. Coracoacromial arch. Teres minor
2. Musculotendinous cuff / rotator cuff.
3, The glenoidal labrum that helps in deepening
Ctenoid cavity
of glenoid cavity. Glenoid labrum
4. Surrounding muscles e.g. muscles attaching Sinovial fluid
the humerus to the pectoral girdle, long head Capsule of
of biceps & the long head of triceps. shoulder joint
5. Fibrous capsule. Figure; Relations and factors maintaining stability of shoulder join
6. Ligaments: Glenohumeral, transverse
humeral and coracohumeral ligament.
7. Atmospheric pressure.
[Ref- A.K. Datta /3rd / 110, 111 + BD Chaurasia / 7th / 146-149]

Q. Describe the shoulder joint mentioning its formation, movements and muscles producing
different movements. [DU-18M,09J,07J,05J, RU-05J, SUST-15N,llJu]
Answer
Shoulder joint:
Formation: Please see above.
Movements & muscles producing movements:
Mbvem&nts^
1. Flexion ^ • Pectoralis major (clavicular head)
movements —
• Anterior fibres of deltoid
• Coracobrachialis
• Short head of biceps
2. Extension • Posterior fibres of deltoid
• Latissimus dorsi
• Teres major
• Long head of triceps
3. Adduction • Pectoralis major
• Latissimus dorsi
• Teres major
• Short head of biceps
• Long head of triceps

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 956 _ —
• Deltoid
:< Muscles produci^^ —
4. Abduction
• Supraspinous
• Serratus anterior
• UoDer & lower fibres of trapezius
5. Medial rotation • Pectoral is major
• Anterior fibres of deltoid
• Latissimus dorsi
• Teres major
• Subscapularis
6. Lateral rotation • Posterior fibres of deltoid
• Infraspinatus
... • Teres minor
[Ref- A.K. Datta / 3rd / 143 + BD Chaurasia / 7th / 149]

I Q. Mention the movements of the shoulder joint. [RU-15J,09Ju] Name the muscles causing
abduction of this joint with their origin, insertion & nerve supply. [RU-19M,07J, CU-15Ju,
1 1 Ju]
Q. Name the muscles causing abduction of arm in sequential order with nerve supply. [CU-19M
14Ju]
Q. Which muscle is the initiator of abduction? [DU-05 J]
Answer

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 Chapter-07: Superior extremity -
957
Movements of shoulder joint;
1. Flexion
2. Extension
3. Adduction
4. Abduction
5. Medial rotation
6. Lateral rotation
7. Circumduction (combination of the above movements)
Muscles causing abduction of the shoulder joint;
• Supraspinatus: Upto 15°
• Deltoid: Upto 90°
• Serratus anterior and upper & lower fibres of trapezius: More than 90°
Abduction is initiated by the supraspinatus, but the deltoid is the main abductor.
Origin, insertion & Nerve supply;
See in respective topics.
[Ref- A.K. Datta / 3rd / 113, 114 + BD Chaurasia / 7th / 149 J

Q. What is abduction? [SUST-08J]

Q. How the abduction of shoulder joint occurs in a sequential order? [CU-17M, SUST-09Ju,07J]
Answer
Abduction: In the limb, abduction is the lateral movement away from the midline of the body. It takes place in
a coronal plane.
Mechanism of abduction of shoulder joint:
Abduction is performed by five muscles; two as prime movers (middle fibers of deltoid and
supraspinatus) and three as synergists (Subscapularis, Infraspinatus and Teres minor).
Abduction in scapular plane is restricted to about 90°. Further abduction of 30° is made by lateral
rotation of humerus. Infraspinatus and teres minor perform the lateral rotation. At this stage, the long
tendon of biceps helps abduction.
v' Abduction of shoulder occurs through 180°. The movement takes place partly at the shoulder joint and
partly at the shoulder girdle.
v' Abduction is initiated by the supraspinatus, but the deltoid is the main abductor. The scapula is rotated
by combined action of the trapezius and serratus anterior. , .
[Ref- A.K. Datta / 3rd / 113, 114 + BD Chaurasia / 7th / 148-150}

Q. What is prime mover and antagonist? [RU-09J]

Answer
Prime mover: A muscle is a prime mover when it is the chief muscle or member of a chief group of muscles
responsible for particular movement.
Example: Quadriceps femoris is the prime mover in extending the knee joint.
Antagonist: Any muscle that opposes the action of the prime mover is an antagonist.
Example: The biceps femoris opposes the action of the quadriceps femoris when the knee joint is
extended.
|Ref-Sneli/8 / 10|

Q. Why wide ranges of movement of shoulder joint occur? [RU-13Ju,05J]

Answer
Cause of wide range of movement of shoulder joint:
Wide ranges of movement of shoulder joint occur due to laxity of its fibrous capsule, and the four times
large size of the head of humerus as compared with the shallow glenoid cavity. The range of movements is
further increased by concurrent movements of the shoulder girdle.
[Ref- A.K. Datta /3rd / 1 15[

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 (SAQ, MCQ) & Viy^
958 ENDEAVOUR ANATOMY FOR WRITTEN
Q. What is frozen shoulder? [RU-05J]
Answer
Frozen shoulder (adhesive capsulitis):
cuff. Eventually allu shoulder movements are
Anuldor mnvpments
This results from tendinitis involving entire rotator
restricted due to adhesions.
|Ref- A.K. Datta / 3rd / 1 igj

joint is a less stable joint. [DU-1 8M,17N,

Q. Explain anatomically/ functionally- Why shoulder
15N,13Ju. SUST-18M] . of shoulder joint.. . ....
functionally- Inferior dislocation [RU-15J,10Ju]
Q. Explain anatomically/
Answer . .
Shoulder joint is a less stable joint / Inferior dislocation of
shoulder |Oint:
joint. The ball is formed by head of the
Shoulder joint is a multi-axial ball and socket type of synovial much shallower and four times
humerus and the socket is formed by glenoid cavity of scapula which
is smaller
(weak) joint of the body. To increase stability, it
than head of the humerus. It is the most mobile and least stable shoulder joint is weak and
is supported by a number of structures of which the capsular ligament of the lax
inferiorly. So shoulder joint is still weak inferiorly which results in occasional inferior
dislocation of the joint.
[Ref- A.K. Datta /3rd/ 110]

Q. Explain from your knowledge of embryology/regional anatomy- Why a dislocation of

shoulder joint is common? [DU-14Ju, CU-19M,18M,14Ju]
Q. Why dislocations of shoulder joint are frequent? [DU-05J]
Q. Why dislocation is common in shoulder joint? [CU-15M,13J]
Answer
Dislocations of shoulder joint are frequent:
Dislocation of the shoulder joint is common due to laxity of the ligaments and disproportionate articular
surfaces.
Initially the dislocation is inferior or sub-glenoid, and this is followed by sub-coracoid, sub-clavicular or
in other areas. The axillary nerve may be affected in inferior dislocation.
[Ref- BD Chaurasia / 6th / 147]
Q. Name the formative elements of elbow joint. Mention its type with its axis. Name the
movements of this joint and the muscles producing these movements. [DU-07J RU-16N 08Ju]
Q-
t1!6
”"sc,lcs involvcd in flexion and extension of elbow joint with their nerve supply.
[CU-15Ju,l IJu] 1

Q. Give the formation and type of elbow joint. [RU-I9N] Name the
muscles producing8 different
movements of this joint. [DU-lOJu, SUST-16M] *
Q. Write short note on: Elbow joint. [DU-19NJ8N, RU-lOJul
’ J
Answer
The elbow joint:
eIb°Wj°int is a synovial joint between the lower end of humerus and
ulna. the upper ends of radius and

Zte This is hinge variety of synovial joint.

Articular surfaces:
UEEerL The capitulum & trochlea of the humerus.
Lower:
3. Upper surface of the head of the radius articulates with capitulum
4. Trochlear notch of the ulna articulates with the trochlea of the
humerus.

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^8»®^ rw
1
I

rhapter-07: Superior extremity

ligaments^
• Capsular ligament
—— 959

• Anterior ligament |
• Posterior ligament
• Ulnar collateral ligament
• Radial collateral or lateral ligament.
BIoo<L™PPJK From anastomosis around the elbow joint.
ScnW‘PPJn The joint receives branches from the following nerves-
• Ulnar nerve
• Median nerve
• Radial nerve
• Musculocutaneous nerve.
Movements:
1 . Flexion: By-
• Brachialis
• Biceps brachii
• Brachioradialis
2. Extension: By-
• Triceps and
• Anconeus.
[Ref- BD Chaurasia / 7th / 151, 1541

Q. Give the origin, insertion and innervation of the chief flexor of elbow joint. [RU-09J]
Answer
Name of the chief flexor of elbow joint:
• Brachialis
• Biceps brachii
• Brachioradialis
Origin, insertion and innervation of the chief flexor of elbow ioint:
Please see above in the portion- The arm (front of the arm).
with movements
Q. Give the origin, insertion, nerve supply and actions of the muscles concerned
of elbow joint. [RU-18M]
Answer
Muscles concerned with movements of elbow ioint:
3. Flexion: By-
• Brachialis
• Biceps brachii
• Brachioradialis
4. Extension: By-
• Triceps and
• Anconeus.
Origin, insertion and innervation of the chief flexor of elbow ioint:
Please see above in the portion- The arm.

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 9«,
_
measurement & practical importance. [
Q. Write short note on: Carrying angle.
[RU-14Ju,UOJJ
when the forearm is
Answer . • f nm the long axis of forearm
g,
,he dhow, and also durhg
disappears in full flexion of
pronation of the forearm.
Factors responsible for carrying angle: , flange.
6 mm d p thnn the lateral
1. The medial flange of the trochlea is process of the ulna placed oblique to the long axis of
is place
2. The superior articular surface of the coronoid
the bone.
Clinical importance: the am
with rne in the midprone position in
1. Due to the presence of this angle, the forearm
comes :ntn
into line witn ai

which the hand is mostly used. . .

not come in close contact with
with
, nF thp
~ angle the border or me loreaun does
Forearm u
2. Due to the presence of the carrying
the lateral surface of the thigh.
3. This facilitates a heavy object grasped by the hand.
[Ref- A.K. Datta / 3rd / 1 17 + BD Chaurasia / 7th / 153-154]

Q. Write briefly on: formation, types & muscles producing movements of radioulnar [DU- joints.
16M,I2Ju, SUST-16M]
Q. Name the radioulnar joints with their types. [RU-15N]
Q. Give the formation and action of radioulnar joints. Name the muscles producing movements
of these joints. [DU-15Ju,09Ju]
Q. What are the joints formed by radius and ulna? Give their types. [RU-08J]
Answer
Radioulnar joints:
The radius and the ulna are joined to each other at the superior and inferior radioulnar joints. The radius
and ulna are also connected by the interosseous membrane which constitutes middle radioulnar joint.
Joint Articular surface Type
1. Superior radioulnar joint 1 . Circumference of the head of radius. Pivot type of synovial joint.
2. Osseofibrous ring, formed by the
radial notch of ulna and the annular
ligament.
2. Middle radioulnar joint Interosseous borders of the shafts of the Syndesmosis type of synovial
radius and ulna joint.
3. Inferior radioulnar joint 1. Head of ulna Pivot type of synovial joint.
2. Ulnar notch of radius
Movements and muscles involved:

1. Pronation
EK >
• Pronator quadratus
• Pronator teres
2. Supination • Supinator
• Biceps brachii
[Ref- BD Chaurasia / 7'" / 155-1571

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ChgV^r-07: Superior extremity
961
Q. State the functions of interosseous
membrane. [DU-16M]

^™seous margins oni'ie^di^ °^s^ous membrane of the forearm is a fibrous sheet that connects the
between the two bones.
joint ‘ “ U lhc
‘ 10 ,nain part
of the radio-ulnar syndesmosis, fibrous
'S a

ls ni®m rane divides the

f . forearm into anterior and posterior compartments, serves as a
imcn or 111use les of the forearm, and
°
t' transfers
re •in erosseous membtane is designed to shift compressive
loads placed on the forearm.
loads (as in doing a hand-stand) from the
distal radius to the proximal ulna.
The fibers within the interosseous membrane are oriented obliquely so that when force is applied the
fibers are drawn taut, shifting more of the load to the ulna. This reduces the wear and tear of placing the
whole load on a single joint.
/ Additionally, as the forearm moves from pronation to supination, the interosseous membrane fibers
change from a relaxed state, to a tense state in the neutral position. They once again become relaxed as
the forearm enters supination.

Q. Define supination [CU-1 U,SUST-14J,13Ju] & pronation. [DU-llJu, CU-10J, SUST-19N,19M,

17N,17M,15N,14J,13Ju/J] Which movement is stronger? Name the joints where these
movements occur. What types of joints are these?
Q. Name the muscles involved with supination [CU-1 1 J] & pronation with their nerve supply.
[DU-16M,1 Uu, RU-19N,17N,16N,14J,1 1J,O8J, CU-15N/M,14J,12Ju,l lJu,08J]
Q. Give origin, insertion and nerve supply of muscles responsible for supination of forearm.
[CU- 1 1 Ju, 1 OJu, SUST-1 9M, 1 7N, 1 5N, 1 4J, 1 3J,09Ju,08 J, 07J]
Q. Give origin, insertion and nerve supply of pronators of forearm. [SUST-l9N,17M,13Ju]
Q. Write short note on: Supination & pronation. [DU-08J, CU-17M]
Answer , . , . ,.
Supination: It is a rotatory movement of the forearm, in which the palm is turned upwards with
the elbow
semiflexed.
Pronation: It is a rotatory movement of the forearm, in which the
palm is tamed downwards with the elbow
semiflexed. .
is an antigravity movement.
Supination is more powerful than pronation because it

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 Muscles involved with these niovemcntS;.
Movements
_— '

Muscles
• Pronator quadratus
.

Pronation
• Pronator teres
Supination • Supinator
, Biceps brachii

r P— a'io"
Or„m. insertion ,.d non-
Plcaxe see in the respective
of muscle.
portions r^-"*
above.
Origin, insertion .nd non e .supply of muscle, responsiblefor supination of forearm:
Please see in the respective portions above.

Q. Write short note on: Superior radioulnar joint. [DU-08Ju]

Answer
Superior radioulnar joint:
Type: Pivot type of synovial joint.
Articular surfaces:
a. Circumference of the head of the radius.
b. Osseofibrous ring formed by the radial notch of ulna and the annular ligament.
Ligaments:
1. Annular ligament &

r
2. Quadrate ligament.
Blood supply: Anastomosis around the lateral side of the
elbow joint.
Nerve supply: Musculocutaneous, median, and radial
nerves.
Movements: Supination and pronation.

[Ref- BD Chaurasia / 7,h / 155]

Q. Describe the wrist joint.
[DU-10J]
Q. Give the formation, type and
movement of wrist joint. [SUST-15N 1 1 JI

mUScIes Producing flexion of wrist joint.

Answer”6
The
[DU-1 1 J]
wrist joint:
... The
ellipsoid
wrist joint is a synovial joint of the
variety between lower end
three lateral bones of proximal of radius and
row of carpus.
Articular surfaces:
• Upper:
1 • Inferior surface of
the lower
end of radius &
2. The articular disc
of the
inferior radioulnar joint.
• Lower:
1 • Scaphoid
2. Lunate &
-
3 Triquetral
bones.

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 Chapter-07: Superior extwiu,
963
1. Capsular ligament
2. Two palmer carpal ligaments.
3. Pa mer radiocarpal ligament
4. Palmer ulnocarpal ligament
5. Dorsal radiocarpal ligament
6. Radial collateral ligament
7. Ulnar collateral ligament
Blood supply: By anterior & posterior carpal arches.
Nene supply: By anterior & posterior
interosseous nerves.
Movements:
I . Flexion: By-
• Flexor carpi radialis
• Flexor carpi ulnaris
• Palmaris longus
The movement is assisted by the long
flexors of the fingers & thumb and the abductor pollicis longus.
2. Extension: By-
• Extensor carpi radialis longus
• Extensor carpi radialis brevis
• Extensor carpi ulnaris
This movement is assisted by the extensors of the fingers & thumb.
3. Abduction: By-
• Flexor carpi radialis
• Extensor carpi radialis longus
• Extensor carpi radialis brevis
• Abductor pollicis longus
• Extensor pollicis brevis . . ,

4. Adduction: By-
• Flexor carpi ulnaris
• Extensor carpi ulnaris
5. Circumduction: Combination of all movements
[Ref- BD Chaurasia I 7th / 158-160]
Q. Write short note on: First carpometacarpal joint. [RU-10J]
Answer
First carpometacarpal joint: First carpometacarpal joint is only carpometacarpal joint which has a separate
joint cavity. This joint is unique to the primate because it permits opposition of the thumb and confers the ability
to hold and manipulate the objects.
Type: Saddle variety of synovial joint.
Articular surfaces:
1 . Distal surface of the trapezium
2. Proximal surface of the base of the first metacarpal bone.
Ligaments:
1. Capsular ligament
2. Lateral ligament
3. Anterior ligament
4. Posterior ligament

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 1

Blood supply: By radial vessels.

Nerve supply: First digital branch of median nerve.
Movements:
I. Flexion
2. Extension
3. Abduction
4. Adduction
5. Opposition
6. Circumduction. [Ref- BD Chaurasia / 7th / 161,162)

Q. Write short note on: First metacarpophalangeal joint.

Answer
First metacarpopharngeal joint:
Type: Ellipsoid variety of synovial joint.
Ligaments:
1. Capsular ligament
2. Palmar ligament
3. Medial collateral ligament
4. Lateral collateral ligament.
Movements and muscles producing them:
I . Flexion: Flexor pollicis longus and brevis.
2. Extension: Extensor pollicis longus and brevis.
3. Abduction: Abductor pollicis brevis.
4. Adduction: Adductor pollicis.
[Ref- BD Chaurasia / 7th / 1 63[
Q Write short note on: Colles’ fracture. [CU-15J,13Ju]
Q. What is Colle’s fracture? [CU-18M,12Ju; RU-14J]
Answer
Colles’ fracture: Fracture of the distal end of radius about 2 Flexion fracture of the
cm above its lower end is called Colles’ fracture.
radius (Smith's fracture)
Cause: This fracture is caused by a fall on the
outstretched hand.
Deformity: The distal fragment is displaced
upwards, backwards and laterally producing a
classical dinner fork deformity.
[Ref- A.K. Datta / 3rd / 19 + BD Chaurasia / 7th / 21]

Q. Write short note on: Smith’s fracture.

Answer
Smith’s fracture:
It is the reverse of Colles’ fracture and produced by
a fall on the back of the hand. It is uncommon. The r
distal Extension fracture of the
fragment is displaced forward and upward carrying radius (Colles' fracture)
the
carpus and hand with it.
Figure: Smith’s fracture and
[Ref- A.K. Datta / 3rd / 122 + BD Chaurasia / .

7th / 21 J Colles’ fracture.

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Chapter-07: Superior extremity— — - —
- - — „
965
q. What happens if a person falls on an outstretched hand?
Answer
Fractures after falling on an outstretched hand:
1. Cones’ fracture, '

2. Supracondylar fracture (common in young age)

3. Dislocation of the elbow.
4. Fracture of clavicle at the junction between the two curvatures of the bone.
5. Fracture of the scaphoid.
.'Ill

(Ref- BD Chaurasia / 7th / 21 1

. . •
fr
Q. What is tennis elbow?
Answer
Tennis elbow:
Abrupt pronation with fully extended elbow may lead to pain and tenderness over the lateral epicondyle
of the humerus known as tennis elbow. It occurs in tennis players.
Cause: It is possible due to-
1 . Sprain of radial collateral ligament, and
2. Tearing of fibers of the extensor carpi radialis brevis.
[Ref- BD Chaurasia 1 7th 1 154-155]

Q. Enumerate the developmental anomalies in relation to the development of upper limb. [RU-
19M,15J,llJu]
Q. Mention the congenital anomalies of upper limb. [RU-18M,13Ju]
Answer
Developmental anomalies in relation to the development of upper limb:
1. Meromelia: partial absence of one or more of the extremities.
2. Amelia: complete absence of one or more of the extremities.
3. Phocomelia: the long bones are absent, and rudimentary hands and feet are attached to the trunk by
small, irregularly shaped bones.
4. Micromelia: all segments of the extremities are present but abnormally short.

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 966 ENDEAVOUR ANATOMY FOR WRITTEN (SAQ, MCQ) & VIVA

MCQ of superior extremity

Q. Nerves arising from the root of brachial d) anconeus produces extension
plexus are- [DU- 1 9N] e) it is supplied by the median nerve
a) dorsal scapular nerve Ans. a) T, b) F, c) F, d) T, e) T.
b) lateral pectoral nerve
c) long thoracic nerve Q. Palmar aponeurosis- [DU- 19M]
d) nerve to sabclavius
a) is thick over thenar eminence
e) thoracodorsal nerve
b) is triangular in shape
Ans. a) T, b) F, c) T, d) F, e) F. c) has its apex toward the root of the fingers
d) represents the degenerative tendon of flexor
Q. Following synovial joints are present in an digitorum profundus
articulated hand- [DU-19N] e) helps to improve hand grip '
a) pivot
Ans. a) F, b) T, c) F, d) T, e) T.
b) ball & socket
c) plane
d) ellipsoid Q. Ulnar nerve supplies the following
e) hinge muscles- [DU-19M]
a) first lumbricals
Ans. a) F, b) F, c) T, d) T, e) T. b) dorsal interossei
c) flexor pollicis longus
Q. Muscles innervated by musculocutaneous d) lateral part of flexor digitorum profundus
nerve include- [DU-19N] e) third lumbricals
a) Biceps brachii
b) triceps Ans. a) F, b) T, c) T, d) F, e) T.
c) teres minor
d) brachialis Q. Axillary group of lymph nodes include-
e) coracobrachial is [DU-19M]
a) apical
Ans. a) T, b) F, c) F, d) T, e) T.
b) lateral
c) pectoral
Q. Nerves related to humerus are- [DU-19N] d) pretracheal ’
a) Radial nerve e) supraclavicular
b) Median nerve
c) Ulnar nerve Ans. a) T, b) T, c) F, d) F, e) F.
d) Axillary nerve
e) Musculocutaneous nerve Q. Breast is- [DU- 18N]
Ans. a) T, b) F, c) T, d) T, e) F. a) a modified sweat gland
b) located beneath the superficial
fascia of
Q. Contents of cubital fossa include- [DU- pectoral region
19N] c) extended from 2nd to 8th rib
in the
a) Median nerve midclavicular line
b) Brachial artery d) apocrine type of gland
c) Tendon of biceps brachii e) ectodermal in origin
d) Ulnar nerve Ans. a) T, b) F, c) F, d) T, e)
e) Cephalic vein T.
Ans. a) T, b) T, c) T, d) F, e) F. Q. Clavicle- [DU- 18N]
a) is the first bone to start
b) ossifies mostly by ossification
Q. Regarding elbow joint- [DU- 19M] cartilage
a) it is hinge in type c) has medullary cavity
b) it is bi axial d) lacks periosteum
e) provides
c) pronator teres produces flexion attachment to trapezius muscles
Ans. a) T, b) F, c) F, d) T,
e) F.

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 Chaptei -07. Superior extremity
— I

Q Following nerves are the

— - 967
branches of the
lateral cord of brachial plexus- [DU-18N1 Q. Nerves directly related to humerus are—
a) musculocutaneous J [DU-18M]
b) ulnar a) radial
c) radial b) median
d) axillary c) ulnar
e) lateral pectoral d) axillary
e) musculocutaneous
Ans. a) T, b) F, c) F, d) F, e) T.
Ans. a) T, b) F, c) T, d) T, e) F.
Q. Median nerve supplies the following
muscles- [DU- 1 8N] Q. Branches of the posterior cord of brachial
a) biceps brachii plexus are- [DU-17N]
b) pal tnaris longus a) Radial nerve
c) flexor carpi radialis b) Thoracodorsal nerve
d) 3rd lumbrical c) Axillary nerve
e) palmar interossei d) Long thoracic nerve
e) Ulnar nerve
Ans. a) F, b) T, c) T, d) F, e) F.
Ans. a) T, b) T, c) T, d) F, e) F.
Q. Abductors of shoulder joint are- [DU- Q. Hypothenar muscles- [DU-17N]
18N] a) are abductor digiti minimi
a) triceps brachii b) are opponens digiti minimi
b) deltoid c) are supplied by deep branches of ulnar nerve
c) supraspinatus d) assist in grip
d) trapezius e) flex the proximal phalanx
e) coracobrachialis
Ans. a) T, b) T, c) T, d) T, e) F.
Ans. a) F, b) T, c) T, d) T, e) F.
Q. Structures passing deep to flexor
Q. Following types of synovial joints are retinaculum are- [DU-17N]
found in an articulated hand- [DU-18M] a) Median nerve
a) plane b) Ulnar nerve
b) condylar c) Ulnar vessels
c) hinge ,
d) Palmaris longus tendon
d) pivot e) Flexor tendons
e) ball & socket Ans. a) T, b) F, c) F, d) F, e) T.
Ans. a) T, b) T, c) T, d) F, e) F.
Q. Deltoid muscle- [DU-17N]
a) is circumpennate in type
Q. Contents of cubital fossa are— [DU-18M] b) is attached to deltoid tuberosity
a) median nerve c) is the site for intramuscular injection
b) ulnar nerve d) is the flexor of shoulder joint
c) radial nerve e) is innervated by radial nerve
d) brachial artery
e) tendon of biceps brachii Ans. a) T, b) T, c) T, d) F, e) F.
Ans. a) T, b) F, c) T, d) T, e) T. Q. Contents of cubital fossa are- [DU-17N]
a) Median nerve
Q. Muscles innervated by axillary nerve are- b) Ulnar nerve
[DU-18M] c) Radial nerve
a) teres major d) Brachial artery
b) teres minor e) Tendon of biceps
c) deltoid Ans. a) T, b) F, c) T, d) T, e) T.
d) triceps
e) coracobrachialis
Ans. a) F, b) T, c) T, d) F, e) F.

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 TOMY^Q^- WRITTEN (SAO, MCQ) &
968 ENDEA VOUR A NA
attachment to the
Q. Clavicle provide
Q. Carpal bone of proximal row Includes- following muscles- [
[DU-17M] a) Deltoid
a) Capitate b) pcctoralis major
b) Hamate c) Serratus anterior
c) Lunate d) Subclavius
d) Scaphoid c) Subscapularis
c) Triquetral
d) T, e) F.
Ans. a) T,b) T, c) F,
Ans. a) T. b) T. c) F, d) F, c) T.

Q. Rotator cuff is formed by the following Q. Branches arising from the trunk of
muscles— [DU- 1 7M] brachial plexus include- [DU-16N]
a) Infraspinatus a) Dorsal scapular nerve
b) Latissimus dorsi b) Lower subscapular nerve
c) Teres major c) Nerve to subclavius
d) Subscapularis d) Suprascapular nerve
e) Supraspinatus e) Upper subscapular nerve
Ans. a) T, b) F, c) F, d) T, e) T. Ans. a) F, b) F, c) T, d) T, e) F.
Q. Structures piercing the clavipectoral fascia
Q. Following muscles of the hand are supplied
include- [DU-1 7M]
a) Basilic vein
by ulnar nerve- [DU-16N]
b) Cephalic vein a) Adductor pollicis
c) Lateral pectoral nerve b) Dorsal interossei
d) Suprascapular nerve c) First and second lumbricals
e) Thoracoacromial nerve d) Opponens pollicis
e) Palmar interossei
Ans. a) F, b) T, c) T, d) F, e) T.
Ans. a) T, b) T, c) F, d) T, e) T.
Q. Muscles of the hand supplied by median
nerve include- [DU-17M] Q. Breast- [DU-16N]
a) Adductor pollicis a) is a modified sweat gland
b) Dorsal interossei b) is located beneath the superficial fascia of
c) 1 a and 2nd lumbricals pectoral region
d) Opponens pollicis c) extends from 2nd to 8th rib in the mid- .
.

e) Palmar interossei clavicular line

d) is apocrine type of gland
Ans. a) F, b) F, c) T, d) T, e) F. e) is ectodermal in origin
Q. Branches of axillary artery includes- [DU- Ans. a) T, b) F, c) F, d) T, e) T.
17M]
a) Superior thoracic artery Q. Median nerve supplies the following
b) Internal thoracic artery muscles- [DU-16M]
c) Vertebral artery a) Flexor carpi ulnaris
d) Lateral thoracic artery b) Dorsal interossei
e) Subscapular artery c) First lumbricals
Ans. a) T, b) F, c) F, d) T, e) T. d) Flexor digitorum superficialis
e) Palmar interossei
Q. Brachialis muscle- [DU-16N] Ans. a) F, b) F, c) T, d) T, e) F.
a) is a muscle of the flexor compartment of
arm
b) originates from the greater tubercle of Q. Structures passing superficial flexor
humerus to
c) is inserted into the radial tuberosity retinaculum of hand are- [DU-16M]
d) has dual nerve supply a) Flexor carpi radialis
e) flexes the elbow joint b) Median nerve

Ans. a) T, b) F, c) F, d) T, e) T. J) Tendon
Palmaris longus tendon
of flexor digitorum superficialis

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 AnS.a) * b) F’ c) T, d) F, e) T. e) thoracoacromial artery
Ans. a) F, b) F, c) T, d) F, e) T.
q. Basilic vein- [DU-16M]
a) Begins at anatomical snuffbox Q- Axilla contains- [DU- 15
Ju]
b) Endsby joining subclavian veins a) root of brachial plexus
c) is medial to biceps brachii in upper am, b) trunks of brachial plexus
d)
e)
Pierces the clavipectoral
Is devoids of valves
fascia^ c) cords of brachial plexus
d) brachial artery
e) axillary vein
Ans. a) F, b) F, c) T, d) F, c) T. Ans. a) F, b) F, c) T, d) T, e) T.
Q. Muscles producing flexion of shoulder
Q. Muscles innervated by radial nerve
joint include- [DU- 16M] include- [DU- 15 Ju]
a) Clavicular part of pectoralis major
b) Clavicular part of deltoid a) triceps
c) Latissimus dorsi b) brachioradialis
c) flexor digitorum longus
d) Subscapularis
d) subscapularis
e) Teres major e) teres minor
Ans. a) T, b) T, c) F, d) F, e) F. Ans. a) T, b) T, c) F, d) F, e) F.
Q. Muscles producing supination of forearm- Q. Branches of subclavian artery: [DU-15Ju]
[DU-15N] a) vertebral artery
a) biceps brachii b) dorsal scapular artery
b) brachioradialis c) superior thyroid artery
c) flexor carpi radialis ‘ / d) internal thoracic artery
d) flexor pollicis longus e) tonsillar artery
e) supinator ' >
Ans. a) T, b) T, c) F, d) F, e) F.
Ans. a) F, b) T, c) T, d) F, e) T.
Q. Muscles connecting scapula with vertebral
Q. Axillary nerve supplies the following column include- [DU-15M]
muscle- [DU-15N] a) trapezius
a) deltoid b) deltoid
b) pectoralis major c) sternocleidomastoid
c) pectoralis minor d) latissimus dorsi
d) teres major e) levator scapulae
e) teres minor Ans. a) T, b) F, c) F, d) T, e) T.
Ans. a) T, b) F, c) F, d) F, e) T.
Q. Branches of subclavian artery: [DU-15M]
Q. An articulated hand bears the following a) vertebral
synovial joints- [DU-15N] b) intrnal thoracic
a) ellipsoid c) thoracoacromial
b) hinge d) superior thyroid
c) pivot e) brachial
d) plane
Ans. a) T, b) F, c)T, d) F, e) F.
e) saddle
Ans. a) T, b) T, c) F, d) T, e) F. Q. Interosseous membrane of forearm- [DU-
15M]
Q- Structures piercing clavipectoral fascia a) is fibrous sheet
[0U-15N] b) extends between radius and ulna
a) cephalic vein c) is a synchondroses type of joint
b) medial pectoral nerve d) provides attachment to muscles
c) lateral pectoral nerve
d) superior thoracic artery

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 , _ _ j^^vouranatom^^
.
c
e) transmits compression forces from ulna to
x e)/ ball & socket
F.
radius Ans. a) T, b) F, c) T, d) T, e)
Ans. a) T, b) T, c) F, d) T, c) T.
Q. Ulnar nerve innervates the following
Q. Triceps muscle is attached to: [DU-15M] muscle- [DU-15J]
a) scapula a) flexor carpi radialis
b) clavicle b) flexor carpi ulnaris
c) humerus c) flexor pollicis longus
d) radius d) |sl & 2nd lumbricals
e) ulna e) 3rd & 4,h lumbricals
Ans. a) T, b) F, c) T, d) F, e) T. Ans. a) F, b) T. c) F, d) T, e) F.

Q. Dorsal interossei muscle- [DU-15M] Q. Structures passing superficial to flexor

a) arise from sides of metacarpal bones retinaculum are- [DU-14Ju]
b) are unipennate in type a) Palmaris longus tendon
c) are located on palmar surface between b) Tendon of flexor digitorum superficialis
metacarpals c) Median nerve
d) are supplied by ulnar nerve d) Flexor carpi ulnaris
e) adduct digits e) Ulnar nerve
Ans. a) T, b) F, c) F, d) T, e) T. Ans. a) T, b) F, c) F, d) F,fe)T.
Q. Mammary gland- [DU-15J] Q. Median nerve- [DU- 14Ju]
a) is ectodermal in origin a) Is formed in the axilla
b) is a modifies sweat gland b) Supplies the muscles of arm
c) lies deep to deep fascia ,
c) Supplies the muscles of forearm
d) overlies the pectoralis major muscle d) Innervates the skin of lateral side of dorsum
e) drains into anterior intercostal vein
of hand
Ans. a) F, b) T, c) F, d) T, e) F e) Compression causes carpal tunnel syndrome
,; ;
<
Q. Nerves arising from the root of brachial Ans. a) T, b) T, c) T, d) T, e) T.
plexus include- [DU- 15J] .
a) long thoracic nerve Q. Palmar aponeurosis- [DU-14Ju] . <
b) nerve to subclavius a) Is the deep fascia of palm
c) dorsal scapular nerve b) Is reinforced by flexor digitorum superficialis
d) thoracodorsal nerve muscle tendon ;!i H .
e) suprascapular nerve p c) Divides into five digital strips
d) Has no role on muscle action
Ans. a) T, b) F, c) T, d) F, e) F. e) Helps to improve hand grip ‘
Q. Structures passing deep to flexor Ans. a) T, b) T, c) T, d) F, e) T
retinaculum tendon of forearm: [DU- 15 J]
a)
median nerve Q. Branches of axillary
b)ulnar nerve
artery are- [DU- 1 4Ju]
a) Superior thoracic
ulnar vessel
c) : b) Thoraco-acromial ;
d)
palmaris longus tendon c) Lateral thoracic ;
e)
tendon of flexor digitorum profundus d)
'
Internal thoracic . :
Ans. a) F, b) T, c) F, d) T, e) F. e) Vertebral
: . (a 3 (d
Ans. a) T, b)T, c) T, d) F, e)
Q. Following types of synovial joints are F
found in an articulated hand- [DU-15J] Q. dermatomes
a) plane supplying
°f hand are- [DU-14Ju] the palmar surface
b)
c)
pivot
condylar
a) C5
-!'
- J • both '

b) C6 >7 /
. d) hynge c) C7 ’

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 Qhapter-07: Superior extremity
d) C8 971
e) T| c) brachial artery
d) ulnar collateral artery
Ans. a) F, b) T, c) T, d) T, c) F. e) biceps brachii tendon
q. Modifications of deep fascia of upper
*PPcr iinih
limb
Ans. a) T, b) F, c) T, d) F, e) T.
include- [DU- 14J] Q. Muscles which attach scapula
a) Interosseous membrane to humerus
b) Retinaculum include- [DU- 13 Ju]
c) Synovial membrane a) deltoid
d) Pectoral fascia b) pectoralis major
e) Axillary fascia c) teres major
d) levator scapulae
Ans. a) F, b) T, c) F, d) T, e) T. e) coracobrachial is
Ans. a) T, b) F, c) T, d) F, e) T.
Q. Muscles acting on both shoulder and elbow
joint- [DU- 14J] Q. Anatomical snuffbox is- [DU- 13 Ju]
a) Biceps brachii a) bounded anterolaterally by adductor pollicis
b) Brachialis longus tendon
c) Coracobrachialis b) bounded posteromedially by flexor pollicis
d) Triceps , .
longus tendon
e) Anconeus c) crossed by cephalic vein in its roof
Ans. a) T, b) F, c) F, d) T, e) F. d) related to superficial palmer arch
e) a site for pulsation of radial artery
Q. Hand muscles supplied by ulnar nerve Ans. a) T, b) T, c) T, d) F, e) F.
include- [DU- 14J]
a) Palmar interossei Q. Structures piercing the clavipectoral fascia
b) Dorsal interossei include- [DU- 13Ju]
c) Opponens pollicis a) lateral pectoral nerve
d) ls,and2ndlumbricals b) medial pectoral nerve
e) Adductor pollicis c) cephalic vein
d) basilica vein
Ans. a) T, b) T, c) F, d) F, e) F. e) axillary vein
•zu > *-■

Q. Nerves arising from the posterior cord of Ans. a) T, b) F, c) T, d) F, e) F.

brachial plexus include- [DU-14J] Q. Muscles attached to the radius include -
a) Axillary nerve [DU-13J]
b) Radial nerve triceps
a) ' j . .
•

c) Thoracodorsal b) supinator ./
d) Nerve to serratus anterior c) anconeus • . ; • .
e) Nerve to subclavius d) pronator quadratus
Ans. a) T, b) T,c) F, d) F, e) F. e) brachialis

Q. Following joints of upper limb are hinge in Ans. a)F, b) T, c)T, d)T,e)F.
type- [DU- 13Ju] Q. Shoulder joint - [DU- 1 3 J]
a) elbow . . a) is a ball and socket type of synovial joint
b) wrist b) posses fibrocartilage
c) intercarpal c) is a stable joint
capsule
d) carpometacarpal d) is reinforced inferiorly by fibrous
e) interphalangeal e) allows wide range of movement
Ans. a) T, b) F, c) F, d) F, e) T. Ans. a)T, b)T, c)T, d) F, e)T.
Q- Contents of cubital fossa include- [DU Q. Muscles supplied by musculocutaneous
13Ju] nerve are — [DU- 1 3 J]
a), median nerve a) latissimus dorsi
b) ulnar nerve

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 MCQl&VIV^
endea VOUR
b) triceps c) dorsal scapular nerve
c) brachialis d) medial pectoral nerve
d) deltoid e) thoracodorsal nerve
e) coracobrachialis Ans. a) T, b) T, c) F, d) T, e) F.
Ans. a) F, b) F, c) T, d) F, e) T.
Q. Cephalic vein- [DU-12Ju]
Q. Axillary group of lymph nodes include - a) is formed in the anatomical snuffbox
[DU-13J] b) passes medial to biceps brachii
a) apical c) is accompanied by lateral cutaneous nerve of
b) pectoral forearm
c) lateral d) drains into axillary vein by piercing
d) supraclavicular clavipectoral fascia
e) pretracheal e) is preferred for cardiac catheterisation
Ans. a) T, b) F, c) T, d) T, e) F. Ans. a) T, b) T, c) T, d) F, e) T.

Q. Palmar aponeurosis - [DU- 13J] Q. Brachialis- [DU- 12J]

a) is a modified deep fascia a) takes origin from greater tubercle of humerus
b) splits into five digital splits b) is inserted into the radial tuberosity of radius
c) presents degenarated distal part of Palmaris c) receives double nerve supply
longus tendon d) flexes the elbow joint
d) protects palmar vessels
e) provides loose attachment of skin
e) forms the boundary of cubital fossa
Ans. a) T, b) T, c) T, d) T, e) F.
Ans. a) T, b) F, c) T, d) T, e) F.
Q. Flexors of shoulderjoint include- [DU-
I2Ju] Q. Muscles acting both on shoulder and elbow
a) pectoralis major joints are- [DU-12J]
b) deltoid a) biceps brachii
c) corachobrachialis b) corachobrachialis
d) latissimus dorsi c) triceps
e) subscapularis d) brachialis
e) anconeus
Ans. a) T, b) T, c) F, d) F, e) F.
Ans. a) T, b) T, c) F, d) F, e) F.
Q. Contents of axilla include- [DU-12Ju]
a)axillary artery Q. Clavicle provides attachment to
the
b) cords of brachial plexus following muscles- [DU-12J]
c)terminal part of cephalic vein a) subclavius
d)roots of median nerve b) deltoid
e)infraclavicular group of lymph node c) pectoralis major
Ans. a) T, b) T, c) T, d) F, e) F. d) serratus anterior
e) subscapularis
Q. Ulnar nerve- [DU-12Ju]
Ans. a) T, b) T, c) T, d) F, e) F.
a) arises from Cs and Ti spinal segments.
b) lies deep to flexor retinaculum
c) lies medial to the hook of hamate
d) innervates flexor carpi ulnaris bone
12jf °f Subc,avian artery' are- [DU-
a) vertebral
e) supplies all lumbricals
b) internal thoracic
Ans. a) T, b) T, c) F, d) F, e) F. c) dorsal scapular
d) superior thyroid
Q. Nerves arising from medial e) tonsillar
cord
brachial plexus include- [DU-12Ju] of
a) medial root of median nerve Ans. a) T, b) F, c) T, d) F, e) F.
b) ulnar nerve

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Chapter'^?’ Superior extremity —
Q. Nerves arising from the root of the
brachial plexus are-[DU-l 1 Ju] b) dorsal interossei
—
’
973

a) Long thoracic c) first lumbrical

b) Dorsal scapular d) flexor digitorum superficialis
c) Supra scapular e) adductor pollicis
d) Lateral pectoral Ans. a)T, b) F,c)T, d) F, e)T.
e) Medial pectoral
Q. Following nerves arise
Ans. a) T, b) T, c) F, d) F, e) F. from posterior cord of
brachial plexus - [DU-1 1 J]
a) axillary
q. Radial artery can be palpated against the b) radial
following bones-[DU-l 1 Ju] c) lateral pectoral
. a) Radius d) thoracodorsal
b) Scaphoid e) suprascapular
c) Lunate
d) Triquitral Ans.- a) T, b)T,c)F, d) F, e)T.
e) Capitate Q. Followings are the superficial veins of upper
Ans. a) T, b) T, c) F, d) F, e) F. limb -[DU-11 J]
a) brachial
Q. Contents of cubital fossa are-[DU-l 1 Ju] b) median cubital
a) Median nerve c) axillary
b) Ulnar nerve d) cephalic
c) Radial nerve e) basilic
d) Brachial artery Ans. a) F, b) T, c) F, d) T, e) T.
e) Tendon of biceps brachii
Ans. a) T, b) F, c) T, d) T, e) T. Q. Flexor retinaculum - [DU-1 1J]
a) is a modification of superficial fascia
Q. Following muscles converge from the scapula b) forms an osteofascial canal
to the humerus-[DU-l 1 Ju] , : c) gives attachment to extensor digitorum longus
a) Pectoral is major d) provides passage to ulnar vessels
b) Trapezius e) is attached to pisiform bone
c) Teres major - Ans. a) F, b) T, c) F, d) T, e) T.
d) Teres minor ,

e) Serratus anterior Q. Wrist joint- [DU-10J]

a) is a bi-axial joint
Ans. a) F, b) F, c) T, d) T, e) T. b) is formed by the lower ends of radius and
Q. Clavipectoral fascia is pierced by-[DU-l 1 Ju]
ulna
c) is an example of saddle joint
a) Cephalic vein d) is a simple joint
b) Lateral pectoral nerve e) flexes by the contraction of flexor carpi
c) Median pectoral nerve radialis
d) Basilic vein
e) Thoraco acromial artery Ans. a) T, b) F, c) F, d) F, e) T.
Ans. a) T, b) T, c) F, d) F, e) T. Q. Interoseous membrane of forearm
- [DU-10J]
a) joins radius and ulna
Q. Structures passing deep to flexor retinaculum b) is a modification of deep fascia
are-[DU-l 1 Ju] c) provides attachment to neighboring
muscles
a) Anterior tibial artery d) transmits weight from ulna to radius
b) Tendon of tibialis anterior e) give passage to the radial nerve
c)' Tendon of extensor hallucis longus F, e) F.
d) Tendon of flexor hallucis longus Ans. a) T, b) T, c) T, d)
e) Tibial nerve Q. Regarding brachial plexus
- [DU-10J]
by the ventral rami ot C5, Co,
Ans. a) F, b) F, c) F, d) F, c) F. a) it is formed
C7, C8&T1
Q- Ulnar nerve supplies - [DU-1 1 J] b) its roots are located in the axilla
a) palmar interossei

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 974 ENDEA yOVKANATO^^
‘
posterior cord of brachial
oNerves arising from
Q
c) its cords are named according to their plexus are- [DU-09-Ju]
relations with the 1st part of axillary artery a) Medial pectoral
d) its roots do not give any branches b) Lateral pectoral
e) its posterior cord is formed by the postei 101 c) Axillary
divisions of all the three trunks d) Radial
Ans. a) T, b) F, c) F, d) F, e) T. c) Thoracodorsal

Q. Contents of axilla arc - [DU-1 OJ]

Ans. a) F, b) F, c) T, d)T, e)T.
a) subclavian artery Q. Muscles originating from radius include -
b) axillary artery [DU-09J]
c) cephalic vein a) Flexor pollicis longus
d) brachial plexus b) Extensor pollicis longus
e) axillary group of lymph nodes c) Extesor pollicis brevis
Ans. a) F, b) T, c) F, d) T, c) T. d) Flexor digitorum profundus
e) Flexor digitorum superficialis
Q. Regarding azygos system of veins - [DU- 1 OJ]
a) it is a connection between superior & inferior Ans. a) F, b) T, c) T, d) T, e) F.
vena cava
b) all the intercostal veins drain into it Q. Muscles innervated by musculocutaneous
c) hemiazygos vein drains into it from left side nerve are- [DU-09J]
d) it enters the thoracic cavity through a) Teres major
venacaval aperture in the diaphragm b) Coracobrachial is
e) it drains into the superior vena cava c) Brachialis
Ans. a) T, b) F, c) T, d) F, e) T. d) Brachioradialis
e) Triceps
Q. Following are the rotator cuff muscles - [DU-
09Ju] Ans. a) F, b) T, c) T, d) T, e) F.
a) Supraspinatus
b) Infraspinatus Q. Basilic vein - [DU-09J]
c) Teres minor a) Begins in the region of anatomical snuffbox
d) Teres major b) Is medial to biceps brachii in the upper arm
e) Biceps brachii c) End by joining subclavian vein
d) Pierces clavipectoral fascia
Ans. a) T, b) T, c) T, d) F, e) F. e) Connected with cephalic vein
Q. Palmar aponeurosis - [DU-09Ju] Ans. a) F, b) T, c) F, d) F, e) T.
a) Is the deep fascia of palm
b) Is reinforced by flexor digitorum superficialis Q. Structures passing superficial to flexor
muscle tendon retinaculum are- [DU-07Ju]
c) Divides into five digital slips a) Median nerve
d) Has got no effect on muscle action b) Tendon of palmaris longus
e) Helps to improve grip c) Palmer cutaneous branch of ulnar nerve
Ans. a) T, b)T,c)F, d) F, e)T, d) Palmer cutaneous branch of radial nerve
e) Ulnar artery
Q. Brachial artery- [DU-09Ju]
a) Is the continuation of axillary artery Ans. a) F, b) T, c) T, d) F, e) T.
b) Commences at the upper border
of teres Q. Muscles producing flexion
major muscle of elbow joint
c) Terminates at the level of are- [DU-07Ju]
lateral epicondyle a) Biceps brachii
of humerus
d) Is a distributing artery b) Brachialis
e) Is auscultated in recording blood c) Pronator teres
pressure d) Anconeus
Ans. a) T, b) F, c) F, d) T, e) T. e) Flexor pollicis longus
Ans. a) T, b) T, c) T, d) F, e) F. , f

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 Chapter-07: Superior extremis
n Multipinnatc muscles are- rnt J mr i 975
L U'u/Ju]
a) Deltoid
b) Subscapularis attached to the greater tuberocity
the humerus are-
c) Tibialis anterior a) teres minor
[DU-07J]
d) Rectus femoris b) subscapularis
e) Flexor pollicis longus c) supraspinatus
d) infraspinatus
Ans. a) T, b) T, c) F, d) F, e) F. e) teres major
q. Groups of lymph nodes draining breast Ans. a) T, b) F, c) T, d) T, e) F.
parenchyma arc- [DU-07Ju]
a) Anterior axillary Q. Damage to the anatomical
snuffbox injury
b) Posterior axillary the- [DU-07J]
c) Parasternal a) ulnar nerve
d) Supraclavicular b) median nerve
e) Subdiaphragmatic c) ulnar artery
d) radial artery
Ans. a) T, b) T, c) F, d) T, e) F. e) cephalic vein
Q. The followings nerves are directly related Ans. a) F, b) F, c) F, d) T, e) F.
to the humerus - [DU-07Ju]
a) Radial Q. The carpal bones in the proximal row are
b) Median I .0 - [DU-06J]
c) Ulnar a) Scaphoid
d) Axillary b) Capitate
e) Musculocutancus c) Triquetral
d) Pisiform
Ans. a) T, b) F, c) T, d) T, e) F. ;
K e) Lunate
Ans. a) T, b) F, c) T, d) T, e) T.
Q. The mammary gland- [DU-07J]
a) is a modified sweat gland Q. Ulnar nerve- [DU-06J]
b) extends from 2nd to 8th rib in the a) Supplies adductor pollicis
midclavicular line b) Lies medial to the hook of hamate
c) is ectodermal in origin c) Supplies all lumbrical muscles
d) secretion is merocrine in nature d) Lies deep to flexor retinaculum
e) secretion is controlled by prolactin e) Has C8 and T1 as its root value

Ans. a) T, b) F, c) T, d) F, e) F. Ans. a) T, b) F, c) F, d) F, e) T.

Q. Lumbrical muscles- [DU-07J] Q. Structures passing deep to flexor

a) are four in number retinaculum are- [DU-06J]
b) arise from tendon of flexor digitorum a) Ulnar nerve
superficialis b) Radial nerve .
c) inserted in to base of proximal phalanx c) Median nerve
d) are supplied by radial nerve d) Radial artery
e) are flexor of meta carpophalangeal joints e) Flexor digitorum superficialis tendon

Ans. a) T, b) F, c) F, d) F, e) T. Ans. a) F, b) F, c) T, d) F, e) T.

Q. Extensor muscles of shoulder joints are- Q. Muscles producing flexion of the elbow
[DU-07J] joint are- [DU-06J]
a) Biceps brachii
a) posterior fibres of deltoid b) Brachialis
b) latissimus dorsi c) Pronator teres
c) teres major d) Anconeus
d) subscapularis ej Fexor pollicis longus
e) suprascapularis
Ans. a) T, b) T, c) F, d) F, e) F.
A»s. a) T, b) T, c) T, d) F, e) F.

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 976 endea VQUJL ^^TX^wing nerves are directly rela(eil „
Q. Musculocutaneous nerve supply following rus-[DU-05Jl
—
muscles [DU-05Ju] a) the radial nerve
a) biceps brachii b) median nerve
b) coracobrachialis c)ulnar nerve
brachialis
c) d)the axillary nerve
d) teres minor c) the mlusculocutaneous
। nerve
e) subscapularis
Ans. a) T. b) T, c) T. d) F, c) F.
Ans.a)T,b)T,c)F,d)T,e)F.
Q. Muscles having double nerve supply arc - O Radial nerve supplies the following
[DU-05Ju] structures - [DU-05J]
a) brachialis
b) biceps brachi
a) brachro-radiahs
b) elbow joint
c) flexor digitorum profundus c) skin of the lower medial part of arm
d) deltoid d) brachialis
e) triceps e) triceps
Ans. a) T, b) F, c) T, d) F, e) F. Ans. a) T, b)T, c) F, d) T, c) T.
Q. The carpal tunnel transmits - [DU-05J] Q The following muscles form the rotator
a) median nerve cuff of shoulder joint - [DU-05J]
b) ulnar nerve
a) supraspinatus
c) tendon of flexor digitorum superficialis
d) tendon of pulmova longus b) teres major
e) radial artery c) infraspinatus
d) subscapularis
Ans. a) T, b) F, c) T, d) F, e) F. e) brachialis

Q. Clinically important vessels are - [DU-05J] Ans. a) T, b) F, c) T, d) T, e) F.

a) radial artery
b) anticubital vein
c) ulnar artery
d) subclavian artery
e) axillary artery
Ans. a) T, b) T, c) F, d) F, e) F.

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