VIVA Questions Upper Limb

Viva Questions Final

STAGE UPPER LIMB
Compiled By: Muhammad Mohsin Ali Dynamo
1st Year MBBS
Tangled?

1. What is Carrying angle of elbow? Why is it more in females?

2. What is significance of carrying angle?
 To enable swinging limbs to stay clear of wider female pelvis during walking.
 During carrying something, like a pail.
3. When carrying angle disappears?
 When forearm is pronated.
 When it is flexed at elbow joint.
4. What is clinical significance of latissimus dorsi ?
 It is used in reconstructive breast surgery. A part of the muscle with an overlying paddle of
skin as a Musculocutaneous flap is rotated around to front of body and used to create a
mound during breast simulation. This skin flap is supplied by thoracodorsal artery.
 It is also used in cardiomyoplast, in which the left lat. Dorsi is wrapped around the left
ventricle as a biological assist device.
5. Name muscle attachments on greater tubercle of humerus.
6. Name muscles used to carry out protraction.
7. Name muscles during depression of scapula.
8. Explain scapulohumeral mechanism and overhead abduction.
9. What are muscle attachments on lateral 1/3 of clavicular shaft?
10. What are muscle attachments on medial 2/3 of clavicular shaft?
11. Name myotomes of upper limb:
- They include:
a. C4—shoulder elevation

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b. C5—shoulder abduction
c. C6—elbow flexion, wrist extension
d. C7—elbow extension, wrist flexion
e. C8—thumb extension
f. T1—finger abduction
12. How Lat. Dorsi acts as a climbing muscle?
 It extends the shoulder joint and medially rotates the humerus (e.g. folding the arms behind
the back, or scratching the opposite scapula), but in combination with pectoralis major it is a
powerful adductor. Especially used in restoring the upper limb from abduction above the
shoulder, it is essentially the climbing muscle.
13. Name climbing muscles of upper limb
 Lat dorsi
 Pect major
14. Name direction of fibers of interosseous membrane and oblique cord.
15. What type of joint is the interosseous membrane?
 A syndesmoses
16. How force is transmitted from hand to axial skeleton?
Hand (via scaphoid) radius (via interosseous membrane)  ulna  humerus glenoid
fossa coracoclavicular ligaments (conoid part)  clavicle  sternum
17. What is a pseudoganglion?
 It is a collection of nerve fibers and fatty tissue with no nerve cells. It is present in
quadrangular space where teres minor is supplied by axillary nerve, and is also seen on
dorsal aspect of wrist joint where it is formed by posterior interosseous membrane.
18. What is significance of extensor expansion?
19. Explain axis of pronation/supination?
20. What are the roles of bicipital aponeurosis?
 Protects brachial artery and median nerve in cubital fossa
 Helps to lessen pressure on biceps tendon on radial tuberosity during pronation and
supination of forearm.
21. What are three functions of lumbricals?
 They cause flexion at MP joints.
 They cause extension at IP joints.
 They are rich in neuromuscular spindle organs, and they give you a sense of proprioception
(spatial orientation) and kinesthesia (sense of motion) of digits due to tension placed by
digital tendons.
22. Why lumbricals flex MP and extend IP joints?
 Because they are anterior to MCP joints, so they flex the knuckles. Also they are posterior to
IP joints, so they extend the distal phalanges.
23. Explain midpalmar space.
24. Explain thenar space.
25. What is handlebar neuropathy? (see KLM)

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26. What is atypical joint? Give examples?

 In atypical joint, the bony surfaces are lined by fibrocartilage, not the usual hyaline cartilage.
The sternoclavicular joint and the acromioclavicular joint are examples.
27. Name structures that pierce clavipectoral fascia (costocoracoid membrane).
28. What is cosmetic importance of retromammary space?
 Breast prostheses during breast reconstruction or augmentation (increasing size) are usually
inserted into the retromammary space.
29. Explain the costoclavicular ligament?
 It has 2 lamellae, anterior and posterior. The fibers of anterior lamellae run upward and
laterally, whereas the fibers of the posterior lamellae run upwards and medially.
30. Describe the impingement syndrome.
 The tendon of supraspinatus with its adherent subacromial bursa may be pinched if the
space between undersurface of acromion and top of humeral head is narrow. This occurs
when arm is elevated forwards. Repetitive impingement leads to chronic condition with
tendinitis or bursitis. Pain is felt during abduction between 60-120◦, a condition known as
painful arc.
31. Name the contents of intertubercular sulcus or bicipital groove.
32. Describe nutrient artery of foramen and its direction. It is a branch of which artery?
33. What are structures damaged in case of fracture of surgical neck of humerus?
34. A person falls on an outstretched hand. Explain fractures that occur depending on age?
 Young child—posterior displacement of distal radial epiphysis.
 Teenager—clavicular fracture.
 Young adult—fracture of scaphoid
 Elderly person—Colles’ fracture
35. Explain palmar aponeurosis.
36. Name branches of medial cord of brachial plexus.
37. Describe course of ulnar nerve.
38. What is action of paradox (see BD appendix 1 for 5th ed.)
39. Describe the injuries to median nerve at different levels.
40. Name 4 levels of ulnar nerve injury (see KLM).
41. Describe course of thoracodorsal artery (see KLM)
42. Describe course of medial and lateral pectoral nerve (see KLM).
43. Why only lateral pectoral nerve pierces clavipectoral fascia?
 Because it has to supply pect. Minor as well.
44. Name joints between radius and ulna.
45. Where clavicular fractures normally occur? Why?
46. Explain the type and variety of wrist joint.
47. Explain movements related with wrist and midcarpal joints.
 Flexion and ulnar deviation-wrist joint
 Extension and radial deviation-midcarpal joint (see KLM)
 Flexion and extension are initiated at midcarpal joint.

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48. Nerve supply, origin and insertion of the following muscles:

a. Pronator quadratus
b. Pronator teres.
c. Flexor pollicis longus
d. F. digitorum profundus (hybrid muscle—dual nerve supply)
e. Pect major.
f. Brachialis
49. Which muscle is embryologically an extensor but functionally a flexor?
 Brachioradialis
50. Explain flexor retinaculum. What structures pass superficial to it?
51. What is hourglass syndrome (see BD w.r.t. ulnar bursa)?
52. Origin of anterior and posterior interosseous nerves?
53. Which nerve is musculospiral nerve?
 Radial nerve, because it passes through spiral or radial groove on posterior humeral surface,
and also between muscles.
54. Give the muscle attachments of dorsal digital expansion?
55. Explain cutaneous innervation of forearm?
56. Describe course of musculocutaneous nerve?
57. Explain wrist drop. What is its cause?
58. Explain injuries to inferior trunk of brachial plexus.
59. What is canal of Guyon?
60. If median nerve is injured between two heads of pronator teres, what is the result? What if
the same nerve is injured deep to flexor retinaculum?
61. What can we do to treat carpal tunnel syndrome?
 The flexor retinaculum is removed.
62. Explain dorsal venous arch?
63. A boil on thumb shows inflammation of which lymph nodes?
 Apical group of axillary lymph nodes.
64. What is role of lat. dorsi in respiration?
 The costal fibers of origin elevate lower four ribs towards humerus helping in inspiration.
 The remainder of the muscle compresses the lower thorax in violent expiratory efforts such
as sneezing or coughing.
65. Other muscles that play a role in respiration?
 Pect minor during inspiration (see KLM)
66. Explain compartment syndrome?
 The fascial sheath and fibrous septa in forearm divide it into lateral, anterior and posterior
compartments. And edema in these compartments can cause compression of blood vessels,
soft tissue injury, ischemia of nerves, muscle ischemia etc. It is treated by fasciotomy
(removal of deep fascia). See Snell for details.
67. What is Poland syndrome? (see KLM)
68. In which plane supination takes place?

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69. Describe Hilton’s law? (see KLM)

70. Describe boundaries and contents of :
a. Quadrangular Space
b. Triangular space
c. Triangular Interval (lower triangular space)
71. Name nerves of lateral cord of B. plexus.
72. Name nerves of posterior cord of brachial plexus.
73. Why range of flexion is greater than range of extension at MCP joints?
 Because joint capsule is weak posteriorly and strong anteriorly.
74. Why abduction/adduction of digits are more during extension at MCP joints? Why no
abduction/adduction takes place at IP joints?
 The collateral ligaments of the MP joint are loose when joint is extended but tight when it is
flexed, so side to side movement at MP joint occurs more during extension compared to
flexion. But in case of IP joint, collateral ligaments are of equal tightness.
75. Explain cruciform anastomosis at wrist?
76. Describe boundaries of anatomical snuffbox and its contents?
77. Why lumbricals have a tendinous origin?
 Lumbricals have to link the flexor and the extensor muscles of the hand with each other
(they have tendinous insertion as well). They have to exert both actions of flexion (at MCP)
and extension (at IP joints). They cannot do this if they are attached to bones, in acse of
which the proximal and distal attachments both would not be mobile (see Gray’s Anatomy,
40th ed.)
78. Why nerve supply of lumbricals varies?
 This is because lumbricals have the same nerve supply as the tendons they arise from.
79. Explain the different layers of intrinsic muscles of hand.
80. Explain the test for palmar and dorsal interossei.
81. Which movement is opposite to claw hand?
 The Z movement, involving flexion at MCP and extension at IP joints (see KLM)
82. Articular disc of SC joint divides it into how many compartments? Explain the movements in
each compartment?
83. What is pivot joint? Give example?
84. Why deltoid causes abduction only till 90◦?
 This is because the multipennate acromial fibers of deltoid that cause abduction have a
greater force of contraction, but shorter range of pull compared to its anterior and posterior
fibers. So they cannot abduct beyong 90◦. Also, at 90 degree abduction, its origin and
insertion come to ie in the same plane, and no further abduction is possible due to deltoid.
85. What is role of supraspinatus in abduction?
 If deltoid alone acts, it tends to raise head of humerus upwards as during shrugging of
shoulders. Supraspinatus braces the head of humerus so that deltoid can contract to
perform abduction. It can do so only till 15-30◦ because at this level its origin comes to lie in
the same plane as the axis of the arm, so no further abduction is caused by it.

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86. What is the Rotator Cuff? Which muscle if Rotator Cuff is not a rotator?
 Supraspinatus.
87. Explain pronator syndrome?
88. Origin, insertion of:
a. Deltoid
b. Trapezius
c. Lat dorsi
d. Pect major
e. Subclavius
f. Supraspinatus
89. Why is axillary nerve called circumflex nerve?
90. What is radial canal or radial tunnel syndrome or supinator channel syndrome?
 Injury of radial nerve at five potential sites, which are:
a. Proximal attachment of ECRB
b. Anterior to radiocapitellar joint
c. Proximal border of supinator (Arcade of Froshe)—most important
d. Distal border of supinator
e. Radial recurrent vessels (Leash of Henry)
91. What is Ulnar Canal (Guyon Canal) Syndrome? (see KLM)
92. What is Skier’s thumb (see KLM)?
93. What is Cubital tunnel syndrome? (see KLM)
94. What is anterior interosseous syndrome? (see KLM)
95. Explain Movements of thumb and their axes?
96. Explain nerves damaged due to humeral shaft fracture at different levels?
97. Explain coracoacromial arch?
98. What is direction of growing end of different long bones of upper limb? What is law of
ossification?
99. What is the Simian crease? (see KLM)
100. What is the significance of palmar spaces?
101. What is importance of forearm space of Parona?
102. Which region is supplied by ascending branch of anterior circumflex humeral vessels?
103. What is Saturday Night Palsy?
104. Explain Dupuytren’s contracture? (see KLM)
105. What is tenosynovitis? What is Quervain tenovaginitis stenosans? (see KLM)
106. What is Raynaud’s disease? (see KLM)
107. Explain avascular necrosis of scaphoid?
108. Why most of work is done in midprone position of forearm?
109. Name ligaments of shoulder joint.
110. Classify first CMC joint.

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These are some of the important questions that were asked in the final stage, upper limb. If you think
any unconventional or important question has been left, do notify.

What follows is a short key to remember the axes of different movements.

Movement Plane Axis

Flexion/Extension Sagittal plane Lateral (transverse)

Abduction/Adduction Coronal plane Anteroposterior (sagittal)

Rotation Transverse plane Longitudinal or vertical

That’s All Folks!

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