A 24-year-old kabaddi player has had his right shoulder dislocate anteriorly four times in two years, each time while the arm was abducted and laterally rotated. MRI is done before surgery. What lesion is it most likely to show?

Detachment of the anteroinferior glenoid labrum

Detachment of the posterior glenoid labrum

Full-thickness tear of the subscapularis tendon

Tear of the superior labrum from front to back

A 32-year-old man in a district hospital has a gunshot injury to the right axilla with torrential bleeding from the axillary artery. A vascular surgeon is not available and the general surgeon decides that ligation is the only option to save his life. At which site is ligation least likely to cost him the limb?

Between the thyrocervical trunk and the subscapular artery

Between the subscapular artery and the profunda brachii

Just distal to the anterior circumflex humeral artery

Just proximal to the profunda brachii origin

Upper limb joints, spaces and vessels

15 NEET-PG practice questions on Upper limb joints, spaces and vessels, part of Anatomy. The first 15 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 19-year-old is brought to casualty with a deep glass cut in the cubital fossa just medial to the palpable biceps tendon. There is brisk bright red bleeding from the wound. Which structure has most likely been cut?
1. ABrachial artery
2. BUlnar nerve
3. CRadial nerve
4. DMedian nerve
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Answer: A · Brachial artery
From lateral to medial, the main contents of the cubital fossa are the biceps tendon, the brachial artery and the median nerve, with the radial nerve tucked laterally under brachioradialis. The structure immediately medial to the biceps tendon is the brachial artery, which divides at the neck of the radius into radial and ulnar arteries. Brisk arterial bleeding fits. The median nerve lies further medial and should be tested after the bleeding is controlled.
- B: The ulnar nerve is behind the medial epicondyle, not in the cubital fossa.
- C: The radial nerve lies lateral to the biceps tendon under brachioradialis.
- D: The median nerve lies medial to the artery and does not bleed briskly.
Question 2 · Medium
A 24-year-old kabaddi player has had his right shoulder dislocate anteriorly four times in two years, each time while the arm was abducted and laterally rotated. MRI is done before surgery. What lesion is it most likely to show?
1. ADetachment of the posterior glenoid labrum
2. BFull-thickness tear of the subscapularis tendon
3. CTear of the superior labrum from front to back
4. DDetachment of the anteroinferior glenoid labrum
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Answer: D · Detachment of the anteroinferior glenoid labrum
Recurrent anterior dislocation in a young athlete is usually due to a Bankart lesion: the anteroinferior labrum and capsule are torn off the glenoid rim, so the humeral head is no longer held in front. A Hill-Sachs lesion, an impaction defect on the posterolateral humeral head, often accompanies it. The shoulder joint is inherently unstable because the glenoid is shallow and the inferior capsule is lax. Surgical repair of the labrum (Bankart repair) is the usual treatment.
- A: Posterior labral detachment goes with posterior instability, not anterior dislocation.
- B: Subscapularis tears are more typical in older patients after dislocation.
- C: A SLAP tear involves the biceps anchor and causes pain more than recurrent dislocation.
Question 3 · Medium
A nursing student is learning venepuncture in the cubital fossa. Her tutor tells her to prefer the median cubital vein because a deeper structure protects the artery and nerve beneath it. Which structure is this?
1. APronator teres muscle
2. BBicipital aponeurosis
3. CBrachioradialis muscle
4. DBrachialis muscle
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Answer: B · Bicipital aponeurosis
The bicipital aponeurosis is a sheet of deep fascia from the biceps tendon that runs medially to the deep fascia of the forearm. The median cubital vein lies superficial to it, while the brachial artery and median nerve lie deep to it, so the aponeurosis shields them from a needle. This is why the median cubital vein is the usual site for venepuncture. It is also why the old practice of venesection here rarely injured the artery.
- A: Pronator teres forms the medial boundary of the fossa, not a covering sheet.
- C: Brachioradialis forms the lateral boundary of the cubital fossa and does not cover the artery.
- D: Brachialis forms the floor of the fossa, lying behind the artery and nerve.
Question 4 · Hard
A 32-year-old man in a district hospital has a gunshot injury to the right axilla with torrential bleeding from the axillary artery. A vascular surgeon is not available and the general surgeon decides that ligation is the only option to save his life. At which site is ligation least likely to cost him the limb?
1. ABetween the thyrocervical trunk and the subscapular artery
2. BBetween the subscapular artery and the profunda brachii
3. CJust distal to the anterior circumflex humeral artery
4. DJust proximal to the profunda brachii origin
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Answer: A · Between the thyrocervical trunk and the subscapular artery
The scapular anastomosis links branches of the subclavian artery (suprascapular from the thyrocervical trunk and the dorsal scapular artery) with the circumflex scapular branch of the subscapular artery. If the artery is tied proximal to the subscapular artery, blood can flow round the scapula and enter the axillary artery again through the subscapular artery, so the limb survives. Ligation distal to the subscapular artery but above the profunda brachii cuts the limb off from this collateral route. Repair or a temporary shunt is still preferred whenever possible.
- B: This segment lies distal to the subscapular artery, beyond the scapular anastomosis.
- C: This site is distal to the subscapular artery, so the scapular collateral cannot refill it.
- D: This site is below the subscapular artery but above the profunda, the most dangerous zone.
Question 5 · Easy
A 21-year-old college footballer falls on his outstretched hand. The wrist X-ray looks normal, but he has marked tenderness in the hollow between the tendons on the radial side of the dorsum of the wrist. Which bone is most likely fractured?
1. ALunate
2. BScaphoid
3. CHamate
4. DTrapezoid
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Answer: B · Scaphoid
The hollow is the anatomical snuffbox, and the scaphoid forms the main part of its floor. Snuffbox tenderness after a fall on the outstretched hand is treated as a scaphoid fracture even if the first X-ray is normal: the wrist is immobilised and imaged again, or MRI is done. Blood vessels enter the scaphoid mainly at its distal part, so a waist fracture can leave the proximal pole without supply and cause avascular necrosis or non-union.
- A: The lunate lies deeper, in line with the third metacarpal, not in the snuffbox floor.
- C: The hamate lies on the ulnar side of the wrist, not under the snuffbox.
- D: The trapezoid lies distal to the snuffbox and is rarely fractured.
Question 6 · Hard
A 63-year-old retired mason fell on his right shoulder. He can raise the arm passively, but when it is placed at 90 degrees of abduction he cannot hold it and it drops. With the elbow at his side, the arm springs back into medial rotation when the examiner releases it from passive lateral rotation. The lift-off test is normal. Which tendons are most likely torn?
1. ASupraspinatus and infraspinatus
2. BSupraspinatus and subscapularis
3. CSubscapularis and teres major
4. DInfraspinatus and teres minor
Answer and explanation in LearnFree account
Question 7 · Medium
A 58-year-old woman fractured the lower end of the right radius six weeks ago; it healed in a cast without displacement. While cooking she suddenly finds she cannot straighten the tip of her thumb. On examination, the tendon forming the ulnar (medial) border of the anatomical snuffbox is no longer felt. Which tendon has ruptured?
1. AExtensor pollicis brevis
2. BExtensor carpi radialis longus
3. CExtensor pollicis longus
4. DAbductor pollicis longus
Answer and explanation in LearnFree account
Question 8 · Easy
A 56-year-old house painter has pain in the right shoulder when raising the arm sideways between about 60 and 120 degrees; below and above this range the movement is painless. Which tendon is most likely involved?
1. ASubscapularis
2. BTeres minor
3. CSupraspinatus
4. DInfraspinatus
Answer and explanation in LearnFree account
Question 9 · Hard
After reduction of an anterior shoulder dislocation, a retired weaver aged 68 cannot lift the back of her right hand off her lower back, and when she presses her palm into her belly she cannot keep the elbow forward. Passive internal rotation is full, but active internal rotation is much weaker than external rotation. There is no numbness over the deltoid, and abduction is nearly full. She had been lifting water pots at home without difficulty until the fall. MRI confirms a full-thickness tear of one rotator cuff tendon. Which nerves supply the torn muscle?
1. AThoracodorsal and long thoracic nerves
2. BUpper and lower subscapular nerves
3. CSuprascapular nerve
4. DAxillary nerve
Answer and explanation in LearnFree account
Question 10 · Easy
The pulse felt in the floor of the anatomical snuffbox belongs to which artery?
1. AUlnar artery
2. BAnterior interosseous artery
3. CPrinceps pollicis artery
4. DRadial artery
Answer and explanation in LearnFree account
Question 11 · Hard
In the casualty, a carpenter has a deep stab wound from a chisel in the centre of his right palm, level with the distal border of the fully extended thumb, with brisk bright-red bleeding that soaks the dressing. The hand is warm and the radial pulse is good. The surgeon explains that the arterial arch at this level lies just deep to the palmar aponeurosis and that the deep arch lies about a finger's breadth closer to the wrist. Mainly the continuation of which artery forms the arch that has been cut?
1. AAnterior interosseous artery
2. BRadial artery
3. CUlnar artery
4. DPrinceps pollicis artery
Answer and explanation in LearnFree account
Question 12 · Medium
A volleyball player who spikes overhead for hours each day has vague pain at the back of the right shoulder, numbness over the lower lateral deltoid and weakness of abduction after the first few degrees. MR angiography shows that the posterior circumflex humeral artery is blocked when the arm is abducted and laterally rotated. Through which space do the compressed structures pass?
1. ALower triangular space
2. BQuadrangular space
3. CSuprascapular notch
4. DUpper triangular space
Answer and explanation in LearnFree account
Question 13 · Medium
Of every 100 shoulder dislocations seen in a district hospital casualty, about 95 are anterior. The humeral head first escapes through the part of the joint capsule that is weakest because no rotator cuff tendon supports it, and then moves forward under the coracoid. Which part of the capsule is this?
1. AAnterior part, deep to subscapularis
2. BInferior part of the capsule
3. CPosterior part of the capsule
4. DSuperior part of the capsule
Answer and explanation in LearnFree account
Question 14 · Medium
A fall on the outstretched arm at a CHC leaves the shoulder squared off, with the arm held away from the chest. The films shown are taken before reduction. Which bedside test best documents the nerve most often injured in this condition?
Figure: Photo: Hellerhoff, CC BY-SA 3.0, via Wikimedia Commons
1. AOpposition of the thumb against the little finger
2. BSensation over the dorsal first web space of the hand
3. CSensation over the lower lateral deltoid and deltoid contraction
4. DExtension of the wrist against resistance
Answer and explanation in LearnFree account
Question 15 · Easy
A toddler holds his forearm limp and pronated after being swung up by the hand. Out of which structure has the radial head slipped?
1. AInterosseous membrane
2. BAnnular ligament
3. CRadial collateral ligament
4. DQuadrate ligament
Answer and explanation in LearnFree account

Upper limb joints, spaces and vessels

A 19-year-old is brought to casualty with a deep glass cut in the cubital fossa just medial to the palpable biceps tendon. There is brisk bright red bleeding from the wound. Which structure has most likely been cut?

A 24-year-old kabaddi player has had his right shoulder dislocate anteriorly four times in two years, each time while the arm was abducted and laterally rotated. MRI is done before surgery. What lesion is it most likely to show?

A nursing student is learning venepuncture in the cubital fossa. Her tutor tells her to prefer the median cubital vein because a deeper structure protects the artery and nerve beneath it. Which structure is this?

A 21-year-old college footballer falls on his outstretched hand. The wrist X-ray looks normal, but he has marked tenderness in the hollow between the tendons on the radial side of the dorsum of the wrist. Which bone is most likely fractured?

A 56-year-old house painter has pain in the right shoulder when raising the arm sideways between about 60 and 120 degrees; below and above this range the movement is painless. Which tendon is most likely involved?

The pulse felt in the floor of the anatomical snuffbox belongs to which artery?

A fall on the outstretched arm at a CHC leaves the shoulder squared off, with the arm held away from the chest. The films shown are taken before reduction. Which bedside test best documents the nerve most often injured in this condition?

A toddler holds his forearm limp and pronated after being swung up by the hand. Out of which structure has the radial head slipped?