1. a) Which nerves) are likely to be injured in fractures of the neck of the humerus?

b) What disabilities will the patient suffer?

2. a) Name the two groups of interrossei muscle.

b) What is the action of each group?

3. a) Give the structures that form the coracoacromial arch.

b) What is the significance of this arch?

4. List the muscles forming the rotator cuff and their nerve supply.

5. List the different groups of axillary lymph nodes.

6. Which cord of the brachial plexus contains fibres from all roots of the plexus?

7. List the source of blood supply to the breast (mammary gland)

8. Name the muscles in the anterior compartment of the arm and their nerve supply.
1. Name the nerves of the upper limb which are likely to be injured in fractures of the humerus.
Mention the site of the humerus.
Axillary nerve Neck of humerus
Radial nerve Shaft of humerus
Ulnar nerve Medial epicondyle
Median nerve Lunate bone

2. Name the two groups of interrossei muscle. What is the action of each group?
Dorsal Abduct
Palmar Adduct

3. Give the structures that form the coracoacromial arch. What is the significance of this arch?
Arch is formed by inferior aspect of the acromion and coracoid process of the scapula with the
coracoacromial ligament spanning between them.
It prevents superior displacementof shoulder joint..

4. List the muscles forming the rotator cuff and their nerve supply.
Supraspinatus suprascapular nerve
Infraspinatus suprascapular nerve
Teres minor axillary nerve
Subscapular Lower and upper subscapular nerves

5. List the different groups of axillary lymph nodes.

Anterior (pectoral), posterior (suscapular), lateral, central, infraclavicular (deltopectora) and
apical.

6. Which cord of the brachial plexus contains fibres from all roots of the plexus?
Posterior
7. List the source of blood supply to the breast (mammary gland)
i. First four perforating arteries of internal thoracic artery
ii. Lateral mammary arteries from lateral thoracic artery.
iii. Lateral cutaneous branches of the posterior intercostal arteries
iv. Branches from thoraco acromial.

8. Name the muscle in the anterior compartment of the arm. What is the nerve supply?
Biceps brachii Musculocutaneous nerve

Upper limb
1. Describe the factors responsible for the stability of the shoulder joint.

2. Describe the boundaries of the cubital fossa and list its contents from medial to lateral.
3. List the intrinsic muscles of the hand and their nerve supply

4. Describe the attachments and content of the clavipectoral fascia

5. Describe the arteries participating in the scapular anastomosis

6. Describe the walls and content of the axilla

7. List the branches, distribution and applied anatomy of the cords of the brachial plexus.

8. Describe the lymph nodes of the axilla.

9. Name the structures passing under the flexor retinaculum at the wrist joint.

10. In fractures of the bones of the upper limb, name the nerves which are very close to the bone
and hence likely to be injured.

11. Describe the lymphatic drainage of the breast.

12. Describe the palmar arches

13. Indicate the most appropriate sites for taking pulse rate in both upper and lower limbs.
1. a) Name the nerves of the upper limb which are likely to be injured in fractures of the humerus
a forearm bone was fractured. Mention the site of the humerus.
2 a) Name the muscle which protracts the scapula and holds it against the thoracic wall.
b) Name the muscle which extends and adducts the hand.
3 a) Give two muscles which extend the forearm.
b) Describe the motion of the radius and ulna during supination and pronation.
4. a) Why is ‘wrist drop’ produced when the radial nerve is injured in the radial groove?
b) List the different groups of axillary lymph nodes.
5. a) What muscles abduct the thumb and what muscle abducts the index fingers?
b) What muscles abduct the middle finger?
6. a) Give the structures that form the coracoacromial arch.
b) What is the significance of this arch?
7. a) Which part of the humerus is most frequently fractured?
b) Which portion of the humerus articulates with the ulna?
8. a) What is the result of compression of the median nerve in the carpal tunnel?
b) Describe the relations of the median nerve to the brachial artery.
9. a) Give the termination of the musculocutaneous nerve after supplying the muscles of the
anterior compartment of the arm.
b) List the muscles which form the posterior wall of the axilla.
10. a) Give the relation of the axillary vein to the axillary artery.
b) What is the motor change that occurs after axillary nerve injury?
11. a) List the muscles forming the rotator cuff and their nerve supply.
b) What muscle can act as an abductor, flexor and extensor of the arm at the shoulder joint?
12. a) Which cord of the brachial plexus contains fibres from all roots of the plexus?
b) Give the relations of the ulnar and median nerves to the flexor retinaculum.
13. Name the contents of the pectoral region
1. Give an outline of the boundaries and contents of the axilla
a) Describe how the brachial plexus is formed
b) List the nerves originating from the different parts of the brachial plexus
c) Outline the injuries to the parts and major nerves of the brachial plexus

2. Concerning the clavicle;

a) Which part of the clavicle is most commonly fractured
b) How and why are the bony fragments displaced?
c) What structure(s) are likely to be damaged in a simple fracture of the clavicle?

3. a) Describe the scapular anastomosis.

b. Why is this knowledge important?
c) What do you understand by the infraspinatus fascia and what is its significance?
d) What causes the winging of the scapular?
e) What part of the clavicle commonly fractures and why?

4. a) What factors are responsible for the instability of the shoulder joint
b) To what position does the shoulder joint commonly dislocate and why?
 c) What happens to the joint movements when the following nerves are injured?
i. Long thoracic nerve
ii. Axillary nerve
iii. Suprascapular nerve.
d) Name the various bursae around the shoulder joint, which of them
communicate with the joint?
e) Name the structures responsible for the stability of the shoulder joint

5. a) Discuss the gross structure of the mammary gland

b) Discuss the origin, insertion and actions of the muscles that form the bed of the
breast
c) Outline clearly its lymphatic drainage. Why is this knowledge very important?
d) Outline the development anomalies of the breast.

6. a) What peripheral nerve is and what artery may be torn in fractures of midhumeral
region?
b) Would elbow flexion be weakened if the x-ray showed a fracture of the humerus
distal to the attachment of the deltoid muscle?
c) What do you understand by wrist drop?

7. List the contents of the:

a) Anterior and posterior compartments of the arm
b) A 20 year old man was involved in a RTA and sustained a fracture along the
surgical neck of his left humerus.
i. What important structures may have been involved
ii. How do you clinically confirm the above structures

8. i. List 8 anatomical happenings at the level of the middle of the arm

ii. A 30 year ild woman was involved in RTA and sustained a fracture at the mid shaft
of his right humerus
i. What nerve was most likely injured and why
ii. What disability does he suffer at the elbow joint

9. a) What are the boundaries of the cubital fossa?

a) b) Name the contents of the contents of the cubital fossa from medial to lateral
b) List the vessels involved in elbow arterial anastomosis.

10. Describe the origins and insertions of the muscles, ligaments and the capsule
associated with the stability of the elbow joint.

11. a) Name the bones that participate in the wrist joint

b)List the carpal bones in the order of classification
c)Which of the carpal ones commonly fractures and why is it
difficult to treat it

12. a) List the muscles of the:

 i. Flexor compartment
ii. Extensor compartment
iii. What are the boundaries of the space of Parona?
b) What is the internervous line of the forearm?

13. Describe the following palsies/ fractures in terms of positions assumed by the fingers
and thumb of the hand; muscles that would show evidence of wasting and nerve
roots were injured
a) Erb-Duchenne palsy
b) Klumpke’s palsy
c) Colles’s fracture
d) Smith fracture
e) Montaggea frature
f) Galeazi fracture

14. a) Differentiate between radial and ulna bursae

b) What are the other spaces of the hand?
c) What is their clinical significance?

15. a) Describe the boundaries of the anatomical snuff box

b) Mention areas in the upper limb where pulse can be taken
c) What is the anatomical basis for taking pulse in these areas?

16. a) List the carpal bones

b) What are the peculiarities of scaphoid bone?

17. a) Name the structures passing below the flexor retinaculum?

b) What do you understand by carpal tunnel syndrome?
a) What are the causes of carpal tunnel syndrome?

18. a) What makes the arterial arcades in the hands?

b) What is the importance of these arcades?
c) Discuss the nerve supply of the dorsum and palm of the hand

19. a) Describe the origin, course and distribution of the median, ulnar and radial nerves.
b) What common injuries can occur to these nerves in this region?
c) In injury of the axillary nerve:
a. What can cause this injury
b. What muscles are affected
c. Any other physical feature
1. Name the groups into which the intrinsic muscles of the hand are divided
What is the nerve supply to these muscles?

2. a) Describe how the arteries of the forearm form the palmar arches

b) What is the anatomical/clinical significance of these arches?

3. Describe in details the superficial and deep lymphatic drainage of the female breast
4. Name the walls of the axilla and the structures making those walls

5. a) Which nerve(s) are likely to be injured in fractures of the medial condyle of the
humerus?

b) What disabilities will the patient suffer?

6. a) Describe the arteries participating in the scapular anastomosis

b) What is the anatomical significance of this anstomosis?

7. Name the ligaments of the shoulder joint.

What is/are the function(s) of each ligament you mention?

1. a) Name the ligaments associated with the shoulder joint.

Glenohumeral ligaments are three weak bands of fibrous tissue that strengthen the front of the
capsule (figure 1.1).
Transverse humeral ligament strengthens capsule and bridges the gap between the two
tuberosities.
Coracohumeral ligament strengthens the capsule above and stretches from the root of the
coracoid process to the greater tuberosity of the humerus.
Accessory ligaments
Coracoacromial ligament extends between the coracoid process and the acromion. Its function
is to protect the superior aspect of the joint (figure 1.3).
Coracoclavicular ligament as the name suggests extends from coracoid process to the clavicle.
It stabilizes the clavicle during shoulder movements.

b) Name the functions of each of those ligaments you have mentioned

2. a) Which muscles form the bed of the breast

The base overlies mostly pectoralis major but inferolaterally; it covers part of serratus anterior
and external oblique muscles.
b) Name the nerves supplying those muscles.
Pectoralis major by medial and lateral pectoral nerves,
Serratus anterior by long thoracic nerve.
External oblique muscles lower six thoracic nerves and iliohypogastric and ilioinguinal nerves
(L1).

3. a) Name the walls of the axilla

The anterior is composed of: pectoralis major, subclavius and pectoralis minor muscles and
pectoral and clavipectoral fasciae
. The posterior is made of the following muscles from above downwards: subscapularis,
latissimus dorsi, and teres major.
The medial wall is also made of: upper four or five ribs and the intercostral spaces covered by
serratus anterior muscle.
The lateral wall has: coracobrachialis and biceps muscles.
The base is made of the skin stretching from between anterior and posterior walls.

b) Which structures are found in each wall?

4. a) Name the muscles of the compartments of the upper arm

Biceps brachii, Coracobrachialis and Brachialis

b) Name their nerve supply

Musculocutaneous nerve

5. a) Describe the venous drainage of the upper limb

b) Name the blood vessels contributing to the scapular arterial anastomosis

Branches from the subclavian artery are suprascapular and superficial cervical artery through
its deep branch. Branches from axillary artery are subscapular artery and its circumflex artery,
anterior and posterior circumflex humeral arteries.
Scapular anastomosis

6. a) Name the arteries contributing to the elbow arterial anastomosis.

Fig. 4. Arterial anastomosis around the elbow joint

b) Name the compartments of the forearm and the nerves supplying each compartment
Anterior by median and ulnar nerves, lateral and posterior by radial nerve
7. a) Name the structures found under the carpal tunnel.
Flexor superficialis tendons
Flexor digitorum longus
Median nerve
Flexor pollicis longus tendon
Flexor carpi radialis tendon

b) What is the clinical significance of this carpal tunnel?

Carpal tunnel syndrome

8. a) Name the structures contributing to the palmar aponeurosis.

Palmaris longus, deep fascia and flexor retinaculum
b) What is the function of this palmar aponeurosis?
Protection and compartmentalization

9. a) Name the groups of intrinsic muscles of the palm of the hand

Lumbrical muscles
Thenar muscles
Hypothenar muscles
Interosseous muscles

b) Name the nerve supply of each group

Lumbrical muscles: The lateral two are supplied by the median nerve. The medial two are
supplied by the deep branch of ulnar nerve
Thenar muscles: They are all supplied by the median nerve except adductor pollicis.
Hypothenar muscles: They are supplied by the deep branch of ulnar nerve.
Interosseous muscles: They are all supplied by the ulnar nerve.

10. a) Name the boundaries of the cubital fossa

The greater part of the floor of fossa is formed by the brachialis muscle medially and supinator
muscle laterally. Roof is by skin, antebrachial fascia reinforced medially by the bicipital
aponeurosis. Brachioradialis forms the lateral boundary and the pronator teres forms the medial
boundary.

b) List its contents from medial to lateral.

Median nerve, brachial artery, tendon of biceps muscle and the radial nerve and its deep branch

c) What is the clinical significance of the cubital fossa?

It is important because it contains all the major nerves and vessels that supply the forearm and
hand. Venopuncture for diagnostic, therapeutic etc purposes

TRUE OR FALSE

---1. Trapezius and serratus anterior muscles are supplied by brachial plexus.
---2. All the dorsal surface of the hand has cutaneous supply from the median nerve.
---3. The ulnar nerve enters the hand deep to the flexor retinaculum.
---4. All rotator cuff muscles have similar function and the same nerve supply.
---5. The brachialis muscle is supplied by both musculocutaneous and radial nerves.
---6. The brachioradialis muscle is a flexor of the forearm in spite of the fact that it belongs to the
extensor group.
---7. The levator scapulae, rhomboideus major and minor are supplied by dorsal scapular nerve.
1. ---Trapezius and serratus anterior muscles are supplied by brachial plexus.
2. ---The axillary nerve is related to the anatomical neck of the humerus.
3. ---The dorsal interossei muscles abduct the fingers.
4. ---All the palmar surface of the hand has cutaneous supply from the median nerve.
5. ---The biceps brachii muscle is a powerful supinator for the flexed forearm.
6. ---The ulnar nerve enters the hand superficial to the flexor retinaculum.
7. ---Protraction of the scapula is produced by serratus anterior
8. ---All rotator cuff muscles have similar function and the same nerve supply.
9. ---The scaphoid bone articulates with the lunate bone as well as the Trapezium.
10. ---The brachial artery terminates at the level of neck of the radius.
11.---The long head of biceps brachii muscle lies intracapsularly as well as intra synovially of the
shoulder joint.
12. ---The brachialis muscle is supplied by both musculocutaneous and radial nerves.
13. ---The biceps brachii muscle is a powerful supinator when the forearm is extended.
14. ---The brachioradialis muscle is a flexor of the forearm in spite of the fact that it belongs to
the extensor group.
15. ---The axillary artery is entirely overlapped by pectoralis major muscle.
16. ---The levator scapulae, rhomboideus major and minor are supplied by dorsal scapular nerve.
17. ---The upper trunk of the brachial plexus is the only trunk which gives branches.
18. ---The axillary nerve passes through the quadrangular space in company with the axillary
vessels.

MARCHING

----1. Deltoid A. ulnar nerve

----2. Serratus anterior B. Axillary nerve
----3. Adductor policis C. Radial nerve
----4. Flexor carpi ulnaris D. Deep branch of ulnar nerve
----5. Extensior carpi ulnaris E. Long thoracic nerve

2. Match artery with its branch

Artery Branch
----1. Axillary artery A. Profunda brachii artery
----2. Brachial artery B. Radial recurrent artery
----3. Radial artery C. Radial collateral artery
----4. Ulnar artery D. Posterior circumflex humeral artery
----5. Profunda brachii artery E. Common interosseous artery