Upper extremities

Question 1

Spinal Accessory Nerve, C3, C4

Answer 1

Trapezius - shoulder shrug against resistance

Question 2

Spinal Accessory Nerve, C3, C4

Answer 2

Trapezius - push palms of hands hard against wall, elbows fully extended - can see and feel the lower fibres of trapezius

Question 3

Brachial Plexus, C5, C6, C7, C8, T1 complete lesions

Answer 3

lateral shoulder to just above the elbow, complete lower arm

Question 4

Brachial Plexus, C5, C6, lesions in upper roots

Answer 4

Lateral shoulder and arm including thumb

Question 5

Brachial Plexus, C8, T1, lesions in lower roots

Answer 5

medial elbow down to last two fingers

Question 6

Rhomboids (dorsal scapular nerve: C4, C5

Answer 6

Arm behind back, press palm of hand backwards against examiner’s hand

Question 7

Serratus anterior (Long thoracic nerve: C5, C6, C7

Answer 7

Patient pushes against a wall. If serratus anterior is paralysed, there is winging of the scapula

Question 8

Pectoralis Major: clavicular head (lateral pectoral nerve: C5, C6

Answer 8

Pectoralis Major: Clavicular Head (Lateral pectoral nerve; CS, C6)
The upper arm is above the horizontal and the patient is pushing forward against the
examiner’s hand. Arrow: the clavicular head of pectoralis major can be seen and felt.

Question 9

Pectoralis Major: Sternocostal Head (Lateral and medial pectoral nerves; C6, C7, C8

Answer 9

The patient is adducting the upper arm against resistance.

Arrow: the sternocostal head can be seen and felt.

Question 10

Supraspinatus (Suprascapular nerve; C5,C6

Answer 10

The patient is abducting the upper arm against resistance.

Arrow: the muscle belly can be felt and sometimes seen.

Question 11

Infraspinatus (Suprascapular nerve; C5, C6

Answer 11

The patient is externally rotating the upper arm at the shoulder against resistance. The
examiner’s right hand is resisting the movement and supporting the forearm with the
elbow at a right angle; his left hand is supporting the elbow and preventing abduction of
the arm. Arrow: the muscle belly can be seen and felt.

Question 12

Latissimus Dorsi (Thoracodorsal nerve; C6, C7, C8)

Answer 12

The upper arm is horizontal and the patient is adducting it against resistance. Lower
arrow: the muscle belly can be seen and felt. The upper arrow points to teres major.

Question 13

Latissimus Dorsi (Thoracodorsal nerve; C6, C7, C8)

Answer 13

Latissimus Dorsi (Thoracodorsal nerve; C6, C7, CS)
The muscle bellies can be felt to contract when the patient coughs.

Question 14

Teres Major (Subscapular nerve; C5, C6, C7

Answer 14

The patient is adducting the elevated upper arm against resistance.
Arrow: the muscle belly can be seen and felt.

Question 15

Musculocutaneous Nerve - supplies muscles ___

Answer 15

Coracobrachialis, Biceps, Brachialis

Question 16

Lesions of the musculocutaneous nerve cause sensory changes in the distribution of the lateral cutaneous nerve of the forearm.

Answer 16

affected area: Lateral forearm from elbow to wrist

Question 17

Biceps (Musculocutaneous nerve; C5, C6)

Answer 17

The patient is flexing the supinated forearm against resistance.
Arrow: the muscle belly can be seen and felt.

Question 18

Axillary Nerve, branches to upper cutaneous nerve of the arm - supplies muscles ___

Answer 18

Deltoid, Teres Minor (below scapula)

Question 19

Deltoid (Axillary nerve; C5, C6)

Answer 19

The patient is abducting the upper arm against resistance.

Arrow: the anterior and middle fibres of the muscle can be seen and felt.

Question 20

Deltoid (Axillary nerve; C5, C6)

Answer 20

The patient is retracting the abducted upper arm against resistance.
Arrow: the posterior fibres of deltoid can be seen and felt.

Question 21

Radial Nerve - branches into posterior interosseous nerve and superficial radial nerve - supplies muscles ___

Answer 21

Supplies muscles: Triceps, long head; triceps, lateral head; triceps, medial head; brachioradialis; extensor carpi radialis longus; Extensor carpi radialis brevis, supinator; extensor carpi ulnaris; extensor digitorum; extensor dititi minimi; abductor pollicis longus; extensor pollicis longus; extensor pollicis brevis; extensor indicis

Question 22

area within which sensory changes may be found in high lesions of the radial nerve (above the origin of the posterior cutaneous nerves of the arm and
forearm). The average area is usually considerably smaller, and absence of sensory changes has been recorded.

Answer 22

medial aspect of lower half of medial upper arm, goes down lower arm down to base of thumb, index finger, and half of middle finger

Question 23

approximate area within which sensory changes may be found in lesions of the radial nerve above the elbow joint and below the origin of the posterior cutaneous nerve of the forearm. (The distribution of the superficial terminal branch of the radial
nerve.) Usual area shaded, with dark blue line; light blue lines show small and large areas.

Answer 23

picture fig.25

Question 24

Triceps (Radial nerve; C6, C7, C8)

Answer 24

The patient is extending the forearm at the elbow against resistance.
Arrows: the long and lateral heads of the muscle can be seen and felt.

Question 25

Extensor Carpi Radialis Longus (Radial nerve; C5, C6)

Answer 25

The patient is extending and abducting the hand at the wrist against resistance. Arrows: the muscle belly and tendon can be felt and usually seen.

Question 26

Brachioradialis (Radial nerve; C5, C6)

Answer 26

The patient is flexing the forearm against resistance with the forearm midway between pronation and supination. Arrow: the muscle belly can be seen and felt.

Question 27

Supinator (Radial nerve; C6, C7)

Answer 27

The patient is supinating the forearm against resistance with the forearm extended at the elbow.

Question 28

Extensor Carpi Ulnaris (Posterior interosseous nerve; C7, C8)

Answer 28

The patient is extending and adducting the hand at the wrist against resistance. Arrows: the muscle belly and the tendon can be seen and felt.

Question 29

Extensor Digitorum (Posterior interosseous nerve; C7, C8)

Answer 29

The patient's hand is firmly supported by the examiner's right hand. Extension at the metacarpophalangeal joints is maintained against the resistance of the fingers of the examiner's left hand. Arrow: the muscle belly can be seen and felt.

Question 30

Abductor Pollicis Longus (Posterior interosseous nerve; C7, C8)

Answer 30

The patient is abducting the thumb at the carpo-metacarpal joint in a plane at right angles to the palm. Arrow: the tendon can be seen and felt anterior and closely adjacent to the tendon of extensor pollicis brevis (cf. Fig. 34).

Question 31

Extensor Pollicis Longus (Posterior interosseous nerve; C7, C8)

Answer 31

The patient is extending the thumb at the interphalangeal joint against resistance. Arrow: the tendon can be seen and felt.

Question 32

Extensor Pollicis Brevis (Posterior interosseous nerve; C7, C8)

Answer 32

The patient is extending the thumb at the metacarpophalangeal joint against resistance. Arrow: the tendon can be seen and felt (cf. Fig. 32).

Question 33

Median Nerve: branches into anterior interosseous nerve, palmar branch, and flexor retinaculum; supplies muscles _______

Answer 33

Supplies muscles: pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis, flexor digitorum profundus I and II, flexor pollicis longus, pronator quadratus, abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, first lumbrical, and second lumbrical

Question 34

The approximate areas within which sensory changes may be found in lesions of the median nerve in: A the forearm, B the carpal tunnel, note sparing of the palmar branch which does not go through the carpal tunnel.

Answer 34

palm of hand from midline of ring finger to thumb, including base of hand, and partial areas of thumb and first three fingers. Carpal tunnel involves midline of ring finger, middle finger, index finger, and half of distal thumb

Question 35

Pronator Teres (Median nerve; C6, C7)

Answer 35

The patient is pronating the forearm against resistance. | Arrow: the muscle belly can be felt and sometime seen.

Question 36

Flexor Carpi Radialis (Median nerve; C6, C7)

Answer 36

The patient is flexing and abducting the hand at the wrist against resistance. Arrow: the tendon can be seen and felt.

Question 37

Flexor Digitorum Superficialis (Median nerve; C7, C8, Tl)

Answer 37

The patient is flexing the finger at the proximal interphalangeal joint against resistance with the proximal phalanx fixed. This test does not eliminare the possibility of flexion at the proximal interphalangeal joint being produced by flexor digitorum profundus.

Question 38

Flexor Digitorum Profundus I and II (Anterior interosseous nerve; C7, C8)

Answer 38

The patient is flexing the distal phalanx of the index finger against resistance with the middle phalanx fixed.

Question 39

Flexor Pollicis Longus (Anterior interosseous nerve; C7, CS)

Answer 39

The patient is flexing the distal phalanx of the thumb against resistance while the proximal phalanx is fixed.

Question 40

Abductor Pollicis Brevis (Median nerve; C8, Tl)

Answer 40

The patient is abducting the thumb at right angles to the palm against resistance. Arrow: the muscle can be seen and felt.

Question 41

Opponens Pollicis (Median nerve; es, Tl)

Answer 41

The patient is touching the base of the little finger with the thumb against resistance.

Question 42

1st Lumbricai-Interosseous Muscle (Median and ulnar nerves; es, Tl)

Answer 42

The patient is extending the finger at the proximal interphalangeal joint against resistance with the metacarpophalangeal joint hyperextended and fixed.