Upper Limb V

Question 1

Injury to this nerve produces paraesthesia over the back of the thumb.

Answer 1

Radial nerve
The radial nerve supplies sensation to the dorsal aspect of the hand and also innervates the extensor muscles of the upper limb.

Question 2

Injury to this nerve produces weakness of finger adduction.

Answer 2

Ulnar nerve
The ulnar nerve supplies the muscles of the hand involved in adduction of the fingers and provides sensation to the medial one and half fingers.

Question 3

Injury to this nerve produces paraesthesia over the deltoid muscle.

Answer 3

Axillary nerve

The axillary nerve (C56) supplies sensation over the deltoid muscle and may be injured in dislocation of the shoulder.

Question 4

Which of the following is true regarding the radial nerve?
(Please select 1 option)
Gives off an anterior interosseous branch
Is derived from the posterior primary rami of the C5 to T1 nerve roots
Is the main nerve supply to the flexor compartments of the arm and forearm
Is the principal branch of the posterior cord of the brachial plexus
Supplies sensation to the extensor aspect of the distal two phalanges of the radial three and a half digits

Answer 4

Is the principal branch of the posterior cord of the brachial plexus

The radial nerve is the continuation of the posterior cord of the brachial plexus.

The brachial plexus is formed by the anterior roots of C5 to T1 spinal nerves. The roots of C5 and C6 join together to form the upper trunk. C7 continues as the middle trunk while C8 and T1 join to form the lower trunk. Each of these trunks divides into anterior and posterior division.

All the posterior divisions join to form the posterior cord while the anterior divisions of the upper and middle trunks join to form the lateral cord and the anterior division of the lower trunk continues as the medial cord.

It is the principal motor supply to muscles of the extensor compartments of the arm, forearm and the dorsum of the hand.

Surface marking of radial nerve is from the point where the posterior wall of axilla and the arm meet to a point two thirds of the way along the line, joining the acromion to the lateral epicondyle and thence to the front of the epicondyle.

The radial nerve supplies all the muscles of the posterior compartment of the arm, gives sensory branches to the skin overlying the posterior compartment and lateral aspect of the arm, and divides in the anterior compartment of forearm into posterior interosseous nerve and its terminal superficial branch.

Through these branches it supplies extensor muscles and skin on the lateral aspect of the forearm. It supplies the skin over the proximal phalanges on the extensor aspect of the radial three and half digits. The dorsal aspect of the distal two phalanges is supplied by median nerve (its branches).

Question 5

Which of the following anatomical relations of the scalenus muscles is true?
(Please select 1 option)
The ascending cervical artery lies lateral to the phrenic nerve
The phrenic nerve passes behind scalenus anterior
The subclavian artery and vein are separated by scalenus medius
The subclavian vein forms the brachiocephalic vein at the lateral border of scalenus anterior
The trunks of the brachial plexus emerge from the lateral border of scalenus anterior

Answer 5

The trunks of the brachial plexus emerge from the lateral border of scalenus anterior This is the correct answerThis is the correct answer
The ascending cervical artery, medial to the phrenic nerve on scalenus anterior, can easily be mistaken for the phrenic nerve at operation.

The phrenic nerve passes inferiorly across scalenus anterior and medius.

The subclavian artery and vein are separated by scalenus anterior.

The subclavian vein joins with the internal jugular to form the brachiocephalic vein at the medial border of scalenus anterior.

The trunks of the brachial plexus emerge from the lateral border of scalenus anterior.

Question 6

Which of the following is correct concerning the cephalic vein?
(Please select 1 option)
It has no valves
It is on the radial aspect of the wrist
It joins the brachial artery at the elbow
It lies deep to the cutaneous nerve of the forearm
It lies medial to the biceps muscle

Answer 6

It is on the radial aspect of the wrist

The cephalic vein forms the superficial venous network on the dorsum of the hand and, beginning at the anatomical snuffbox, ascends along the lateral border of the limb.

In the upper arm it lies lateral to the biceps muscle in the deltopectoral groove and perforates the clavipectoral fascia to drain into the axillary vein.

The axillary vein is formed by the vena comitans of the brachial artery and the basilic vein above the lower border of the posterior wall of the axilla.

Question 7

Which of the following is true regarding the median nerve?
(Please select 1 option)
It has a root value of C4, C5 and C6
It is the terminal branch of the lateral cord of the brachial plexus
It lies lateral to the brachial artery in the antecubital fossa
It passes between the heads of the pronator teres muscle
It passes superficial to the flexor retinaculum

Answer 7

It passes between the heads of the pronator teres muscle

The median nerve originates from the medial and lateral cords of the brachial plexus (C5, C6 and C7). Within the upper arm it lies lateral to the brachial artery, crossing to the medial side above and through the antecubital fossa. It then passes between the heads of the pronator teres muscle which it supplies, and other branches supply the flexor carpi radialis, palmaris longus and flexor digitorum superficialis muscles.

The anterior interosseous branch of the median nerve supplies

The pronator quadratus
Flexor pollicis longus
The lateral half of flexor digitorum profundus.
Within the hand, a superficial cutaneous branch passes over the flexor retinaculum, with the main branch passing deep to the flexor retinaculum.

Within the palm, the recurrent branch supplies the muscles of the thenar eminence (the flexor pollicis brevis, abductor pollicis brevis and opponens pollicis muscles, except the adductor supplied by the ulnar nerve). Within the palm, the median nerve supplies the two lateral lumbrical muscles, and provides cutaneous sensory and sympathetic fibres to the palmar surface of the thumb and to the lateral two and a half fingers and nail beds.

Question 8

Which of the following muscular tendons does not make up the rotator cuff in the shoulder?
(Please select 1 option)
	 Infraspinatus
	 Latissimus dorsi
	 Subscapularis
	 Supraspinatus
	 Teres minor

Answer 8

Latissimus dorsi

The rotator cuff is an important structure in the shoulder joint which helps in stabilising the humeral head within the glenoid, particularly when the arm is flexed or abducted by the deltoid muscle.

It is formed by a sheath of conjoint tendons which run over the top of the shoulder capsule and insert into the greater tuberosity of the humerus.

The tendons which make up the rotator cuff of the shoulder are

Supraspinatus
Infraspinatus
Teres minor
Subscapularis.
Supraspinatus inserts into the tip of the greater tuberosity of the humerus. It is responsible for initiating abduction of the arm.

Infraspinatus inserts just behind and below the tip of the tuberosity. It helps in external rotation of the arm.

Teres minor is completely hidden beneath the deltoid, as it passes behind the origin of the triceps to get inserted at the greater tuberosity of the humerus.

Subscapularis is the only rotator cuff muscle that gets inserted into the lesser tuberosity of the humerus.

Latissimus dorsi and coracobracilis do not play any part in the formation of the rotator cuff.

Question 9

Which of the following is true regarding the subclavian artery?
(Please select 1 option)
Arises from the brachiocephalic trunk on the left side
Gives off the thoracoacromial trunk
Gives off the vertebral artery
Has a surface marking of the mid-clavicle to the acromioclavicular joint
Passes superficial to the scalenus anterior

Answer 9

Gives off the vertebral artery

Surface markings: Indicated by an arch between the medial end of the sternoclavicular joint and the lateral end at mid clavicle.
Course: On the right it originates from the brachiocephalic trunk and on the left, from the arch of the aorta. It passes posterior to the scalenus anterior and becomes the axillary artery at the lateral border of the first rib.
Branches: Vertebral, internal thoracic, deep cervical and highest intercostal arteries and thryocervical trunk.

Question 10

Which of the following is true regarding the posterior interosseous nerve?
(Please select 1 option)
Is a branch of the median nerve
Passes medially around the radial neck
Passes through the two heads of pronator
Supplies extensor carpi radialis longus
Supplies the intercarpal joints

Answer 10

Supplies the intercarpal joints This is the correct answerThis is the correct answer
The radial nerve gives off the posterior interosseous nerve in the forearm.

The posterior interosseous nerve emerges from below the brachioradialis at the level of the elbow joint. Then it passes between the humeral and ulnar heads of supinator to curve laterally around the radial neck to enter the extensor compartment of the forearm.

The posterior interosseous nerve supplies all extensors except extensor carpi radialis longus which is supplied by the radial nerve.

The nerve travels along the interosseous membrane giving articular branches to the elbow, wrist and intercarpal joints.

Question 11

The superior vena cava is formed by the union of which of the following?
(Please select 1 option)
Left jugular vein and right brachiocephalic trunk
Right and left brachiocephalic trunks
Right brachiocephalic trunk and left subclavian vein
Right brachiocephalic trunk and right subclavian vein
The thoracic duct

Answer 11

Right and left brachiocephalic trunks

The superior vena cava is formed by the union of the two brachiocephalic veins, this vessel then descends vertically and terminates in the right atrium.

The superior vena cava receives the azygos vein before piercing the fibrous pericardium.

Each of the brachiocephalic veins is formed in the root of the neck by the union of the internal jugular and subclavian veins.

The thoracic duct joins with the left brachiocephalic vein as it enters the thorax.

Question 12

Which one of the following is not part of the axillary lymph nodes?
(Please select 1 option)
	 Central group
	 Clavicular group
	 Lateral group
	 Pectoral group
	 Subscapular group

Answer 12

Clavicular group

The clavicular is not a group of the axillary lymph nodes.

Question 13

Which of the following is true regarding the first rib?
(Please select 1 option)
The lower trunk of the brachial plexus lies behind the first rib
The scalenus medius muscle is attached to the scalene tubercle
The stellate ganglion lies anterior to its neck
The subclavian artery lies in front of the scalene tubercle
The under surface bears a groove for the subclavian vein

Answer 13

The stellate ganglion lies anterior to its neck

The lower trunk of the brachial plexus lies on the upper surface of the first rib (not behind).

The scalene tubercle provides the insertion for the tendon of scalenus anterior, not medius.

The stellate ganglion does lie anterior to the neck of the first rib.

The upper surface of the first rib (in front of the scalene tubercle) bears a groove for the subclavian vein.

The subclavian artery runs in a separate groove behind the scalene tubercle (not in front).

Question 14

Which muscle initiates abduction of the shoulder?

	A.	Infraspinatus
	B.	Latissimus dorsi
	C.	Supraspinatus
	D.	Deltoid
	E.	Teres major

Answer 14

Supraspinatus
he intermediate portion of the deltoid muscle is the chief abductor of the humerus. However, it can only do this after the movement has been initiated by supraspinatus. Damage to the tendon of supraspinatus is a common form of rotator cuff disease.

Question 15

Which of the nerves listed below is responsible for the innervation of the lateral aspect of flexor digitorum profundus?

	A.	Ulnar nerve
	B.	Anterior interosseous nerve
	C.	Radial nerve
	D.	Median nerve
	E.	Posterior interosseous nerve

Answer 15

anterior interrosseus
The anterior interosseous nerve is a branch of the median nerve and is responsible for innervation of the lateral aspect of the flexor digitorum profundus.

Question 16

The first root of the brachial plexus commonly arises at which of the following levels?

	A.	C6
	B.	C5
	C.	C3
	D.	C2
	E.	C8

Answer 16

C5
It begins at C5 and has 5 roots. It ends with a total of 15 nerves of these 5 are the main nerves to the upper limb (axillary, radial, ulnar, musculocutaneous and median)

Question 17

A 35 year old man falls and sustains a fracture to the middle third of his clavicle. Which vessel is at greatest risk of injury?

	A.	Subclavian vein
	B.	Subclavian artery
	C.	External carotid artery
	D.	Internal carotid artery
	E.	Vertebral artery

Answer 17

Subclavian
The subclavian vein lies behind subclavius and the medial part of the clavicle. It rests on the first rib, below and in front of the third part of the subclavian artery, and then on scalenus anterior which separates it from the second part of the artery (posteriorly).

Question 18

A 33 year old man sustains an injury to his forearm and wrist. When examined in clinic he is unable to adduct his thumb. What is the most likely underlying nerve lesion?

	A.	Radial nerve
	B.	Superficial branch of the ulnar nerve
	C.	Median nerve
	D.	Posterior interosseous nerve
	E.	Deep branch of the ulnar nerve

Answer 18

Deep ulnar branch

Damage to the deep branch of the ulnar nerve may result in an inability to adduct the thumb. This is tested clinically by trying to withdraw a piece of paper from a patients hand grasped between thumb and index finger.

Question 19

Which of the following structures separates the subclavian artery and vein?

	A.	Digastric muscle
	B.	Prevertebral fascia
	C.	Anterior scalene muscle
	D.	Middle scalene muscle
	E.	Omohyoid

Answer 19

Anterior scalene muscles
The anterior scalene muscle is an important anatomical landmark and separates the subclavian vein (anterior) from the subclavian artery (posterior).

Question 20

scalene muscles

Answer 20

The 3 paired muscles are:
Scalenus anterior: Elevate 1st rib and laterally flex the neck to same side
Scalenus medius: Same action as scalenus anterior
Scalenus posterior: Elevate 2nd rib and tilt neck to opposite side

Innervation Spinal nerves C4-6
Origin Transverse processes C2 to C7
Insertion First and second ribs
Important relations
The brachial plexus and subclavian artery pass between the anterior and middle scalenes through a space called the scalene hiatus/fissure.
The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as it crosses over the first rib.

Question 21

A 23 year old man is involved in a fight outside a nightclub and sustains a laceration to his right arm. On examination he has lost extension of the fingers in his right hand.

Answer 21

Radial nerve

The radial nerve supplies the extensor muscle group.

Question 22

A 40 year old lady trips and falls through a glass door and sustains a severe laceration to her left arm. Amongst her injuries it is noticed that she has lost the ability to adduct the fingers of her left hand.

Answer 22

Ulnar nerve

The interossei are supplied by the ulnar nerve.

Question 23

A 28 year old rugby player injures his right humerus and on examination is noted to have a minor sensory deficit overlying the point of deltoid insertion into the humerus.

Answer 23

Axillary nerve

This patch of skin is supplied by the axillary nerve

Question 24

A cervical rib is due to which of the following?

A.	Hyperplasia of the annulus fibrosus
B.	Proliferation of the nucleus pulposus
C.	Fusion of the transverse processes of the 6th and 7th cervical vertebrae
D.	An accessory cervical vertebra
E.	Elongation of the transverse processes of the 7th cervical vertebra

Answer 24

E. Elongation of the transverse processes of the 7th cervical vertebra

Cervical ribs occur as a result of the elongation of the transverse process of the 7th cervical vertebra. It is usually a fibrous band that attaches to the first thoracic rib.

Question 25

A 21 year old man is stabbed in the antecubital fossa. A decision is made to surgically explore the wound. At operation the surgeon dissects down onto the brachial artery. A nerve is identified medially, which nerve is it likely to be?

	A.	Radial
	B.	Recurrent branch of median
	C.	Anterior interosseous
	D.	Ulnar
	E.	Median

Answer 25

The median nerve is formed by the union of a lateral and medial root respectively from the lateral (C5,6,7) and medial (C8 and T1) cords of the brachial plexus; the medial root passes anterior to the third part of the axillary artery. The nerve descends lateral to the brachial artery, crosses to its medial side (usually passing anterior to the artery). It passes deep to the bicipital aponeurosis and the median cubital vein at the elbow.
It passes between the two heads of the pronator teres muscle, and runs on the deep surface of flexor digitorum superficialis (within its fascial sheath).
Near the wrist it becomes superficial between the tendons of flexor digitorum superficialis and flexor carpi radialis, deep to palmaris longus tendon. It passes deep to the flexor retinaculum to enter the palm, but lies anterior to the long flexor tendons within the carpal tunnel.

Question 26

A man sustains a laceration between the base of the little finger and wrist. Several weeks after the injury there is loss of thumb adduction power. Which nerve is most likely to have been injured?

	A.	Superficial ulnar nerve
	B.	Deep ulnar nerve
	C.	Median nerve
	D.	Radial nerve
	E.	Recurrent branch of median nerve

Answer 26

Ulnar nerve injury at wrist

Branches of the ulnar nerve in the wrist and hand
At the wrist the ulnar nerve divides into superficial and deep branches. The superficial branch lies deep to the palmaris brevis. It divides into two; to produce digital nerves, which innervate the skin of the medial third of the palm and the palmar surface of one and a half fingers.
The deep branch arises from the nerve on the flexor retinaculum lateral to the pisiform bone. It passes posteriorly between the abductor and short flexor of the little finger supplying them, and supplying and piercing the opponens digiti minimi near its origin from the flexor retinaculum, turns laterally over the distal surface of the Hook of the Hamate bone. It eventually passes between the two heads of adductor pollicis with the deep palmar arch and ends in the first dorsal interosseous muscle. In the palm the deep branch also innervates the lumbricals and interosseous muscles.

Question 27

A 25 year old man is stabbed in the upper arm. The brachial artery is lacerated at the level of the proximal humerus, and is being repaired. A nerve lying immediately lateral to the brachial artery is also lacerated. Which of the following is the nerve most likely to be?

	A.	Ulnar nerve
	B.	Median nerve
	C.	Radial nerve
	D.	Intercostobrachial nerve
	E.	Axillary nerve

Answer 27

Median nerve The brachial artery begins at the lower border of teres major and terminates in the cubital fossa by branching into the radial and ulnar arteries. In the upper arm the median nerve lies closest to it in the lateral position. In the cubital fossa it lies medial to it.

Question 28

What is the course of the median nerve relative to the brachial artery in the upper arm?

	A.	Medial to anterior to lateral
	B.	Lateral to posterior to medial
	C.	Medial to posterior to lateral
	D.	Medial to anterior to medial
	E.	Lateral to anterior to media

Answer 28

Lateral to anterior to medial

Relations of median nerve to the brachial artery:
Lateral -> Anterior -> Medial

The median nerve descends lateral to the brachial artery, it usually passes anterior to the artery to lie on its medial side. It passes deep to the bicipital aponeurosis and the median cubital vein at the elbow. It enters the forearm between the two heads of the pronator teres muscle.

Question 29

A 22 year old falls over and lands on a shard of glass. It penetrates the palmar aspect of his hand, immediately lateral to the pisiform bone. Which of the following structures is most likely to be injured?

A.	Palmar cutaneous branch of the median nerve
B.	Lateral tendons of flexor digitorum superficialis
C.	Ulnar artery
D.	Flexor carpi radialis tendons
E.	Lateral tendons of flexor digitorum profundus

Answer 29

The ulnar nerve and artery are at most immediate risk in this injury.

Question 30

A motorcyclist is involved in a road traffic accident. He suffers a complex humeral shaft fracture which is plated. Post operatively he complains of an inability to extend his fingers. Which of the following structures is most likely to have been injured?

	A.	Ulnar nerve
	B.	Radial nerve
	C.	Median nerve
	D.	Axillary nerve
	E.	None of the above

Answer 30

Radial

Mnemonic for radial nerve muscles: BEST

B rachioradialis
E xtensors
S upinator
T riceps

The radial nerve is responsible for innervation of the extensor compartment of the forearm.

Question 31

A 48 year old lady is undergoing an axillary node clearance for breast cancer. Which of the structures listed below are most likely to be encountered during the axillary dissection?

	A.	Cords of the brachial plexus
	B.	Thoracodorsal trunk
	C.	Internal mammary artery
	D.	Thoracoacromial artery
	E.	None of the above

Answer 31

Thoracodorsal

Beware of damaging the thoracodorsal trunk if a latissimus dorsi flap reconstruction is planned.

Theme from 2009 Exam
The thoracodorsal trunk runs through the nodes in the axilla. If injured it may compromise the function and blood supply to latissimus dorsi, which is significant if it is to be used as a flap for a reconstructive procedure.

Question 32

A 53 year old lady is recovering following a difficult mastectomy and axillary nodal clearance for carcinoma of the breast. She complains of shoulder pain and on examination has obvious winging of the scapula. Loss of innervation to which of the following is the most likely underlying cause?

	A.	Latissimus dorsi
	B.	Serratus anterior
	C.	Pectoralis minor
	D.	Pectoralis major
	E.	Rhomboids

Answer 32

Serratus anterior
Winging of the scapula is most commonly the result of long thoracic nerve injury or dysfunction. Iatrogenic damage during the course of the difficult axillary dissection is the most likely cause in this scenario. Damage to the rhomboids may produce winging of the scapula but would be rare in the scenario given.

Question 33

A 23 year old man falls and slips at a nightclub. A shard of glass penetrates the skin at the level of the medial epicondyle, which of the following sequelae is least likely to occur?

A.	Atrophy of the first dorsal interosseous muscle
B.	Difficulty in abduction of the the 2nd, 3rd, 4th and 5th fingers
C.	Claw like appearance of the hand
D.	Loss of sensation on the anterior aspect of the 5th finger
E.	Partial denervation of flexor digitorum profundus

Answer 33

Claw like appearance of hand
Injury to the ulnar nerve in the mid to distal forearm will typically produce a claw hand. This consists of flexion of the 4th and 5th interphalangeal joints and extension of the metacarpophalangeal joints. The effects are potentiated when flexor digitorum profundus is not affected, and the clawing is more pronounced.More proximally sited ulnar nerve lesions produce a milder clinical picture owing to the simultaneous paralysis of flexor digitorum profundus (ulnar half).

This is the ‘ulnar paradox’, due to the more proximal level of transection the hand will typically not have a claw like appearance that may be seen following a more distal injury. The first dorsal interosseous muscle will be affected as it is supplied by the ulnar nerve.

Question 34

Which of the following structures separates the subclavian artery from the subclavian vein?

	A.	Scalenus anterior
	B.	Scalenus medius
	C.	Sternocleidomastoid
	D.	Pectoralis major
	E.	Pectoralis minor

Answer 34

Scalenus anterior

The artery and vein are separated by scalenus anterior. This muscle runs from the the transverse processes of C3,4,5 and 6 to insert onto the scalene tubercle of the first rib.

Question 35

A 43 year old lady is due to undergo an axillary node clearance as part of treatment for carcinoma of the breast. Which of the following fascial layers will be divided during the surgical approach to the axilla?

	A.	Sibsons fascia
	B.	Pre tracheal fascia
	C.	Waldayers fascia
	D.	Clavipectoral fascia
	E.	None of the above

Answer 35

The clavipectoral fascia is situated under the clavicular portion of pectoralis major. It protects both the axillary vessels and nodes. During an axillary node clearance for breast cancer the clavipectoral fascia is incised and this allows access to the nodal stations. The nodal stations are; level 1 nodes inferior to pectoralis minor, level 2 lie behind it and level 3 above it. During a Patey Mastectomy surgeons divide pectoralis minor to gain access to level 3 nodes. The use of sentinel node biopsy (and stronger assistants!) have made this procedure far less common.

Axilla

Boundaries of the axilla
Medially Chest wall and Serratus anterior
Laterally Humeral head
Floor Subscapularis
Anterior aspect Lateral border of Pectoralis major
Fascia Clavipectoral fascia

Content:
Long thoracic nerve (of Bell) Derived from C5-C7 and passes behind the brachial plexus to enter the axilla. It lies on the medial chest wall and supplies serratus anterior. Its location puts it at risk during axillary surgery and damage will lead to winging of the scapula.
Thoracodorsal nerve and thoracodorsal trunk Innervate and vascularise latissimus dorsi.
Axillary vein Lies at the apex of the axilla, it is the continuation of the basilic vein. Becomes the subclavian vein at the outer border of the first rib.
Intercostobrachial nerves Traverse the axillary lymph nodes and are often divided during axillary surgery. They provide cutaneous sensation to the axillary skin.
Lymph nodes The axilla is the main site of lymphatic drainage for the breast.

Question 36

A 23 year old climber falls and fractures his humerus. The surgeons decide upon a posterior approach to the middle third of the bone. Which of the following nerves is at greatest risk in this approach?

	A.	Ulnar
	B.	Antebrachial
	C.	Musculocutaneous
	D.	Radial
	E.	Intercostobrachial

Answer 36

The radial nerve wraps around the humerus and may be injured during a posterior approach. An IM nail may be preferred as it avoids the complex dissection needed for direct bone exposure.

Question 37

A 42 year old teacher is admitted with a fall. An x-ray confirms a fracture of the surgical neck of the humerus. Which nerve is at risk?

Answer 37

Axillary nerve

The Axillary nerve winds around the bone at the neck of the humerus. The axillary nerve is also at risk during shoulder dislocation.

Question 38

A 32 year old window cleaner is admitted after falling off the roof. He reports that he had slipped off the top of the roof and was able to cling onto the gutter for a few seconds. The patient has Horner’s syndrome.

Answer 38

Radial nerve

The correct answer is Brachial Trunks C8-T1

The patient has a Klumpke’s paralysis involving brachial trunks C8-T1. Classically there is weakness of the hand intrinsic muscles. Involvement of T1 may cause a Horner’s syndrome. It occurs as a result of traction injuries or during delivery.

Question 39

65. A 32 year old rugby player is hit hard on the shoulder during a rough tackle. Clinically his arm is hanging loose on the side. It is pronated and medially rotated.

Answer 39

Brachial Trunks C5-6

The patient has an Erb’s palsy involving brachial trunks C5-6.

Question 40

The vertebral artery traverses all of the following except?

		A.	Transverse process of C6
	B.	Transverse process of the axis
	C.	Vertebral canal
	D.	Foramen magnum
		E.	Intervertebral foramen

Answer 40

Intervertebral foramen
The vertebral artery passes through the foramina which lie within the foramina of the transverse processes of the cervical vertebral, not the intervertebral foramen.