During a fight a man is stabbed in the lateral chest beneath the right arm. The wound does not enter the chest cavity. Physical examination reveals that the vertebral (medial) border of the patient's scapula projects posteriorly and is closer to the midline on the injured side. On return visit the patient complains that he cannot reach as far forward (such as to reach for a door knob) as he could before the injury. The nerve injured which caused these symptoms is the:
axillary long thoracic musculocutaneous radial suprascapular
A man suffers a penetrating wound through the anterior axillary fold, with resulting damage to one of the main terminal branches of the brachial plexus. Among the effects is a significant weakening of flexion of the elbow. One or more other effects to be expected is (are):
Loss of cutaneous sensation on the tips of several fingers Only loss of cutaneous sensation on the anterolateral surface of the forearm Only weakening of flexion at the shoulder Weakening of flexion at the shoulder and loss of cutaneous sensation on the anterolateral surface of the arm Weakening of flexion at the shoulder and loss of cutaneous sensation on the anterolateral surface of the forearm
A person sustains a left brachial plexus injury in an auto accident. After initial recovery the following is observed: 1) the diaphragm functions normally, 2) there is no winging of the scapula, 3) abduction cannot be initiated, but if the arm is helped through the first 45 degrees of abduction, the patient can fully abduct the arm. From this amount of information and your knowledge of the formation of the brachial plexus where would you expect the injury to be:
axillary nerve posterior cord roots of plexus superior trunk suprascapular nerve
The cords of the brachial plexus are:
above the clavicle, medial to the scalenus anticus (anterior scalene). above the clavicle, behind the scalenus anticus (anterior scalene). at or below the clavicle, closely related to the axillary artery. at or below the clavicle, closely related to the axillary vein.
An open arterial anastomosis in the shoulder occurs between the suprascapular artery and which other artery?
Anterior circumflex humeral Circumflex scapular Dorsal scapular Thoracodorsal Transverse cervical
The long thoracic nerve innervates which muscle? Anterior scalene Middle scalene Serratus anterior Teres major Subscapularis
A man riding a motorcycle hit a wet spot in the road, lost control, and was thrown from his bike. He landed on the right side of his head and the tip of his shoulder, bending his head sharply to the left and stretching the right side of his neck. Subsequent neurological examination revealed that the roots of the 5th and 6th cervical nerves had been torn away from the spinal cord.
Following the above injury, which of the movements of the arm at the shoulder would you expect to be totally lost?
adduction abduction flexion extension medial rotation
Following the above injury there would most likely be diminished cutaneous sensation over what part of the upper limb?
the back of the shoulder the pectoral region the top of the shoulder and the lateral side of the arm the medial side of the arm and forearm the tip of the little finger
A patient is found to have a melanoma (cancer arising in pigment cells) originating in the skin of the left forearm. After removal of the tumor from the forearm, all axillary lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed.
Which axillary lymph nodes would not be removed by this procedure?
Apical Central Lateral Pectoral Subscapular
Postoperative examination revealed that the medial border and inferior angle of the left scapula
became unusually prominent (projected posteriorly) when the arm was carried forward in the sagittal plane, especially if the patient pushed with outstretched arm against heavy resistance (e.g., a wall). What muscle must have been denervated during the axillary dissection?
Levator scapulae Pectoralis major Rhomboideus major Serratus anterior Subscapularis
During a motorcycle accident, an 18-year-old male landed on the right lateral side of his rib cage with his right upper limb abducted. In the hospital he was found to have "winging" of the right scapula. Which nerve was likely damaged in the accident? Accessory Lateral pectoral Long thoracic Phrenic Vagus
During an industrial accident, a sheet metal worker lacerates the anterior surface of his wrist at the junction of his wrist and hand. Examination reveals no loss of hand function, but the skin on the thumb side of his palm is numb. Branches of which nerve must have been severed?
Lateral antebrachial cutaneous Medial antebrachial cutaneous Median Radial Ulnar
The nerve which passes through the quadrangular space of the posterior shoulder innervates which muscle?
Deltoid Infraspinatus Subscapularis Supraspinatus Teres major
You are in the emergency room when a patient is brought in, the loser in a street fight.
He has received a stab wound about 1.5 cm long in the right side of the chest about 1.5 cm below and 1 cm medial to the coracoid process of the scapula. He has lost a lot of bright red blood from a large (approx. 1.2 cm in diameter) severed artery found deep at this location. Intravenous fluids are immediately administered and a surgeon is called in to repair the artery. He begins by making an incision through the skin and subcutaneous tissue just below the clavicle, then cuts the clavicular head of the pectoralis major muscle and retracts it downward to obtain sufficient exposure of the area. He next encounters a partially severed muscle running downward and medially from the coracoid process. He divides the remaining fibers of the muscle and has you retract it downward.
This exposes a bloody fat-filled space full of vessels and nerves.
Which space or cavity was opened when the surgeon reflected the muscles
axillary space infraspinatous fossa quadrangular space subdeltoid bursa triangular space
The surgeon next encounters a large (about 2 cm in diameter) horizontally running vein, fortunately intact, which is also retracted downward. This exposes the damaged artery. He knows that the cords of the brachial plexus are closely associated with this artery, so he carefully retracts one found superolateral and one found inferomedial to the artery and then proceeds to repair the artery itself and close the wound.
The large artery that was severed was the:
axillary brachial radial subscapular suprascapular
Later when you see the patient it is clear that he has pronounced neurological deficits. There is lack of cutaneous sensation between his thumb and index finger on the dorsal side, diminished sensation on the dorsal surface of the forearm, arm, and lateral side of the shoulder. He has "wrist drop" (inability to extend the wrist), lack of extension at the elbow, and although abduction can be initiated, it cannot be completed. Flexion, extension, medial and lateral rotation of the arm are not significantly affected. There is no "winging of the scapula." Later exploration by a neurosurgeon reveals that a single large nerve bundle posterior to the artery was also severed, accounting for the neurological findings
The large nerve bundle lying posterior to the artery which was also severed was the:
C 7 root middle trunk posterior cord posterior division radial nerve
Neurological testing of a patient reveals no cutaneous sensation on the tip of the index finger. Such a finding would indicate injury to some portion of which nerve?
axillary median musculocutaneous radial ulnar
You are attending an axillary lymph node dissection in a patient with a melanoma in the upper limb. The surgeon says, "We are going to sample the level II lymph nodes posterior to the pectoralis minor muscle." Having excelled in anatomy, you realize that she is referring to the anatomical nodes known as
apical axillary nodes central axillary nodes lateral axillary nodes lateral pectoral nodes subscapular axillary nodes
In the axilla the pectoralis minor is a landmark, being closely related to all of the following structures except:
cephalic vein cords of the brachial plexus lateral thoracic artery medial pectoral nerve second part of the axillary artery
In a patient with Erb-Duchenne palsy, a nerve arising from the superior trunk of the brachial plexus is nonfunctional. This nerve is the:
Suprascapular Dorsal scapular Long thoracic Lateral pectoral Medial pectoral
The axillary nerve arises directly from which part of the brachial plexus?
inferior trunk lateral cord medial cord middle trunk posterior cord superior cord
Which of the following is not a direct branch of the axillary artery?
anterior circumflex humeral posterior circumflex humeral thoracoacromial thoracodorsal subscapular
While putting metal panels on the roof of a barn, one of the panels slips out of the hands of the man on the roof. During an attempt to catch the panel, a worker below is struck by its sharp edge. The panel hits across the anterior surface of his right arm at midlength and the impact severs all of the tissue to the bone. When examined in the emergency room it is noted that the patient can only weakly flex his elbow and the lateral side of his forearm is numb. In addition to the muscles, which nerve is injured?
axillary median musculocutaneous radial ulnar
While treating the patient (in the preceding question) the doctor observes, "You were fortunate that the panel did not sever the large artery running down the medial side of your arm." The large artery referred to lies in the neurovascular compartment and supplies most everything below the elbow; this artery is the:
axillary brachial deep brachial radial ulnar
In a case of Erb's palsy, where roots C5 and C6 of the brachial plexus are avulsed (torn out) which muscle is paralyzed?
Latissimus dorsi Pectoralis minor Supraspinatus Trapezius Triceps brachii
If the second part of the axillary artery was interrupted, collateral blood flow could pass from branches of the thyrocervical trunk into which artery?
Anterior humeral circumflex Circumflex scapular Deep brachial Posterior humeral circumflex Thoracoacromial
In a fracture of the surgical neck of the humerus, which artery may be injured?
Subscapular Posterior humeral circumflex Radial recurrent Deep brachial Circumflex scapular
While riding a bike, a patient fell against a tree and fractured the shaft of the humerus at midlength. What nerve may be injured because of its close proximity to the injury?
Ulnar Radial Axillary Medial antebrachial cutaneous Median
Loss of sensation from the tip of the index finger is indicative of injury to which nerve?
Radial Median Ulnar Musculocutaneous Medial antebrachial cutaneous
In a fracture of the midshaft of the humerus, which artery is most likely to be injured?
Subscapular Posterior circumflex humeral Radial recurrent Deep brachial Circumflex scapular
As an inexperienced phlebotomist (blood drawer) attempts to insert the needle to draw blood from the median cubital vein, the patient suddenly screams and complains of pain and burning in the middle and thumb side of his palm. The nerve accidentally impaled on the needle was the
lateral antebrachial cutaneous medial antebrachial cutaneous median ulnar posterior antebrachial cutaneous radial superficial radial
In a diving accident that severed the spinal cord below the sixth cervical vertebra, which muscle would be affected?
Deltoid Infraspinatus Latissimus dorsi Levator scapulae Trapezius
Which muscle is the strongest medial rotator of the arm?
Coracobrachialis Infraspinatus Subscapularis Supraspinatus Teres minor
An elderly man complained of pain in his shoulder when he brought his forearm and hand behind his back while dressing. It was determined that the pain was caused by stretching of the lateral rotators of his arm during this motion. Which muscle was most likely involved?
Infraspinatus Latissimus dorsi Subscapularis Supraspinatus Teres major
A woman riding a mountain bike on a rough trail hits a rut and is thrown from the bike. Her upper arm hits a tree, fracturing the humerus just above the insertion of the teres major muscle. Later, during examination, it is noted that she cannot extend her forearm at the elbow or hand at the wrist. Which nerve must have been injured?
Axillary Median Musculocutaneous Radial Ulnar
In old age, the supraspinatus tendon is sometimes ruptured where it blends with the capsule of the shoulder joint. Following this kind of injury one might expect
difficulty in adducting the arm difficulty in flexing the arm difficulty in abducting the arm difficulty in extending the arm difficulty in medially rotating the arm
During a strenuous game of tennis a 55 year old woman complained of severe shoulder pain that forced her to quit the game. During physical examination it was found that she could not initiate abduction of her arm, but if her arm was elevated to 45 degrees from the vertical (at her side) position, she had no trouble fully abducting it. Injury to which muscle was responsible?
deltoid infraspinatus supraspinatus teres major trapezius
A man is in an auto accident and sustains several injuries, among them are:
on the back of his head in the occipital area,
on his chest just above the nipple,
on the lateral side of his arm,
lateral forearm at midlength,
dorsal hand between his thumb and index finger.
Abrasions and contusions (bruises) about his right shoulder
A fractured right radius near its distal end
Later, while undergoing physical therapy because of his shoulder injury, he comments that it is very painful when his forearm is brought across his chest (medial or internal rotation of the humerus). You deduce that the pain is due to stretching of the lateral (external) rotators of the shoulder. Which muscle was most likely the source of his pain?
infraspinatus latissimus dorsi rhomboideus major supraspinatus teres major
An elderly patient complains of shoulder pain and has difficulty abducting his arm.
Arthroscopy is done in which a dye is injected into the shoulder joint and an X-ray taken.
The radiologist notes that the dye has leaked from the shoulder joint into the subacromial bursa. What tendon would need to be ruptured for this to occur?
deltoid infraspinatus latissimus dorsi supraspinatus teres minor
A person riding a mountain bike on a rustic trail hits a rut, the fork of the bike breaks and the person is thrown into a tree, severely fracturing the upper end of his humerus. During the repair the surgeon ties off the artery traveling through the quadrangular space to stop the hemorrhage. Which artery did he ligate?
dorsal scapular posterior circumflex humeral scapular circumflex subscapular suprascapular
After initial examination, a patient is sent to radiology. Radiographs reveal that the portion of the scapula forming the tip or point of the shoulder has been fractured. This bone is the
acromion angle coracoid glenoid spine
Several deficits in muscle function of the right upper limb were noted, including inability to abduct the arm. This was caused by denervation of which muscle?
deltoid infraspinatus latissimus dorsi teres minor trapezius
The rotator cuff is composed of all of the following muscles except:
infraspinatus subscapularis supraspinatus teres major teres minor
Following a gunshot wound to the shoulder, a patient is unable to abduct the arm between 0 and 15 degrees, with reduced lateral rotation of the humerus. What nerve is probably injured?
Accessory (CN XI) Axillary Median Suprascapular Ulnar
A scaffold falls on the right shoulder of a construction worker lacerating the side of his neck and suprascapular area, severing C5 spinal nerve just lateral to the vertebral column. Subsequent to the injury, the patient could not elevate the tip of his shoulder or retract it and had difficulty fully abducting his arm. Given this scenario answer the following questions.
Due to the bleeding, the surgeon ligated (tied off) the suprascapular artery as it crossed the top of the scapula. There was no concern however, as she knew that direct collateral branches of which artery would supply the normal distribution of the suprascapular artery.
anterior circumflex humeral posterior circumflex humeral scapular circumflex subscapular thoracodorsal
The patient was unable to retract his scapula because of paralysis of the trapezius and
infraspinatus levator scapulae rhomboids serratus posterior superior supraspinatus
Would there be loss of cutaneous sensation over the shoulder due to loss of the nerves supplying the C5 dermatome?
When the C5 spinal nerve was severed were any preganglionic sympathetic fibers cut?