Pectoral Girdle, Shoulder and Arm
1. The stability of the shoulder joint
a. Is primarily due to the strong capsule – musculotendinous rotator cuff
b. Is assisted by the rotator cuff muscles <= correct, SSIT: sub, supra, infra, tminor
c. Is aided by the splinting effect of short head of biceps – shunt (not splint) muscles: deltoid, long
head triceps, coracobrachialis, short head of biceps
d. Is weakest posteriorly - inferiorly
e. Is reliant on the deep glenoid cavity - shallow
2. In the upper arm
a. The musculocutaneous nerve pierces and supplies the triceps muscle – radial passes between lat
and med heads and pierces lateral intermuscular septum, musculocutaneous pierces
coracobrachialis
b. The axillary nerve arises from the medial cord of the brachial plexus – post
c. The median nerve crosses in front of the brachial artery <= starts lat, crosses ant, ends med
d. The ulnar nerve passes between the 2 heads of pronator teres – median, ulnar between FCU,
radial between supinator
e. The radial nerve spirals around the front of the humerus - back
3. The axillary artery
a. Becomes the brachial artery at the lower border of teres minor – teres major
b. Is anteromedial to the axillary vein – the vein is anteromedial to the artery
c. Runs with branches of the brachial plexus in the 2nd part - cords
d. Gives off the subscapular artery from the third part <= 1st: superior thoracic, 2nd: thoraco-acromial
and lateral thoracic, 3rd: subscapular, anterior and posterior circumflex humeral (S,TL,SAP)
e. Commences at the medial border of the clavicle – the medial border 1st rib
4. The trunks of the brachial plexus are found
a. Between the scalene muscles – the roots
b. In the posterior triangle
c. Around the second part of the axillary artery – the cords
d. Behind the clavicle – the divisions
e. Immediately after the intervertebral foramina -?roots
5. The brachial plexus
a. Is formed from fibres from C4 to T1
b. Gives off 2 branches from the trunks <= suprascapular and nerve to
c. Gives off the radial nerve from the lateral cord - post
d. Has the ulnar nerve as the largest branch of the medial cord <= it is
e. Gives off the suprascapular nerve from the lateral cord – superior trunk
6. Biceps brachii
a. Is supplied by the axillary nerve
b. Has no action on the shoulder joint
c. Arises from the infraglenoid tubercle
d. Has a short head attached in common with brachialis - coracobrachialis
e. Inserts into both radius and ulna <= debatable in Moore’s
7. Triceps
a. Is supplied by three branches of the radial nerve – In Moore’s it is, by a study in 2004 showed long
head is really spplied by axillary
b. Arises via its medial head from the lateral side of the radial groove – superior to radial groove
c. May be weakened by mid humeral fractures – radial supply comes off proximally
d. Arises via the long head from the infraglenoid tubercle - true
e. Assists in supination of the forearm – only extension (+ long head as shunt)
8. Regarding the brachial plexus, all of the following are true EXCEPT:
a. The roots forming the plexus originate from the anterior rami of C5, 6, 7, 8 and T1
b. The roots lie between the scalenus medius and scalenus posterior muscles <= anterior/medius
c. The trunks lie in the lower part of the posterior triangle
d. The divisions are formed behind the clavicle
e. The cords are formed at the outer border of the 1st rib
9. The axillary artery
a. Becomes the brachial artery at the upper border of teres major - lower
b. Gives rise to the thoracoacromial artery as its largest branch c. Lies medial to the axillary vein – the vein is antero medial to the artery
d. Gives rise to the superior thoracic artery which supplies latissimus dorsi – superior thoracic
supplies 1st/snd intercostal spaces and upper slips serratus anterior. thoracodorsal a. -> lat. dorsi
e. Is the continuation of the third part of the subclavian artery <= true
10. The brachialis muscle:
a. Arises from the upper third of the humerus – distal half
b. Inserts into the coronoid process and tuberosity of ulna <= true
c. Is suppled exclusively by the medial nerve - musculocutaneous
d. Is a powerful supinator of the forearm – chief flexor
e. Adducts the arm – doesn’t cross the GHJ
11. Paralysis of which nerve results in inability to initiate abduction of the arm
a. Axillary nerve – continue abduction via deltoid
b. Suprascapular nerve <= to supraspinatous thus true
c. Subscapular nerve – upper and lower to subscap, lower to teres major
d. Dorsal scapular nerve – to rhomboids and lev scap
e. Thoracodorsal nerve – to lat dorsi
12. The axilla
a. Communicates with the anterior triangle of the neck – no posterior via cervicoaxillary canal
b. Contains lymph nodes draining the upperlimb and lateral chest wall <= true
c. Has an anterior wall made up by the serratus anterior muscle – medial, anterior is pec muscles and
clavipectoral fascia
d. Has an apex bounded by the humerus, clavical and scapula – apex is outer 1st rib, clavical and
scapular, humerus w/ intertubercular groove is the medial wall
e. Has no medial wall – as above it does
13. The brachial artery:
a. Crosses anterior to the median nerve in the arm – is crossed anteriorly by the median nerve
b. Gives off the nutrient artery to the humerus <= true
c. Lies deep to biceps
d. Has the ulnar nerve on its medial side – posteriomedial?
e. Gives muscular branches to triceps
14. The major stabilising factor of the sternoclavivular joint it
a. The acromioclavicular ligament
b. The costoclavicular ligament <= not detailed in Moore’s
c. The interclavicular ligament
d. The sternoclavicular ligament
e. The coracoclavicular ligament
15. The Musculocutaneous nerve:
a. Supplies brachioradialis – by radius
b. Terminates as the posterior interosseous nerve – there is no posterior interosseus
c. Supplies all of the brachialis muscle – no, the radial does also…
d. Contains fibres from C5, C6, C7 and C8 – C5,6
e. Arises from the lateral cord of the brachial plexus <= true
16. An injury to the posterior cord of the brachial plexus will result in which of the following?
a. Winging of the scapula – roots 5,6,7 -> long thoracic
b. Paralysis of supraspinatus and infraspinatus – superior trunk -> suprascapular
c. Paralysis of the clavicular part of pectoralis major – lat cord -> lateral pectoral
d. Numbness along the posterior part of the upper arm – SsTAR: upper posterolat via axiallary ->
superior lateral cutaneous nerve, and radial to inferior lateral cutaneous nerve
of arme. Numbness along the medial part of the upper arm – medial
17. Which statement regarding the brachial plexus is true?
a. It is formed by the posterior rami of C5, 6, 7, 8, T1 - anterior
b. The roots unite to form the trunks behind the clavicle – the trunks are in the (post) triangle,
divisions behind the clavicle
c. The only branch from the trunks is thoracodorsal nerve to supra and infraspinatus – the
suprascapluar nerve (and possibly the nerve to subclavius), the dorsal scapular spplies rhomboids
and levator scapulae
d. The cords are formed at the outer border of the first rib <=
e. The ulnar nerve receives a branch from the lateral cord which carries fibres to flexor carpi ulnaris
18. Fracture of the humerus can commonly result in which of the following lesions?
a. Paralysis of triceps
b. Numbness over posterior part of upper arm
c. Numbness over 1st dorsal interosseous <=
d. Numbness over posterior forearm and lateral upper arm
e. Paralysis of long flexors of fingers
19. The posterior compartment of the arm has
a. The lateral head of triceps arising from the infraglenoid tubercle of the scapula
b. The radial nerve occupying the whole of the spiral groove
c. Triceps being innervated by three branches of the radial nerve
d. Radial nerve giving off lower lateral cutaneous nerve of arm and lateral cutaneous nerve of
forearm
e. The medial head of triceps also inserts into the elbow joint capsule
20. The actions of deltoid include:
a. Abduction of the arm with supraspinatus
b. Extension of the arm with latissimus dorsi
c. Flexion and medial rotation of the arm with pectoralis major
d. Steadying the arm in abduction (anterior and posterior fibres)
e. All of the above <=
21. The triangular space below teres major in the axilla transmits the profunda brachii vessels and
a. Musculocutaneous nerve
b. Ulnar nerve
c. Median nerve
d. Radial nerve <=
e. Axillary nerve – via quad w/ posterior circumflex humeral
22. The nerve supply of teres major is
a. Thoracodorsal nerve
b. Dorsal scapular nerve
c. Axillary nerve
d. Lower subscapular nerve <=
e. Suprascapular nerve
23. The second part of the axillary artery gives rise to the
a. Superior thoracic artery – 1st
b. Subscapular artery – 3rd
c. Suprascapular artery – from subclavian (via thyrocervical trunk usually, tITS)
d. Circumflex humeral arteries – 3rd
e. Thoracoacromial artery <= S,TL,SAP, 2nd: thoracoacromial and lateral thoracic
24. The axillary nerve contains fibres from
a. C5, 6 <=
b. C5, 6, 7
c. C6, 7
d. C7
e. C8, T1
25. The radial nerve
a. Passes out of the axilla below the lower edge of teres major <= the triangular space is lower border
teres major, humerus and long head of triceps, so correct
b. Supplies the shoulder joint – suprascapluar, axillary and lateral pectoral nerves
c. Supplies a small patch of skin on lateral surface of arm – a large strip posterolaterally and supplies
skin on dorsum of hand
d. Is motor to flexor muscles of forearm - median
e. Is cutaneous to dorsal surface of tips of index and middle fingers - median
26. Infraspinatus
a. Medially rotates the shoulder joint – subscap pect major
b. Laterally rotates the shoulder joint – correct, main action
c. Inserts into the lower facet on greater tuberosity of humerus – middle, S#SIT
d. Is supplied by the lower subscapular nerve - suprascapular
e. Extends the shoulder joint – deltoid, teres major, lat dorsi, long head triceps
27. Regarding triceps
a. The long head lies lateral to the medial head - medial
b. The lateral head arises from the lateral intermuscular septum – lateral head in proximal to the
radial groove
c. The medial head receives 3 branches of the radial nerve
d. Damage to the radial nerve at the midshaft of the humerus will interrupt supply to triceps – no
branches arise high (in axilla)
e. The long head arises from the infraglenoid tubercle of the scapula <= true
28. Pectoralis minor inserts into
a. Coracoid process <= superior and medial ascpect
b. Medial lip of intertubercular groove
c. Lateral lip of intertubercular groove
d. Anterior lip of deltoid tuberosity
e. Infraglenoid tubercle
29. Regarding subclavius
a. Its nerve supply is from the medial trunk of the brachial plexus (C5, 6) – superior trunk
b. It lies on top of the clavipectoral fascia - within
c. It arises from the angle of the first rib – the costochondral margin
d. It inserts into the subclavian groove on the inferior surface of the clavicle – insert into middle third
e. It can prevent damage to the subclavian artery from a fractured clavicle <=
30. Regarding pectoralis major
a. It provides direct attachment of pectoral girdle to the axial skeleton
b. It forms part of the posterior wall of the axilla - anterior
c. Its insertion into the scapula is to the lateral lip of the intertubercular groove - humerus
d. The humeral insertion extends distally to deep fascia of arm - ?
e. Its sternocostal head arises from manubrium, sternum, external oblique and upper 6 costal
cartilages <= true
31. Regarding pectoralis major, all are true EXCEPT:
a. It may have rectus sternalis accompanying it
b. The medial pectoral nerve pierces pectoralis minor to reach pectoralis major
c. The laterl pectoral nerve pierces the clavipectoral fascia to reach pectoralis major <=
d. Its actionis medial rotation and abduction – medial rotation and aDduction
e. Fibres from the posterior leaf of the trilaminar tendon insert into the shoulder joint capsule
32. The clavipectoral fascia has all but one of the following features
a. Encloses pectoralis minor and subclavius - true
b. Forms the costocoracoid ligament at the lower border of pectoralis minor <= upper
c. Forms the suspensory ligament of the axilla - true
d. Is pierced by lymphatics and the cephalic vein - true
e. Is pierced by thoracoacromial vessels and the lateral pectoral nerve - true
33. Regarding pectoralis minor, all are true except
a. It arises from ribs 3, 4, 5 deep to pectoralis major - true
b. It is supplied by both medial and lateral pectoral nerves – mostly the medial, but some lateral
pectoral nerve fibers pass to it via the medial pectoral nerve
c. It acts to protract the scapula – it does
d. It is used as a landmark to divide the axillary artery into 3 parts <= true
e. It inserts into medial and lower border of the coracoid process – medial and superior surface
34. Trapezius
a. Has an extensive midline origin from superior nuchal line to spinous process of T12 - true
b. Inserts into lateral 1/3 of clavicle, acromion and all of the spine of the scpula - true
c. Supplied by the spinal part of the accessory nerve - true
d. Acts to rotate the scapula – upward rotation
e. Is antagonised by the rhomboids and levator scapulae – downward rotation
35. Regarding the muscles of the upper limb
a. Latissimus dorsi is not supplied by the brachial plexus – thoracodorsal n. from post cord (SsTar)
b. The triangle of auscultation is bounded by the lateral border of trapezius, the upper border of
latissimus dorsi and the vertebral border of the scapula – lateral border of scapula
c. Damage to the thoracodorsal nerve results in winging of the scapula – long thoracic
d. The rhomboid muscles are supplied by the suprascapular nerve – dorsal scapular (C5)
e. Serratus anterior is the only muscle of the upper limb supplied by all segments of the brachial
plexus – it is via long thoracic c5,6,7. Pect major is supplied by all
36. Regarding the cutaneous nerve supply to arm and forearm
a. C3/4 supply pectoral and upper shoulder
b. Branches of the brachial plexus supply arm and forearm
c. C4/5/6/T1 supply the majority of the arm
d. ?
e. ?
37. Regarding the brachial plexus
a. Serratus anterior is supplied by C6, 7, 8
b. All branches originate from roots, divisions or cords – none from divisions, 2 from trunks, 2 from
roots
c. Suprascapular nerve comes off the posterior cord – superior trunk
d. Dorsal scapular nerve comes off C5 <=
e. ?
38. Which does not pass through the clavipectoral fascia
a. Lymph vessels
b. Cephalic vein
c. Medial pectoral nerve <=
d. Thoracoacromial artery
e. Lateral pectoral nerve
39. Which is incorrect regarding the lateral intermuscular septum
a. Medial head of triceps arises from it <=
b. It has brachioradialis as an anterior relation
c. It is pierced by the radial nerve - true
d. It extends along the lateral supracondylar line
e. ?
40. Regarding the shoulder joint
a. The humeral head is twice the area of the glenoid cavity – 3x
b. The short head of biceps is intracapsular – long head
c. It often communicates anteriorly with subscapularis bursa <= true
d. It is reinforced by important glenohumeral ligaments -?
e. It is only supplied by the axillary nerve – suprascapular and lateral pectoral
41. The upper brachial plexus supplies
a. The medial rotators of the shoulder – C 6,7,8
b. The adductors of the shoulder – C6,7,8
c. The extensors of the elbow – C7,8
d. Small muscles of the hand – T1
e. Sensation of the lateral side of arm and forearm <=
42. Regarding subclavius
a. Its nerve supply is from the medial trunk of the brachial plexus (C5, 6)
b. It lies on top of the clavipectoral fascia - within
c. It arises from the angle of the first rib – 1st costochondral cart -> inferior mid 1/3 clavicle
d. It inserts into the subclavian groove on the inferior surface of the clavicle <= also true
e. It can prevent damage to the subclavian artery from a fractured clavicle <=
43. Pectoralis major
a. Is quadrilateral in shape – fan shaped
b. Has a head that arises from the posterior surface of the clavicle
c. Inserts into the medial lip of the bicipital groove
d. Lies between biceps and the humeral shaft
e. Is supplied by all five segments of the brachial plexus <= true, by lateral pectoral (C5,6,7) and
medial pectoral (C8, T1) nn.
44. Latissimus dorsi
a. Arises from the spinous processes of T2 to L5 –inferior 6 thoracic, thoracolumbar fascia, iliac crest
and lower 3-4 ribs
b. Spirals around the upper border of teres major – lower border
c. Arises from the iliac crest <= true
d. Inserts in the lesser tuberosity of the humerus – inserts into base of intertubercular groove
e. Externally rotates the humerus - internally
45. The sternoclavicular joint
a. Communicates with the manubriosternal joint
b. Is mostly stabilised by the costoclavicular ligament <=
c. Is the fulcrum of movements at the sternoclavicular joint
d. Contains two fibrocartilaginous discs
e. Is supplied by nerve branches from C8 and T1
46. teres major
a. arises from the medial border of the scapula – mid lateral
b. forms the lower border of the quadrandular space <=
c. forms the lateral border of the triangular space - humerus
d. is supplied by the axillary nerve
e. largely acts to extend the arm – adduct and medially rotate
47. the axillary artery
a. arises from the vertebral artery
b. is divided into 3 parts by teres major – pect minor
c. is clasped in its parts by the cords of the brachial plexus <=
d. has no branches in its 3rd part
e. supplies the pectoral muscles via the superior thoracic artery – superior thoracic doesn’t supply
much (subclav, upper slips of serratus ant and 1st and 2nd intercostals), the pectoral mm. are supplied
by the lateral thoracic a.
48. with regard to the brachial plexus
a. the axillary nerve is derived from the lateral cord - post
b. the radial nerve is derived from C7, C8, T1 – C5-T1
c. the nerve to subclavius is the only branch from the trunks – suprascapular n
d. there are seven divisions of the trunks
e. the roots lie between the scalene muscles <=
49. an injury to the middle trunk of the brachial plexus
a. would mean that C8 sensation is altered
b. will manifest in the medial cord
c. will affect the median nerve <=
d. will affect the long thoracic nerve
e. all of the above
50. the rotator cuff is formed from all of the following EXCEPT:
a. subscapularis
b. supraspinatus
c. infraspinatus
d. teres minor
e. teres major <=
51. the subacromial bursa
a. is strengthened anteriorly by the glenohumeral ligaments
b. lies under the coracoacromial ligament <= true, between the supraspinatus and the ligament
c. envelopes the distal end of the coracoid process
d. if inflamed will be more tender when abducted – there will be a painful arc 60-90deg, then relief
e. all of the above
52. with regard to the biceps brachii muscle
a. the long head arises from the greater tuberosity of the humerus
b. the short head arises from the acromion
c. it is a supinator of the forearm <=
d. it is supplied by branches of the median nerve
e. the two heads merge in the upper arm
53. the brachial artery
a. lies lateral to the basilic vein <=
b. lies anterior to the cephalic vein
c. is crossed posteriorly by the median nerve
d. runs parallel but deep to the profunda brachii artery
e. is the continuation of the subclavian artery
54. the triceps muscle
a. is a misnomer because it only has two heads
b. is supplied by the radial nerve <=
c. stabilises the shoulder in adduction <=
d. will often have its nerve supply compromised by humeral shaft fractures
e. derives its blood supply from the posterior interosseous artery