Median Nerve

 

MEDIAN NERVE

Q. 1 Median Nerve supplies all EXCEPT:
 A

Opponens pollicis

 B

Adductor pollicis

 C

Flexor pollicis brevis

 D

Abductor pollicis brevis

Q. 1 Median Nerve supplies all EXCEPT:
 A

Opponens pollicis

 B

Adductor pollicis

 C

Flexor pollicis brevis

 D

Abductor pollicis brevis

Ans.B

Explanation:

Adductor pollicis

REF: http://en.wikipedia.org/wiki/Median_nerve, Gray’s anatomy, 39th edition, P 931,932 See chart of previous question for explanation


Q. 2 In  cubital  fossa,  which  structure  is  medial most
 A Median nerve
 B Brachial artery
 C Biceps tendon
 D Radial nerve
Q. 2 In  cubital  fossa,  which  structure  is  medial most
 A Median nerve
 B Brachial artery
 C Biceps tendon
 D Radial nerve
Ans.A

Explanation:

Median nerve.

Cubital fossa

-This area is clinically important for venepuncture  and for blood pressure  measurement. It is an imaginary triangle with borders being:

* Laterally, the medial border of brachioradialis  muscle

* Medially, the lateral border of pronator teres muscle

* Superiorly, the intercondylar  line, an imaginary line between the two condyles of the humerus

* The floor is the brachialis & supinator muscle

* The roof is the skin and fascia of the arm and forearm

– Contents of cubital fossa (lateral to medial) are: Radial nerve, Biceps tendon, Artery and Median nerve.


Q. 3

If median nerve is injured at the wrist then loss of function of all of the following will take place except?

 A

Lumbrical muscles to the Index finger.

 B

Lumbrical muscles to the middle finger.

 C

Muscles of the thenar eminence

 D

Adductor pollicis

Q. 3

If median nerve is injured at the wrist then loss of function of all of the following will take place except?

 A

Lumbrical muscles to the Index finger.

 B

Lumbrical muscles to the middle finger.

 C

Muscles of the thenar eminence

 D

Adductor pollicis

Ans.D

Explanation:

Motor nerve supply of Median nerve in the hand:

Thenar muscles which include

  1. Flexor pollicis brevis
  2. Opponens pollicis
  3. Abductor pollicis

Q. 4

Median nerve lesion at the wrist causes all of the following, EXCEPT:

 A Thenar Atrophy
 B Weakness of Adductor Pollicis
 C Weakness of 1st and 2nd Lumbricals
 D Weakness of Flexor Pollicis Brevis

Q. 4

Median nerve lesion at the wrist causes all of the following, EXCEPT:

 A Thenar Atrophy
 B Weakness of Adductor Pollicis
 C Weakness of 1st and 2nd Lumbricals
 D Weakness of Flexor Pollicis Brevis
Ans.B

Explanation:

Median nerve lesion at wrist  will lead to atrophy of thenar eminence, weakness to flexor pollicis brevis, 1st and 2nd lumbricals. Adductor pollicis is supplied by the ulnar nerve.
Ref: Neurology, Marco Mumenthaler, Heinrich Mattle, 4th Edition, Page 749-783; Snell’s Clinical Anatomy, 7th Edition, Page 482,483.

Q. 5

TRUE/FALSE statements about carpal tunnel syndrome are:
1. Occurs in pregnancy
2. Affects medial three and half fingers
3. Associated with hypothyroidism
4. Froment sign positive

5. Median nerve involvement is present

 A 1,2,3 true & 4,5 false
 B 1,3,5 true & 2,4 false
 C 1,2,3,4 true & 5 false
 D 1,2,3,5 true & 4 false

Q. 5

TRUE/FALSE statements about carpal tunnel syndrome are:
1. Occurs in pregnancy
2. Affects medial three and half fingers
3. Associated with hypothyroidism
4. Froment sign positive

5. Median nerve involvement is present

 A 1,2,3 true & 4,5 false
 B 1,3,5 true & 2,4 false
 C 1,2,3,4 true & 5 false
 D 1,2,3,5 true & 4 false
Ans.B

Explanation:

Carpal tunnel syndrome is caused by the compression of the median nerve at wrist and is most common type of nerve entrapment syndrome.

 This is usually due to excessive use of the hands and occupational exposure to repeated trauma.

Infiltration of the transverse carpal ligament with amyloid (as occur in multiple myeloma) or thickening of connective tissue in rheumatoid arthritis, acromegaly, amyloidosis, mucopolysaccharidosis and hypothyroidism are less common cause of the syndrome.

It is not uncommon for the condition to make its appearance during pregnancy.

The syndrome is essentially a sensory one; the loss or impairment of superficial sensations affect the palmar aspect of the thumb. Index and middle fingers (especially the index finger) and may or may not split the ring finger. So the lateral three and half fingers are involved (not medial 3 1/2 fingers). The paresthesia are characteristically worsen during night.

Froment sign is seen in ulnar nerve injuries not in median nerve injuries.

Ref: Apley’s 8/e, Page 247-48; Harrison 17/e, Page 2153-54, 2231, 47; Maheshwari 3/e, Page 56.


Q. 6

Which of the following carpal bone fracture causes median nerve involvement?

 A Scaphoid
 B Lunate
 C Trapezium
 D Trapezoid

Q. 6

Which of the following carpal bone fracture causes median nerve involvement?

 A Scaphoid
 B Lunate
 C Trapezium
 D Trapezoid
Ans.B

Explanation:

Perilunate dislocation

Among all of the lunate dislocation, perilunate dislocation is most common. The most common type of perilunate instability is transscaphoid perilunate fracture dislocation. Median nerve is most commonly involved nerve. The most commonly used method of closed reduction is tavernier’s maneuver.
Ref: Rockwood & Green’s fracture in Adults 6/e, Page 864-82.

Q. 7

Carpel tunnel syndrome is due to compression of:

 A Radial nerve
 B Ulnar nerve
 C Palmer branch of the Ulnar nerve
 D Median nerve

Q. 7

Carpel tunnel syndrome is due to compression of:

 A Radial nerve
 B Ulnar nerve
 C Palmer branch of the Ulnar nerve
 D Median nerve
Ans.D

Explanation:

Carpel tunnel syndrome is due to compression ofmedian nerve.

Ref: Harrison’s Internal Medicine, 14th Edition, Page 2467; Essential Orthopedics By J Maheswari, 2nd Edition, Page 257


Q. 8

A 50 year old handicraft lady presented with numbness and weakness of the right hand. On examination, there was atrophy of the thenar eminence and and hypoaesthesia in the area. Compression of which of the following nerve could explain the presentation?

 A Ulnar Nerve
 B Radial Nerve
 C Axillary Nerve
 D Median Nerve

Q. 8

A 50 year old handicraft lady presented with numbness and weakness of the right hand. On examination, there was atrophy of the thenar eminence and and hypoaesthesia in the area. Compression of which of the following nerve could explain the presentation?

 A Ulnar Nerve
 B Radial Nerve
 C Axillary Nerve
 D Median Nerve
Ans.D

Explanation:

Median nerve innervates the thenar muscles and the skin over it. The likely condition is  Carpal Tunnel Syndrome.


Q. 9

Median Nerve supplies all of the structures, EXCEPT?

 A Opponens pollicis
 B Adductor pollicis
 C Flexor pollicis brevis
 D Abductor pollicis brevis

Q. 9

Median Nerve supplies all of the structures, EXCEPT?

 A Opponens pollicis
 B Adductor pollicis
 C Flexor pollicis brevis
 D Abductor pollicis brevis
Ans.B

Explanation:

The median nerve enters the hand through the carpal tunnel, deep to the flexor retinaculum along with the tendons of flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus.

From there it sends off several branches:
1. Recurrent branch to muscles of the thenar compartment (the recurrent branch is also called “the million dollar nerve”). Here it provides motor innervation to opponens pollicis, abductor pollicis brevis and flexor pollicis brevis.
2. Digital cutaneous branches to common palmar digital branch and proper palmar digital branch of the median nerve which supply the:
a) Lateral (radial) three and a half digits on the palmar side
b) Index, middle and ring finger on dorsum of the hand
3. The median nerve supplies motor innervation to the first and second Lumbricals of the hand.

Q. 10

A 12 year old, presents with a severely damaged nail on his index finger, after accidentally crushing the finger while closing a door. A decision is made to excise the injured nail. In preparation for the procedure, the physician would most likely anesthetize a branch of which of the following nerves?

 A Anterior interosseous nerve
 B Median nerve
 C Musculocutaneous nerve
 D Radial nerve

Q. 10

A 12 year old, presents with a severely damaged nail on his index finger, after accidentally crushing the finger while closing a door. A decision is made to excise the injured nail. In preparation for the procedure, the physician would most likely anesthetize a branch of which of the following nerves?

 A Anterior interosseous nerve
 B Median nerve
 C Musculocutaneous nerve
 D Radial nerve
Ans.B

Explanation:

The median nerve supplies the surface of the lateral palm, the palmar surface of the first three digits and the distal dorsal surface of the index and middle fingers (including the nail beds). Therefore, prior to performing surgery in this area, it is essential to anesthetize a branch of this nerve (possibly a proper digital branch) to eliminate pain sensation around the nail bed of the index finger.

Neither the anterior interosseous nor the musculocutaneous nerves supplies the hand. The anterior interosseous nerve supplies the flexor pollicis longus, the lateral half of flexor digitorum profundus, and pronator quadratus.
The musculocutaneous nerve supplies the coracobrachialis, biceps, and most of the brachialis muscle, then becomes the lateral cutaneous nerve of the forearm.
The radial nerve supplies skin on the radial side of the dorsal surface of the hand, but not the fingertips.

Q. 11

All of the following muscles of pollex are supplied by median nerve, EXCEPT?

 A Adductor pollicis
 B Opponens pollicis
 C Abductor pollicis brevis
 D Flexor pollicis brevis

Q. 11

All of the following muscles of pollex are supplied by median nerve, EXCEPT?

 A Adductor pollicis
 B Opponens pollicis
 C Abductor pollicis brevis
 D Flexor pollicis brevis
Ans.A

Explanation:

Pollex means Thumb, which means strong in latin. There are four short muscles of thumb (pollex), they are abductor pollicis brevis, opponens pollicis, flexor pollicis brevis and adductor pollicisThe first three of these muscles form the thenar eminence. All these muscles are supplied by median nerve except for adductor pollicis which is innervated by ulnar nerve.


Q. 12

If median nerve is injured at the wrist, then loss of function of all of the following muscles will take place, EXCEPT?

 A Lumbrical muscles to the Index finger
 B Lumbrical muscles to the middle finger
 C Muscles of the thenar eminence
 D Abductor pollicis

Q. 12

If median nerve is injured at the wrist, then loss of function of all of the following muscles will take place, EXCEPT?

 A Lumbrical muscles to the Index finger
 B Lumbrical muscles to the middle finger
 C Muscles of the thenar eminence
 D Abductor pollicis
Ans.D

Explanation:

Median nerve (C6–T1): Provides most of the innervation to the anterior forearm, excluding one and one half muscles, the flexor carpi ulnaris and the ulnar half of the flexor digitorum profundus muscle, which are innervated by the ulnar nerve. The median nerve continues into the hand to innervate the thenar eminence and lumbricals 1 and 2. It provides cutaneous innervation to the medial palmar side of the hand and the palmar surface of digits 1 through 3 and half of digit 4.


Q. 13

A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to damaged in this patient?

 A Musculocutaneous nerve
 B Median nerve
 C Ulnar nerve
 D Radial nerve

Q. 13

A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to damaged in this patient?

 A Musculocutaneous nerve
 B Median nerve
 C Ulnar nerve
 D Radial nerve
Ans.B

Explanation:

Carpal tunnel syndrome is caused by swelling of the flexor digitorum superficialis, profundus, and flexor pollicis longus tendons, resulting in pressure on the median nerve. Repetitive motions of the fingers and wrist, hormonal changes, and vibration can be causes of tendon swelling. It results in tingling, numbness, and pain in the cutaneous distribution of the median nerve (lateral side). In more severe cases, atrophy of the thenar eminence may be present.

Q. 14

A patient has a tiny (0.2 cm), but exquisitely painful tumor under the nail of her index finger. Prior to surgery to remove it, local anesthetic block to a branch of which of the following nerves would be most likely to achieve adequate anesthesia?

 A Axillary nerve
 B Median nerve
 C Musculocutaneous nerve
 D Radial nerve

Q. 14

A patient has a tiny (0.2 cm), but exquisitely painful tumor under the nail of her index finger. Prior to surgery to remove it, local anesthetic block to a branch of which of the following nerves would be most likely to achieve adequate anesthesia?

 A Axillary nerve
 B Median nerve
 C Musculocutaneous nerve
 D Radial nerve
Ans.B

Explanation:

The tumor in question is probably a glomus tumor, which is a benign tumor notorious for producing pain far out of proportion to its small size. The question is a little tricky (but important clinically for obvious reasons) because it turns out that the most distal aspect of the dorsal skin of the fingers, including the nail beds, is innervated by the palmar digital nerves rather than the dorsal digital nerves. Specifically, the median nerve through its palmar digital nerves supplies the nail beds of the thumb, index finger, middle finger, and half of the ring finger.
The axillary nerve  musculocutaneous nerve , and radial nerves do not supply the nail beds.

Q. 15

A 16 years old girl failed in her final examination. Disgusted with life , she cut across the front of wrist at the flexor retinaculum . She was rushed to hospital and the surgeon noticed that the cut was superficial. All the following structures would have been damaged by this cut EXCEPT?

 A Ulnar nerve
 B Median nerve
 C Palmar cutaneous branch of median nerve
 D Superficial branch of radial artery

Q. 15

A 16 years old girl failed in her final examination. Disgusted with life , she cut across the front of wrist at the flexor retinaculum . She was rushed to hospital and the surgeon noticed that the cut was superficial. All the following structures would have been damaged by this cut EXCEPT?

 A Ulnar nerve
 B Median nerve
 C Palmar cutaneous branch of median nerve
 D Superficial branch of radial artery
Ans.B

Explanation:

Median nerve lies deep to the flexor retinaculum and is not damaged by cuts which are superficial. 
Structures crossing superficial to flexor retinaculum are:
 
From medial to lateral:
  • Superficial branch of ulnar nerve and ulnar artery
  • Tendon of palmaris longus
  • Palmar cutaneous branch of median nerve
  • Origin of the thenar muscles
Structures passing deep to flexor retinaculum are:
  • Median nerve
  • Tendons of flexor digitorum superficialis
  • Tendon of flexor digitorum profundus
  • Tendon of flexor pollicis longus
  • Ulnar bursa and radial bursa

Q. 16

True about peripheral nerve injury in upper limb :

 A Radial nerve injury cause anaesthesia over anatomical snuff box
 B Index finger anesthesia is caused by median nerve injury
 C Ulnar nerve injury cause claw hand
 D All

Q. 16

True about peripheral nerve injury in upper limb :

 A Radial nerve injury cause anaesthesia over anatomical snuff box
 B Index finger anesthesia is caused by median nerve injury
 C Ulnar nerve injury cause claw hand
 D All
Ans.D

Explanation:

A i.e. Radial nerve injury cause anaesthesia over anatomical snuff box; C i.e. Ulnar nerve injury cause claw hand; B i.e. Index finger anesthesia is caused by median nerve injury


Q. 17

True regarding median nerve is/are

 A Deep to pronator teres heads
 B Lateral & medial cords
 C Lateral to axillary artery in axilla
 D All

Q. 17

True regarding median nerve is/are

 A Deep to pronator teres heads
 B Lateral & medial cords
 C Lateral to axillary artery in axilla
 D All
Ans.D

Explanation:

All Correct – A,B, C,


Q. 18

If median nerve is injured at the wrist then loss of function of all of the following will take place except:

 A Lumbrical muscles to the Index finger.
 B Lumbrical muscles to the middle finger
 C Muscles of the thenar eminence
 D Adductor pollicis

Q. 18

If median nerve is injured at the wrist then loss of function of all of the following will take place except:

 A Lumbrical muscles to the Index finger.
 B Lumbrical muscles to the middle finger
 C Muscles of the thenar eminence
 D Adductor pollicis
Ans.D

Explanation:

D i.e. Adductor pollicis


Q. 19

Median nerve injury at wrist, is commonly tested by:

 A Contraction of abductor pollicis brevis
 B Contraction of flexor pollicis brevis
 C Loss of sensation on palm
 D Loss of sensation on ring finger

Q. 19

Median nerve injury at wrist, is commonly tested by:

 A Contraction of abductor pollicis brevis
 B Contraction of flexor pollicis brevis
 C Loss of sensation on palm
 D Loss of sensation on ring finger
Ans.A

Explanation:

Injury or compression of median nerve at wrist (eg carpel tunnel syndrome) can be tested by

1.      Pen test for loss of action of Abductor pollicis brevis

2.      Ape thumb deformity Q (adducted posture of thumb)

3.      Loss of opposition & abduction of thumb Q (d/ t wasting of thenar muscles)

4.      Sensory loss – lateral 31/2 of digits & 2/3 palm (autonomous zone is tip of index & tniddle finger)

Abductor pollicis longus is supplied by posterior interosseous nerve (br. of radial nerve)Q; so abduction of thumb is not completely lost.


Q. 20

Muscle supplied by median nerve:

 A Opponens pollicis
 B Abductor pollicis brevis
 C Flexor pollicis brevis
 D All

Q. 20

Muscle supplied by median nerve:

 A Opponens pollicis
 B Abductor pollicis brevis
 C Flexor pollicis brevis
 D All
Ans.D

Explanation:

A, B, C,  i.e. Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis, & First lumbricals


Q. 21

A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to damaged in this patient:

 A Musculocutaneous nerve
 B Median nerve
 C Ulnar nerve
 D Radial nerve

Q. 21

A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to damaged in this patient:

 A Musculocutaneous nerve
 B Median nerve
 C Ulnar nerve
 D Radial nerve
Ans.B

Explanation:

B i.e. Median Nerve


Q. 22

Ape thumb deformity is seen in involvement of :

 A Median nerve
 B Ulnar nerve
 C Radial nerve
 D Axillary nerve

Q. 22

Ape thumb deformity is seen in involvement of :

 A Median nerve
 B Ulnar nerve
 C Radial nerve
 D Axillary nerve
Ans.A

Explanation:

A i.e. Median Nerve


Q. 23

Which complication may arise after supra-condylar fracture?

 A Median nerve injury
 B Damage to brainchild artery
 C Cubitus varus
 D All of the above

Q. 23

Which complication may arise after supra-condylar fracture?

 A Median nerve injury
 B Damage to brainchild artery
 C Cubitus varus
 D All of the above
Ans.D

Explanation:

D i.e. All of the above


Q. 24

In supra condylar fracture of humerus, the nerve most commonly injured is

 A Radial nerve
 B Ulnar nerve
 C Median nerve
 D Auxiliary nerve

Q. 24

In supra condylar fracture of humerus, the nerve most commonly injured is

 A Radial nerve
 B Ulnar nerve
 C Median nerve
 D Auxiliary nerve
Ans.C

Explanation:

C i.e. Median nerve

  • Anterior interosseous nerve is the most commonly injured nerve with loss of motor- power to flexor pollicis longus & deep flexor to the index finger in extension type supracondylar fractureQ
  • Over all involvement of peripheral nerve in fracture supracondylar humerus is AIN > median nerve > radial nerve > ulnar nerveQ

Q. 25

The most common nerve involvement is dislocation of Lunate is

 A Median nerve
 B Anterior interosseus
 C Posterior interosseus
 D Median nerve

Q. 25

The most common nerve involvement is dislocation of Lunate is

 A Median nerve
 B Anterior interosseus
 C Posterior interosseus
 D Median nerve
Ans.A

Explanation:

A i.e. Median nerve


Q. 26

Which carpal bone fracture causes median nerve involvement?

 A Scaphoid
 B Lunate
 C Trapezium
 D Trapezoid

Q. 26

Which carpal bone fracture causes median nerve involvement?

 A Scaphoid
 B Lunate
 C Trapezium
 D Trapezoid
Ans.B

Explanation:

B i.e. Lunate


Q. 27

Labourers nerve is another name for which nerve:

 A Median nerve
 B Radial nerve
 C Ulnar nerve
 D Axillary nerve

Q. 27

Labourers nerve is another name for which nerve:

 A Median nerve
 B Radial nerve
 C Ulnar nerve
 D Axillary nerve
Ans.A

Explanation:

The median nerve controls the coarse movements of the hands, as it supplies most of the long muscles of the front of the forearm a nd therefore called the ‘labourer’s nerve’.

The median nerve is formed from parts of the medial and lateral cords of the brachial plexus

The median nerve is the only nerve that passes through the carpal tunnel.

Innervation

  • Upper Arm

No motor innervation.

  • Forearm

It innervates most of the flexors in the forearm except flexor carpi ulnaris and the medial two digits of flexor digitorum profundus, which are supplied by the ulnar nerve.

Unbranched, the median nerve supplies the following muscles:

  • Pronator teres
  • Flexor carpi radialis
  • Palmaris longus
  • Flexor digitorum superficialis muscle.

The anterior interosseus branch supplies the following muscles:

  • Lateral (radial) half of flexor digitorum profundus muscle
  • Flexor pollicics longus muscle
  • Pronator quadratus Hand.

In the hand, the median nerve supplies motor innervation to the 1st and 2nd lumbricals and the muscles of the thenar eminence of the hand by a recurrent thenar branch.

The rest of the intrinsic muscles of the hand are supplied by the ulnar nerve.

Injury

  • Injury of this nerve at a level above elbow joint results in loss of pronation and a decrease in flexion of the hand at the wrist joint.
  • In the hand, thenar muscle are paralysed and atrophy with in time. Opposition and flexion movements of thumb are lost, and thumb and index finger are arrested in adduction and hyperextension position. This appearance is referred as ape hand deformity.

In addition, in palmar side of the hand sensation of lateral part of hand, first three fingers and lateral half of the f our t h finger and in dorsal side sensation of distal S! portion of first three fingers and lateral half of distal S! portionof fourth finger is lost.


Q. 28

Structure passing deep to flexor retinaculum at wrist:

 A Ulnar nerve
 B Median nerve
 C Radial nerve
 D Ulnar artery

Q. 28

Structure passing deep to flexor retinaculum at wrist:

 A Ulnar nerve
 B Median nerve
 C Radial nerve
 D Ulnar artery
Ans.B

Explanation:

The flexor retinaculum stretches across the front of the wrist and converts the concave anterior surface of the hand into an osteofascial tunnel, the carpal tunnel, for the passage of:

  • The median nerve
  • Flexor tendons of the thumb (flexor pollicis longus and fingers) (flexor digitorum superficialis and profundus).
  • Radial and the ulnar bursa

It is attached medially to the pisiform bone and the hook of the hamate and laterally to the tubercle of the scaphoid and the trapezium bones.

The attachment to the trapezium consists of superficial and deep parts and forms a synovial-lined tunnel for passage of the tendon of the flexor carpi radialis.

The lower border is attached to the palmar aponeurosis.


Q. 29

Humeral supracondylar fracture commonly results in which nerve injury:

September 2007

 A Musculocutaneous nerve
 B Radial nerve
 C Ulnar nerve
 D Median nerve

Q. 29

Humeral supracondylar fracture commonly results in which nerve injury:

September 2007

 A Musculocutaneous nerve
 B Radial nerve
 C Ulnar nerve
 D Median nerve
Ans.D

Explanation:

Ans. D: Median Nerve

Supracondylar humerus fracture:

  • Most common < 10 years, peak age 5-8 years
  • Constitutes 80% of all pediatric distal humerus fractures
  • 2:1 males to female ratio

Classificatio:

  • Extension type: Extension type accounts for 90-98% of all supracondylar fractures
  • Flexion type

Gartland Classification is commonly used to classify extension type of injuries:

I: Nondisplaced

IIA: displaced, posterior cortex intact; rotationally stable, intact posterior cortex acts like a hinge

IIB: displaced, posterior cortex intact; rotationally unstable

III: completely displaced, no cortical contact, most often a medial periosteal sleeve intact when medially displaced and vice-versa

Management:

i. Closed Reduction is done for type I and type II fractures. Closed reduction is not attempted in type III fractures. Assessing adequacy of reduction:

  • Jones view: hyperflexion shoot through elbow
  • Baumann’s Angle: comparison to uninjured side, difference of more than 5degrees is unacceptable
  • Anterior Humeral Line

Type III fracture:

  • Increased swelling and soft tissue injury
  • Proper neurovascular and compartment assessment
  • Closed reduction and percutaneous pinning is the management of choice, 2 pins may achieve stability

Neurologic Injury:

  • 5-19% of supracondylar farctures
  • More in type III supracondylar fractures
  • Median nerve 52% (especially posteromedial displacement)
  • Radial nerve: 28%
  • Most are neuropraxic injuries
  • Motor Recovery may take 7-12 weeks
  • Sensory recovery may take nearly 6 months

Q. 30

Nerve supply of nail bed of middle finger:

March 2013 (c)

 A Radial nerve
 B Ulnar nerve
 C Median nerve
 D Axillary nerve

Q. 30

Nerve supply of nail bed of middle finger:

March 2013 (c)

 A Radial nerve
 B Ulnar nerve
 C Median nerve
 D Axillary nerve
Ans.C

Explanation:

Ans. C i.e. Median nerve


Q. 31

Total claw hand is seen in the paralysis of:

September 2005

 A Ulnar and median nerve
 B Ulnar nerve
 C Median nerve
 D Radial nerve

Q. 31

Total claw hand is seen in the paralysis of:

September 2005

 A Ulnar and median nerve
 B Ulnar nerve
 C Median nerve
 D Radial nerve
Ans.A

Explanation:

Ans. A: Ulnar and median nerve

Claw hand deformity is manifested by flattening of the transverse metacarpal arch and longitudinal arches, with hyperextension of MCP joints and flexion of the PIP and DIP joints;

This deformity is produced by imbalance of the intrinsic & extrinsics:

i. Intrinsic muscles must be markedly weakened or paralyzed to produce claw deformity;

Long extensor muscles hyperextend the MCP joint, & long flexor muscles flex the PIP and DIP joints; weakness of the

long flexors (as in high palsy) actually decreases claw fingers;

In ulnar nerve palsy, only the medial two fingers develops clawing while all the four fingers develop clawing in combined median and ulnar nerve palsy.


Q. 32

Anterior interosseous nerve is a branch of‑

 A Radial nerve
 B Median nerve
 C Ulnar nerve
 D Axillary nerve

Q. 32

Anterior interosseous nerve is a branch of‑

 A Radial nerve
 B Median nerve
 C Ulnar nerve
 D Axillary nerve
Ans.B

Explanation:

Ans. is ‘b’ i.e., Median nerve

  • Anterior interosseous nerve is a branch of median nerve.
  • Anterior interosseous artery is a branch of ulnar artery.

Q. 33

Inability to pronate forearm is due to injury to which nerve ‑

 A Ulnar
 B Radial
 C Median nerve
 D Musculocutaneous

Q. 33

Inability to pronate forearm is due to injury to which nerve ‑

 A Ulnar
 B Radial
 C Median nerve
 D Musculocutaneous
Ans.C

Explanation:

Ans. is ‘c’ i.e., Median nerve

  • Pronation of the forearm is by two muscles pronator teres and pronator quadratus. These two muscles are supplied by median nerve. Thus injury to median nerve produces inability to pronate forearm.
  • The median nerve is also called labourer’s nerve. The median nerve arises by two roots, one from the lateral cord (C5,6,7) and the other from the medial cord (C8, T1). The various muscles supplied by median nerve are : ‑

1) In the forearm

  • All the flexor muscles of the forearm, except the flexor carpi ulnaris and the medial half of flexor digitorum profundus to the ulnar two fingers. These muscles are : –
  1. Pronater teres
  2. Flexor digitorum superficialis
  3. Flexor pollicis longus
  4. Flexor carpi radialis
  5. Flexor digitorum profundus (lateral half)
  6. Pronator quadratus
  7. Pulmaris longus

2) In hand

  • Median nerve supplies : –
  1. Thenar muscles (except adductor pollicis) – Flexor pollicis brevis, opponens pollicis and abductor pollicis brevis. Adductor pollicis is supplied by ulnar nerve.
  2. First two lumbricals

Q. 34

Nerve supply of opponens pollicis ‑

 A Superficial branch of ulnar nerve
 B Deep branch of ulnar nerve
 C Median nerve
 D Posterior interosseous nerve

Q. 34

Nerve supply of opponens pollicis ‑

 A Superficial branch of ulnar nerve
 B Deep branch of ulnar nerve
 C Median nerve
 D Posterior interosseous nerve
Ans.C

Explanation:

Hand muscles supplied by median nerve are :-

i) Thenar muscles (except adductor pollicis) :- Flexor pollicis brevis, opponens pollicis and abductor pollicis brevis. Adductor pollicis is supplied by ulnar nerve.

ii) First two lumbricals.

Hand muscles supplied by ulnar nerve are :‑

1) Superficial terminal branch : It supplies palmaris brevis and skin of palmar surface of medial 1% fingers.

2) Deep terminal branch : It supplies adductor pollicis, all interossei, medial two (3rd & 4th)lumbricals and all hypothenar muscles except palmaris brevis (i.e. abductor digiti minimi, flexor digiti minimi, opponens digiti minimi).


Q. 35

Nerve supply of pronator teres ‑

 A Ulnar nerve
 B Median nerve
 C Posterior interosseous
 D Radial nerve

Q. 35

Nerve supply of pronator teres ‑

 A Ulnar nerve
 B Median nerve
 C Posterior interosseous
 D Radial nerve
Ans.B

Explanation:

Median nerve


Q. 36

Median nerve lesion at the wrist causes all of the following.except ‑

 A Thenar atrophy
 B Weakness of Adductor pollicis
 C Weaknes of 1st and 2nd lumbricals
 D Weakness of Flexor pollicis brevis

Q. 36

Median nerve lesion at the wrist causes all of the following.except ‑

 A Thenar atrophy
 B Weakness of Adductor pollicis
 C Weaknes of 1st and 2nd lumbricals
 D Weakness of Flexor pollicis brevis
Ans.B

Explanation:

Ans. is ‘b’ i.e., Weakness of Adductor pollicis

Adductor pollicis is supplied by ulnar nerve.



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