Fossae and Spaces of the Upper Limb MCQs

Answer- A. Ulnar nerve dysfunction The symptoms often first appear during night, since many people sleep with flexed wrists. (Flexion decreases the space in carpal tunnel which results in increased pressure over median nerve). Sensory symptoms can often be reproduced by percussing over median nerve (Tina's sign) or by holding the wrist fully flexed for a minute (Phalen's test). As the disease progresses, clumsiness of hand and impairment of digital function develop.

The quadrangular space is bounded medially by the long head of the triceps tendon, laterally by the humerus, superiorly by teres minor, and inferiorly by teres major. It is traversed by the axillary nerve and the posterior humeral circumflex artery. The triangular space is medial to the quadrangular space. It is bounded laterally by the tendon of the long head of the triceps, superiorly by teres minor, and inferiorly by teres major. The circumflex scapular artery, which is a branch of the subscapular artery, traverses this space. The dorsal scapular artery and suprascapular artery contribute to the scapular anastamoses with the circumflex scapular artery, but neither of these vessels are in the quadrangular or triangular spaces. Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Upper Limb Page number - 818

Upper Quadrangular space It has the following boundaries: – the teres major inferiorly – the long head of the triceps laterally For the superior border, some sources list the teres minor, while others list the subscapularis. It contains the scapular circumflex vessels.

B i.e. Inferior rectal nerve Through a posterior horse shoe shaped recess both ischiorectal fossae are connected behind the anal canal; so a unilateral abscess may become bilateral. During dissection of ischio rectal fossa, inferior rectal, pudendal, posterior scrotal or labial nerve & vessels along with perforating branches of S2-S3 and perineal branches of S4 nerve may get damaged.

The anatomical snuff box is bounded on the ulnar side by the tendon of extensor pollicis longus. It is bounded radially by the tendons of abductor pollicis longus and extensor pollicis brevis. The radial artery lies in the floor of the snuff box, and scaphoid can be felt in the floor of the anatomical snuff box. Extensor carpi radialis longus and brevis attach their tendons to the base of the second and third metacarpals, respectively. Brachioradialis inserts its tendon on the lateral side of the base of the styloid process of the radius. Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Upper Limb Page number - 801

The quadrangular space of the shoulder is an important passageway allowing the posterior humeral circumflex vessels and their companion axillary nerve to pass from the axilla to the posterior aspect of the shoulder. The neurovascular bundle runs across the surgical neck of the humerus to enter the quadrangular space. The space itself (sometimes termed the lateral axillary hiatus) is formed by four structures: teres major, teres minor, long head of the triceps, surgical neck of the humerus. The vessels contribute to the collateral network around the shoulder. The axillary nerve supplies the teres minor and deltoid muscles and a cutaneous area on the superolateral aspect of the arm (i.e., the skin overlying the lower aspect of the deltoid). Reference: Textbook of Gray's Anatomy for students, 3rd Edition, Upper Limb Page number - 737

The cadaveric image shown is of cubital fossa and From medial to lateral, the contents of the cubital fossa include the median nerve, the brachial artery, the biceps tendon, and the radial nerve Reference : Textbook of Gray's Anatomy for students, 3rd Edition, Upper Limb Page number -799

The flexor retinaculum spans between the carpal bones to make the carpal tunnel. The contents of the carpal tunnel are: the tendons of flexor digitorum superficialis and flexor digitorum profundus (all contained in the ulnar bursa); the tendon of flexor pollicis longus (contained in the radial bursa) and the median nerve. So, the radial bursa is the only listed structure that is found in the carpal tunnel. The ulnar nerve is superficial to the flexor retinaculum - it's not in the carpal tunnel. The palmar aponeurosis and superficial palmar arterial arch are found on the superficial surface of the palm of the hand, they are not structures found at the wrist. Adductor pollicis is a muscle in the adductor-interosseous compartment of the hand - it is not found near the wrist. Reference : Textbook of Gray's Anatomy for students, 3rd Edition, Upper Limb Page number - 818