Chapter 1

Anatomy and Kinesiology

1
 SCHUCMANN RETEST A A. Biceps D. deltoid
B. pronator teres E. rhomboids
Directions: Each of the questions or incomplete statements C. supraspinatus
below is followed by five suggested answers or completions. 13. During abduction of the arm, the infraspinatus,
Select the single BEST answers in each case. subscapularis, and teres minor muscles contract. What is
the purpose of their contraction during this movement? D
1. The term “kinesiology” refers to the study of B A. to add additional power to the action of abduction
A. muscle anatomy B. to help initiate abduction
B. movements C. to prevent uncontrolled rotation during abduction
C. ligamentous stress analysis D. to hold the humeral head in its socket
D. limb circulation E. all of the above
E. none of the above 14. Injury to the radial nerve in the spiral groove would result
2. Lordosis of the spine normally occurs in which spinal in weakness of E
area(s)? A. elbow flexion D. thumb adduction
A. cervical D. both A and C B. elbow extension E. wrist extension
B. thoracic E. all of the above C. wrist flexion
C. lumbar 15. A patient with a musculocutaneous nerve injury is still able
3. Functions of the human vertebral column include E to flex the elbow. The major muscle causing this elbow
A. protection D. both A and C flexion is the A
B. support E. all of the above A. Brachioradialis D. extensor carpi ulnaris
C. mobility B. flexor carpi ulnaris E. pectoralis major
4. The nerve that supplies cutaneous sensation to the C. pronator quadratus .
dorsum of the medial one and one-half fingers is the C 16. Which of the following muscles is not innervated by the
A. posterior antebrachial cutaneous median nerve? C
B. superficial radial A. abductor pollicis brevis
C. ulnar B. flexor pollicis longus
D. median C. medial heads of flexor digitorum profundus
E. lateral brachial cutaneous D. superficial head of flexor pollicis brevis
5. The muscle(s) that are active during the initiation of E. pronator quadratus
humeral abduction is (are) D 17. The nerve that innervates the first lumbrical muscle in the
A. supraspinatus hand is the A
B. infraspinatus A. median nerve
C. deltoid B. ulnar nerve
D. both A and C C. radial nerve
E. all of the above D. anterior interosseus nerve
6. The muscle that is active during all movements of the E. lateral cutaneous nerve of the hand (1:39)
arms is the 18. After a nerve injury, regeneration occurs proximally first
A. supraspinatus D. deltoid and then progresses distally at a rate of about 1-mm per
B. pectoralis major E. subscapularis day. Following a radial nerve injury in the axilla, which
C. pectoralis minor muscle would be the last to recover? C
7. During the mid stance phase of the gait cycle, the knee is A. long head of the triceps
normally held in which position D B. anconeus
A. five degrees of hyperextension C. extensor indicis
B. full extension D. extensor digiti minimi
C. five degree of flexion E. supinator
D. fifteen degrees of flexion 19. A bony mass is vaguely felt in the posterior midline of the
E. All of the above could be true, knee position varies neck about two fingerbreadths beneath the occipital
from person to person. protuberance. It is the
8. During the normal gait cycle, when do the hamstrings A. inferior articular process of C!
have their maximum activity? D B. spinous process of the axis
A. just after heel - strike C. spinous process of the atlas
B. just after toe - off D. spinous process of C7
C. during mid - stance E. odontoid process
D. during the end of the swing phase 20. The number of vertebrae present at birth is approximately
E. hamstrings remain inactive during normal walking A. 26 D. 36
9. The pretibial group of muscles is maximally active at which B. 29 E. 37
portion of the gait cycle? C. 33
A. toe - off 21. The number of vertebrae present in an adult is generally:
B. swing - through A
C. heel - strike A. 26 D. 36
D. foot - flat B. 29 E. 37
E. heed - rise C. 33
10. The maximum activity of the gluteus medius and minimus 22. Intervertebral discs are responsible for approximately what
muscles occurs at which point in the normal gait cycle? percentage of the total length of the vertebral column? E
A. toe off A. 5% D. 20%
B. swing through B. 10% E. 25%
C. heel strike C. 15%
D. mid - stance 23. After a compression fracture of a vertebral body, stability
E. heel - rise of the spine is maintained by which ligament? D
11. A patient presents with severe weakness of the deltoid A. ligamentum flavum
muscle and wrist extensors. Where would the lesion B. posterior longitudinal ligament
probably be located? B C. interspinous ligament
A. C6 nerve root D. anterior longitudinal ligament
B. posterior cord of the brachial plexus E. supraspinous ligament
C. C7 nerve root 24. The most common direction of disc protrusion causing
D. middle trunk of the brachial plexus neurological involvement in the lumbar area is B
E. radial nerve A. Posterior D. anterolateral
12. A patient was involved in a motorcycle accident and it is B. Posterolateral E. anterior
suspected that he may have avulsed his C5 nerve root at C. lateral
its origin. To test this impression, what is the best muscle 25. The most limited motion in the lumbar spine is C
to check electro physiologically? E A. flexion

2
 B. lateral bending D. just anterior to the S2 vertebra
C. rotation E. 1 cm posterior to the upper one fourth of the lemur
D. extension 36. The most important flexor of the shoulder joint is the D
E. the lumbar spine is not limited in any direction of A. coracobrachialis
movement B. biceps brachii
26. The chief motion permitted in the thoracic spine is C C. clavicular head of the pectoralis major
A. flexion D. anterior portion of the deltoid
B. rotation E. serratus anterior
C. lateral bending 37. Erb’s palsy involves injury to the upper trunk of the brachial
D. extension plexus. What is the typical posture of a limb affected by
E. the thoracic spine is virtually immobile Erb’s palsy? E
27. A patient com plains of a burning sensation in the A. extension, abduction and internal rotation
anterolateral aspect of the thigh. Dysfunction of which B. flexion, adduction, and external rotation
nerve could lead to these symptoms? A C. extension, abduction and external rotation
A. lateral femoral cutaneous D. flexion, adduction and internal rotation
B. femoral E. extension, adduction and internal rotation
C. obturator 38. Which of the following flexor muscles is not innervated by
D. genitofemoral the median nerve? B
E. ilioinguinal A. flexor carpi radialis D. flexor digitorum superficials
28. The sciatic nerve consists of two divisions (medial and B. flexor carpi ulnaris E. flexor pollicis longus
lateral) which eventually separate into distinct nerves. The C. palmaris longus
medial and lateral divisions, respectively, form the B 39. The anterior interosseus branch of the median nerve
A. femoral and obturator nerve innervates which muscles? D
B. tibial and common peroneal nerves A. flexor pollicis longus
C. obturator and femoral nerve B. pronator teres
D. common peroneal and tibial nerves C. pronator quadratus
E. obturator and tibial nerves D. both A and C
29. The subtalar joint of the foot is an articulation between the E. all of the above
A 40. Most of the power for forearm supination is supplied by
A. calcaneus bones and talus which of the following muscles? D
B. talus and navicular bone A. palmaris longus
C. calcaneus and cuboid bone B. pronator quadratus
D. tibia and talus C. supinator
E. cuboid and navicular bones D. biceps
30. The saphenous nerve supplies cutaneous sensation to the E. brachioradials
medial aspect of the leg. From which nerve does the 41. A birth injury which results in injury to the lower portion of
saphenous nerve arise? D the brachial plexus is referred to as C
A. obturator A. Bell’s palsy
B. peroneal B. Erb’s paralysis
C. sciatic C. Klumpke’s paralysis
D. femoral D. Saturday night palsy
E. the saphenous nerve arises as a direct branch from E. Tinel’s sign
the sacral plexus 42. To perform the act of opposition of the thumb, rotation must
31. The tibial nerve passes into the foot where in divides into occur at which joint? C
its terminal branches. What route does the tibial nerve A. radioulnar
follow to enter the foot? E B. Intercarpal
A. it passes along the dorsal aspect of the ankle, then into C. Carpometacarpal
the foot D. Proximal interphalangeal
B. it passes anterior to the lateral malleolus E. Distal interphalangeal
C. it passes under the flexor retinaculum and posterior to 43. The median nerve passes into the hand by B
the lateral malleolus A. passing through the pronator quadratus muscle
D. it passes anterior to the medial malleolus B. passing beneath the flexor retinaculum
E. it passes under the flexor retinaculum and posterior to C. passing through Guyon’s canal
the lateral malleolus D. piercing the intermuscular septum
32. To plantarflex the foot against a load of 100 pounds, E. none of the above
approximately how much force must be generated by the 44. The flexor digitorum profundus muscle is primarily a flexor
triceps surae muscle? D of which joints? E
A. 50 lbs. D. 200 lbs. A. metacarpophalangeal
B. 100 lbs. E. 250 lbs. B. proximal interphalangeal
C. 150 lbs. C. intercarpal
33. Injury to the deep branch of the peroneal nerve would D. radiocarpal
result in a sensory deficit to which of the following E. distal interphalangeal
locations? E 45. The lumbar plexus is occasionally injured at the point
A. medial side of the foot where it passes through a muscle. The muscle
B. lateral side of the foot causing the compression is the E
C. lateral one and one half toes A. gluteus maximus
D. medial border of the sole of the foot B. gluteus medius
E. adjacent dorsal surfaces of the first and second toes C. quadratus lumborum
34. A brachial plexus injury involving the upper portion of the D. obturator externus
plexus produces winging of the scapula. Weakness of E. psoas major
which of the following muscle would produce the winging 46. The quadriceps femoris is an important knee extensor.
observed? E Which portion of this muscle also causes hip flexion? D
A. long head of the triceps A. vastus medialis
B. supraspinatus B. vastus intermedius
C. deltoid C. vastus lateralis
D. pectoralis major D. rectus femoris
E. serratus anterior E. the vastus lateralis and vastus medialis act together to
35. The center of gravity of the human body is located D produce hip flexion
A. at the level of the T12 vertebar 47. The adductor magnus muscle is innervated by two nerves.
B. just anterior to the T6 vertebra These nerves are the D
C. at the level of the xiphoid process A. posterior branches of the obturator and femoral

3
 B. sciatic and anterior branches of the obturator B. supinator E. biceps
C. femoral and anterior branches of the obturator C. deltoid
D. posterior branches of the obturator and sciatic 60. The muscle which compose the triceps surae are the
E. femoral and sciatic 1. soleus
48. The “spring ligament” is thought to provide some elasticity 2. plantaris
to the arch of the foot. Another name for the “spring 3. gastrocnemius
ligament” is the E 4. flexor hallucis longus
A. long plantar ligament A. if only 1,2 and 3 are correct
B. metatarsal interosseus ligament B. if only 1 and 3 are correct
C. tarsal interosseus ligament C. if only 2 and 4 are correct
D. dorsal tarsal ligament D. if only 4 is correct
E. plantar calcaneonavicular ligament E. if all are correct
49. In the neck, the joint where the maximum amount of 61. Muscles innervated by the superficial branch of the
rotation occurs is the B peroneal nerve include the
A. altantooccipital joint D. C5/ C6 interspace 1. peroneus longus
B. atlantoaxial joint E. C6/C7 interspace 2. peroneus tertius
C. C3/C4 interspace 3. peroneus brevis
50. In the neck, the joint where the maximum amount of the 4. tibialis anterior
flexion-extension occurs is the A A. if only 1,2 and 3 are correct
A. atlantooccipital joint B. if only 1 and 3 are correct
B. atlantoaxial joint C. if only 2 and 4 are correct
C. C3/C4 interspace D. if only 4 is correct
D. C5/C6 interspace E. if all are correct
E. C6/C7 interspace 62. Muscle that participate in upward shrugging of the shoulder
51. The most limited motion in the lumbar spine is C include the
A. flexion 1. rhomboid major
B. extension 2. levator scapula
C. rotation 3. rhomboid minor
D. lateral bending 4. trapezius
E. none of the above A. if only 1,2 and 3 are correct
52. The chief muscle used for supination of the forearm with B. if only 1 and 3 are correct
the elbow fully extended is the A C. if only 2 and 4 are correct
A. supinator D. if only 4 is correct
B. brachioradialis E. if all are correct
C. biceps 63. Abduction of the shoulder is performed by which of the
D. pronator teres following muscles?
E. palmaris longus 1. infraspinatus
53. The primary support for the low back in the position of full 2. supraspinatus
forward flexion is provided by the B 3. teres minor
A. abdominal muscle 4. deltoid
B. vertebral ligaments A. if only 1,2 and 3 are correct
C. errector spinae muscle B. if only 1 and 3 are correct
D. iliotibial band C. if only 2 and 4 are correct
E. costovertebral ligaments D. if only 4 is correct
54. The shoulder joint is capable to much motion but sacrifices E. if all are correct
some stability to achieve this degree of motion. The 64. The deltoid muscle helps produce which of the following
weakest portion of the shoulder joint capsule is located D shoulder motions?
A. Anteriorly D. inferiorly 1. flexion
B. Posteriorly E. superiorly 2. extension
C. laterally 3. adduction
55. Which of the following muscle movement dislocation of the 4. abduction
shoulder in the position of full abduction E A. if only 1,2 and 3 are correct
A. supraspinatus B. if only 1 and 3 are correct
B. infraspinatus C. if only 2 and 4 are correct
C. teres minor D. if only 4 is correct
D. subscapularis E. if all are correct
E. all of the above 65. Ligaments found along the lateral aspect of the ankle joint
56. In unresisted pronation of the forearm, which muscle is the include the
prime mover? A 1. anterior talofibular
A. pronator quadratus 2. calcaneofibular
B. pronator teres 3. postenor talofibular
C. brachioradialis 4. calcaneonavicular
D. flexor carpi ulnaris A. if only 1,2 and 3 are correct
E. biceps B. if only 1 and 3 are correct
57. The primary extensor of the metacarpopphalangeal joints C. if only 2 and 4 are correct
in the hand is the A D. if only 4 is correct
A. extensor digitorum E. if all are correct
B. extensor carpi radialis longus
C. extensor carpi ulnaris Matching Type A
D. dorsal interossei muscles A. sciatic nerve
E. palmaraneorossei muscle B. peroneal nerve
58. The primary importance of the lumbrical muscles of the C. femoral nerve
hand is in B D. tibial nerve
A. flexion of the metacarpopphalangeal joints E. obturator nerve
B. extension of the interphalangeal joints
C. abduction of the fingers
D. flexion of the carpometacarpal joints 66. nerve primarily responsible for knee extension
E. flexion of the radiocarpal joint 67. nerve primarily responsible for knee flexion
59. The axillary nerve can occasionally be injured, where it 68. nerve primarily responsible for hip adduction
passes through a muscle. Which muscle would this be? D 69. nerve primarily responsible for eversion of the foot
A. pronator teres D. coracobrachialis 70. nerve primarily responsible for ankle dorsiflexion

4
5
 Chapter 1
Answers and Commentary
1. D. Kinesiology is the study of bone and joint
movement and includes consideration of muscle
function and joint mechanics.
2. D. The term “lordosis” describes the type of
spinal curve normally found in the lumbar region-
the “arch” of the back – and in the cervical region.
The spinal curve found in the thoracic region is
referred to as a kyphosis.
3. E. The vertebral column supports the trunk,
provides mobility for various activities, and
protects the spinal cord and posterior aspects of
the thoracic and abdominal regions.
4. C. The ulnar nerve supplies cutaneous
sensation to both the palmar and dorsal aspects
of the medial one and one half fingers.
5. D. Early kinesiologic studies reported that the
supraspinatus muscle alone initiated humeral
abduction. Later studies have shown that the
6
deltoid muscle is also active during the initiation
of abduction.
6. D. The deltoid muscle is divided into three
functional components: anterior, lateral, and
posterior. While one portion serves as the prime
mover the other two portions often function as
stabilizers.
7. D. During the normal gait cycle the knee is fully
extended at both heel-strike and toe-off, but is
flexed during mid-stance. An early sign of
weakness of the quadriceps is the absence of
flexion during mid-stance.
8. D. At the end of the swing phase of the gait
cycle, the hamstring muscles becomes active.
They perform a lengthening contraction and help
decelerate the swinging leg.
9. C. The peak in activity of the pretibial muscles
during heel-strike prevents the foot from slapping
down on the floor. By performing a lengthening
 contraction, the foot is gradually brought into full
contact with the ground.
10. D. During the stance phase of the gait cycle, the
gluteus medius and gluteus minimus muscles are
active. These muscles function to help keep the
trunk balanced over the support leg.
11. D. The deltoid muscle is innervated by the C5
and C6 nerve roots and by the axillary nerve,
which is formed from the posterior cord of the
brachial plexus. The wrist extensors are
innervated primarily by the C7 and C8 nerve
roots and the radial nerve. The radial nerve is
also formed from the posterior cord of the
brachial plexus would be the most likely site for
the lesion.
12. E. The nerve to the rhomboid muscles--the
dorsal scapular nerve—originates directly from
the C5 nerve root. Abnormalities of the muscle in
this case would help localize the lesion to the C5
nerve root. All of the other upper (and lower)
extremity muscles are innervated by more than
one spinal nerve segment.
13. D. When the deltoid muscle acts alone it has a
tendency to elevate the humeral head rather than
to abduct the arm. The infraspinatus,
subscapularis, and teres minor muscles help
stabilize the humeral head and permit the deltoid
muscle to abduct the arm rather than elevate the
humeral head.
14. D. The radial nerve branches to the triceps
usually arise proximally before the nerve has left
the axilla.
15. A. The brachioradialis muscles originates
proximally enough on the humerus and passes
far enough in front of the elbow to be an efficient
elbow flexor. The muscle is most efficient when
the thumb is up.
16. C. The lateral portion of the flexor digitorum
profundus muscles is innervated by the anterior
interosseous branch of the median nerve, while
the medial portion of the muscle is innervated by
the ulnar nerve.
17. A. In the hand, the median nerve innervates the
first two lumbricals, the hypothenar muscles, the
adductor pollicis, and the deep head of the flexor
pollicis brevis.
18. C. The extensor indicis is the last muscle to be
innervated by the radial nerve and is therefore
thel ast muscle to recover following an injury to
the radial nerve.
19. B. The spinous process of C2 (the axis) can be
palpated with some difficulty. Below this level the
spinous processes are buried by the neck
musculature until the C6/C7 level is reached.
20. C. Vertebrae generally found at birth include 7
cervical vertebrae, 12 thoracic vertebrae, 5
lumbar vertebrae, 5 sacral vertebrae, and 3 or 4
coccygeal vertebrae.
21. A. In the adult there are generally 7 cervical
vertebrae, 12 thoracic vertebrae, 5 lumbar
vertebrae, 1 sacrum, and 1 or 2 coccygeal
vertebrae.
7
22. E. In normal adults intervertebral discs
contribute about 25% of the total vertebral
column height. During the aging process disc
degeneration occurs and the disc spaces
gradually narrow. This accounts for a loss of
height in the older person.
23. B. The broad anterior longitudinal ligament
stretches form the sacrum to the occiput. Since
compression fractures will usually involve
damage to the anterior portions of the vertebral
bodies, hyperextension of the spine will tighten
the anterior longitudinal ligament and help pull
the fracture fragments back into position.
24. B. In the lumbar area the posterior longitudinal
ligament narrows so that at the L5/S1 interspace,
the ligament covers only the central area of the
disc. The posterolateral areas are not covered by
this ligament and are the most common sites of
disc herniation.
25. C. Lateral motion and flexion-extension are
relatively free in the lumbar spine, but rotation is
extremely free in the lumbar spine, but rotation is
extremely limited because of the anatomical
alignment of the articular facet joints.
26. B. In the thoracic spine, flexion and extension
are limited because of the orientation of the
articular facet joints. The ribs also limit these
motions. Lateral bending is the freest movement
in the thoracic spine.
27. A. The lateral femoral cutaneous nerve is
occasionally compressed at or near the inguinal
ligament. This leads to paresthesias and
dysesthesias along the anterolateral aspect of
the thigh—an entity known clinically as meralgia
paresthetica.
28. D. The medial (tibial) and lateral (common
peroneal) portions of the sciatic nerve separate
just above the knee.
29. E. The subtalar joint is important because it
permits inversion and eversion of the hindfoot.
30. D. Injuries to the femoral nerve present with
sensory deficit along the medial aspect of the leg
owing to saphenous nerve involvement.
31. E. The tibial nerve (or its branches) is
occasionally compressed as it passes under the
flexor retinaculum, giving rise to what is known as
the tarsal tunnel syndrome.
32. D. The lever arm over which the triceps surae
must act is rather short, and much force must
therefore be generated to achieve plantar flexion.
Other muscles which pass posteriorly to the
malleoli can also contribute to plantar flexion, but
these muscles have extremely short lever arms
and together can generate a force of only 5 to
15% that of triceps surae.
33. E. The superficial branch of the peroneal nerve
innervates most of the dorsum of the foot, with
the sensory distribution of the deep branch being
limited to the adjacent surfaces of the great and
second toes.
34. E. The long thoracic nerve originates proximally
from the C5, C6, and C7 nerve roots. The
 serratus anterior muscle is innervated by this 50. A. The atlantooccipital joint allows flexion and
nerve. Winging of the scapula occurs with extension, but minimal rotation or lateral bending.
serratus anterior weakness and most prominent 51. C. Minimal rotation occurs in the lumbar spine
when the arm is held in front of the body. because of the anatomical alignment of the facet
35. D. During normal relaxed standing the major joints. These joints tend to lock together when
support of the body is ligamentous. Except for the rotation is attempted.
calf muscles, the muscles are essentially inactive 52. A. With the elbow in a flexed position, the biceps
during relaxed standing. muscle is the major forearm supinator. Full elbow
36. D. In addition to being the most important extension reduces the mechanical advantage of
shoulder flexor, the anterior deltoid muscle also the biceps and causes the supinator muscle to
participates in internal rotation of the shoulder. assume the major role in forearm supination.
37. E. The muscles affected by Erb’s palsy are 53. D. During the initiation of trunk forward flexion,
those innervated by C5 and C6. Included are the the erector spinae muscles are quite active
major shoulder and elbow flexors as well as the during full forward flexion the erector spinae
shoulder abductors and external rotators. Muscle muscles relax and the primary support is
imbalance between the normally functioning ligamentous. For this reason patient should be
muscles results in the typical deformity. taught to lift with their backs.
38. B. The flexor carpi ulnaris muscles is innervated 54. D. Because the weakest portion of the shoulder
by the ulnar nerve. joint capsule is located inferiorly, the shoulder is
39. D. In addition to innervating the pronator least stable in a position of abduction.
quadratus and flexor pollicis longus muscles, the 55. E. The “rotator cuff” muscles are the primary
anterior interosseus nerve also innervates the stabilizers of the shoulder joint in the position of
lateral portion of the flexor digitorum profundus humeral abduction.
muscle. 56. A. The pronator quadratus muscle is the prime
40. D. The biceps muscle supplies most of the pronator of the forearm during both fast and slow
power for supination and is most efficient when pronation when the movement is unresisted.
the elbow is in the flexed position. 57. A. The extensor digitorum muscle is the sole
41. C. With Klumpke’s paralysis, the muscles of the extensor of the metacarpophalangeal joints.
forearm and hand are most affected. This type of 58. B. Extension of the interphalangeal joints is the
brachial plexus injury is much less common than primary function of the lumbrical muscles. These
is Erb’s palsy. muscles can aid in flexion at the
42. C. The carpometacarpal joint of the thumb is metacarpophalangeal joints only when the
quite mobile and allows abduction, adduction, interphalangeal joints are fully extended.
flexion, extension, and rotation to occur. 59. D. Other nerves can sometimes be injured
43. B. The space beneath the flexor retinaculum is where they pass through muscles. The median
called the carpal canal, and is a common site of nerve has occasionally been compressed as it
median nerve compression ( the carpal tunnel passes through the pronator teres, and the radial
syndrome) nerve as it passes through the supinator.
44. C. The flexor digitorum profundus muscle 60. A.
attaches on the distal phalanges and is primarily 61. A.
a flexor of the distal interphalangeal joints. It will 62. A.
also aid in flexion at the proximal interphalangeal 63. B.
and metacarpophalangeal joints. 64. B.
45. E. The lumbar plexus passes through the psoas 65. D.
major muscle. Hemorrhage into this muscle— 66. A. Inversion is produced by muscles passing to
which most commonly occurs in patients or around the medial border of the foot. Eversion
receiving anticoagulants—can occasionally is produced by muscles passing to or around the
cause lumbar plexus compression. lateral border of the foot.
46. D. The rectus femoris muscle attaches to the 67. E.
anterior inferior iliac spine and is the only head of 68. D.
the quadriceps to pass over the hip joint. 69. C.
47. D. The anterior fibers of the adductor magnus 70. D.
muscle receive innervation from the posterior 71. A.
branch of the obturator nerve. The more posterior 72. B.
fibers receive sciatic innervation. 73. C.
48. E. The plantar calcaneonavicular ligament forms 74. B.
a sling that functions to resist downward 75. E.
movement of the talus. 76. B.
49. B. The atlas rotates around the dens (or 77. A.
odontoid process), which projects superiorly from 78. C.
the axis or C2 vertebra. 79. A.

8
80. D. Athletic injuries to the knee most often
damage the medial side. The medial meniscus,
by being firmly attached to the tibial collateral
ligament, is relatively immobile and more prone
to being torn than is the lateral meniscus, which
is not attached to the fibular collateral ligament.
The “terrible triad”, a severe athletic injury, results
in damage to the tibial collateral ligament, the
medial meniscus, and the anterior cruciate
ligament.
81. C.
82. D.
83. A.
84. B.
85. B.
86. D. In normal relaxed standing, ligaments
maintain the stability at the knee and hip. Since
the center of gravity of the body passes in front of
the ankle joint, the soleus muscle must contact to
counterbalance the natural tendency for the body
to fall forward.
87. B. The peroneus longus and brevis muscles are
innervated by the superficial branch of the
peroneal nerve, while the tibialis anterior,
extensor digitorum longus, peroneus tertius, and
extensor digitorum brevis are the muscles
innervated by the deep branch of this nerve.
88. B. The gastrocnemius muscle has two heads—
one medial and one lateral. These two heads
plus the deeper soleus form the triceps surae and
attach to the calcaneus by means of the tendo
calcaneus (Achilles tendon)
89. C. The gluteus maximus muscle will abduct the
limb only when the hip is flexed to 90 degrees. In
other positions it causes adduction. The tensor
fasciae lata is an abductor, but is able to
generate only one-fifth the combined power of
the gluteus medius and minimus muscles.
90. A. The patella provides increased quadriceps
leverage by holding the quadriceps tendon
anterior to the knee center of rotation. Rotation of
the tibia upon the femur is primarily performed by
the knee flexor muscles.
91. B. The cervical lordosis that develops prior to
lumbar lordosis helps balance the head upon the
trunk. The cervical and lumbar lordoses are
secondary or compensatory spinal curvatures
because they develop after birth. Thoracic
kyphosis, which is present at birth, is a primary
curvature.
92. B. The majority of the shoulder girdle muscles
are innervated by both the C5 and C6 spinal
nerves and the upper trunk of the brachial plexus.
Scapular movement during movements of the
humerus permits greater motion at the shoulder
joint.
93. C. The brachial plexus is formed by the C5-T1
anterior or ventral rami. The posterior posterior
portion of the plexus gives rise to the axillary,
radial, thoracodorsal, and subscapular nerves.
The radially innervated muscles are primarily
extensors of the elbow, wrist, and fingers.
9
94. A. The thoracic outlet syndrome is due to
compression of the “neurovascular bundle”
(brachial plexus and axillary or subclavian artery)
in the thorax before the bundle enters the upper
extremity. Arteriography and electrodiagnosis
may help to make the diagnosis. Chest and
cervical spine x-rays may also provide useful
information as to etiology.
95. E. The deltoid muscle participates in most
shoulder motions because it passes anteriorly,
posteriorly, and laterally to the shoulder joint. The
anterior fibers produce flexion and internal
rotation, the posterior fibers, extension and
external rotation, and the lateral fibers, abduction.
96. C. Earlier studies reported that the
supraspinatus muscle initiated shoulder
abduction, but more recent studies have shown
that the supraspinatus and deltoid muscles work
together to produce abduction.
97. E. The upper portion of the trapezius muscle
elevates the lateral border of the scapula, while
the rhomboids and levator scapulae muscles
elevate the medial border of the scapula.
98. A. Costal pits (costal foveae) are situated such
that each rib articulates with three of the pits—
one on a transverse process, one on the upper
border of a vertebral body, and one on the lower
border of the next-higher vertebral body.
99. C. The atlantooccipital joints are stabilized
primarily by muscles and by the shape of the joint
itself. The joint capsule is rather weak.
100. C. Variation in plexus anatomy can result in
variations in symptoms and physical findings if
pathology should occur.
101. E. The sartorius muscle—the “tailor muscle”—
flexes the hip since it passes anteriorly to the hip
joint. It attaches to the medial tibia posterior to
the knee axis of motion. Its lateral attachment to
the anterior superior iliac spine allows it to be a
weak abductor of the thigh.
102. B. The obturator nerve supplies the major thigh
adductor muscles, with the exception of the
posterior portion of the adductor magnus, which
receives innervation from the sciatic nerve.
103. C. With weakness of the hip abductor muscles,
the pelvis will drop toward the unaffected side
when weight is borne on the affected extremity.
To help minimize this pelvic drop, many patients
will learn to laterally bend their trunk toward the
affected side during the stance phase on that leg.
104. C. The tibia articulates with the femur and
transmits weight to the foot. The fibula does not
articulate with the femur but with the tibia distal to
the knee. The peroneal nerve passes laterally
around the head of the fibula; in this position the
peroneal nerve is superficial and can be easily
injured. One type of peroneal nerve injury in this
location is called the “crossed-leg” palsy.
105. E. The deltoid ligament is important in that it
helps limit eversion of the ankle.
106. A. With a sprained ankle the lateral ankle joint
ligaments are most often injured. The mechanism
 of injury is usually forceful inversion of a
plantarflexed foot.
107. C. Contraction of both sternocleidomastoid
muscles will result in forward flexion of the head
and neck. Unilateral contraction results in lateral
flexion to the same side and rotation of the face
to the opposite side
108. C. The brachial plexus, subclavian artery, or
both can occasionally be compressed between
the scalenus anticus and scalenus medius
muscles. This is referred to as the scalenus
anticus syndrome—a type of thoracic outlet
syndrome.
109. A. Abduction at the shoulder is initiated by both
the deltoid and supraspinatus muscles. External
rotation, which accompanies abduction, permits
the greater tubercle to slide under the acromion.
110. B. The latissimus dorsi muscle functions to
extend the arm and depress the shoulder, the
muscle prevents the shoulder from being
displaced upward by weight transmitted through
an ambulatory assistive device such as a crutch.
111. A. The subclavius muscle originates from the
inferior surface of the clavicle and inserts on the
first rib.
112. C. The capsule of the acromioclavicular joint is
rather weak and the joint surfaces are so shaped
as to favor overriding of the acromion by the
clavicle. Most of the stability at the
acromioclavicular joint is provided by ligaments.
113. C. The dens or odontoid process projects
upward from C2 and is firmly attached to C1 by
ligaments. The dens serves as a pivot around
which the atlas rotates.
10
114. C. When the transversospinalis muscles act
bilaterally, the spine is extended. When these
muscles are unilaterally, rotation occurs.
115. C. The iliopsoas muscle is a major hip flexor. It
can reverse its action and increase the amount of
lumbar lordosis. An increase in the amount of
Lumbar lordosis may be a factor in the production
of back pain.
116. A. The medial and lateral plantar nerves in the
foot are distributed in nearly the same pattern, as
are the median and ulnar nerves in the hand.
117. B. The annular ligament encircles the head of
the radius and prevents distal displacement of
this bone. The annular ligament permits rotation
of the radial head, which is essential for forearm
pronation and supination.
118. B. The elbow joint
includes the humeral-radial
and humeral-ulnar joints.
The elbow is strengthened
by muscles and by the
shape of the humeral-ulnar
articulation. The articular
capsule is weak and the
radial collateral ligament
attaches to the annular
ligament