{"id":8473,"date":"2025-11-24T00:01:26","date_gmt":"2025-11-24T08:01:26","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=8473"},"modified":"2026-07-10T14:00:21","modified_gmt":"2026-07-10T22:00:21","slug":"usmle-step-1-question-of-the-day-axillary-nerve-injury","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Axillary nerve injury"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em>Today\u2019s USMLE\u00ae Step 1 question of the day focuses on a 66-year-old man who presents to to an emergency room for evaluation of left shoulder pain after a fall. Which of the following movements would be limited by this nerve injury? Let\u2019s find out!<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 66-year-old man comes to the emergency department to be evaluated for <strong>left shoulder pain<\/strong> after a fall. The patient was skiing when he was accidentally hit from the right side and <strong>fell on his left shoulder <\/strong>and <strong>outstretched left hand.<\/strong> The patient did not strike his head or lose consciousness. Past medical history is noncontributory. <strong>Vitals are within normal limits.<\/strong> Physical examination shows a man supporting his left arm with his right hand. There is <strong>tenderness <\/strong>and <strong>swelling <\/strong>at the proximal humerus. An <strong>x-ray<\/strong> of the left shoulder is shown below. <strong>Axillary nerve injury<\/strong> is suspected. <\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"797\" height=\"797\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/image_846a34.png\" alt=\"\" class=\"wp-image-8476\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/image_846a34.png 797w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/image_846a34.png?resize=150,150 150w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/image_846a34.png?resize=300,300 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/image_846a34.png?resize=768,768 768w\" sizes=\"auto, (max-width: 797px) 100vw, 797px\" \/><figcaption class=\"wp-element-caption\">Reproduced from&nbsp;<a href=\"https:\/\/radiopaedia.org\/cases\/surgical-neck-of-humerus-fracture\" target=\"_blank\" rel=\"noreferrer noopener\">Radiopedia<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following actions <em>will be impaired<\/em> due to this nerve injury?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Elbow, wrist, and finger extension<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Abduction and adduction of the fingers<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Wrist flexion and thumb opposition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Arm abduction at the shoulder<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Forearm flexion and supination<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Arm abduction at the shoulder<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Elbow, wrist, and finger extension<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Elbow, wrist, and finger extension are functions of the <strong>radial nerve<\/strong> (C5-T1), which can be injured with <strong>midshaft fractures<\/strong> of the <strong>humerus<\/strong>. This patient has a fracture of the neck of the humerus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Abduction and adduction of the fingers<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The <strong>ulnar nerve<\/strong> is susceptible to injury in patients with fractures of the <strong>hook of hamate<\/strong> of the hand which can be seen in athletes. <strong>Ulnar nerve injury<\/strong> can cause inability to <strong>abduct the index and little fingers<\/strong> and <strong>inability to adduct the thumb.<\/strong> This patient\u2019s presentation and radiograph are consistent with a <strong>fracture <\/strong>of the <strong>surgical neck<\/strong> of the humerus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Wrist flexion and thumb opposition<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Proximal median nerve injury<\/strong> can result from <strong>supracondylar fractures<\/strong> of the <strong>distal humerus<\/strong> at the elbow and can lead to the <strong>inability to flex the wrist<\/strong> and <strong>oppose the thumb<\/strong>. This patient has a fracture of the surgical neck of the humerus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Forearm flexion and supination<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> <strong>Upper nerve trunk compression<\/strong> can injure the <strong>musculocutaneous nerve<\/strong>. Patients typically present with <strong>loss of arm abduction <\/strong>at the shoulder (&gt;15 degrees) and <strong>loss of sensation<\/strong> over the lateral arm. Compression of the musculocutaneous nerve lower in the arm at the <strong>coracobrachialis muscle<\/strong>, can lead to weakness with <strong>forearm flexion <\/strong>and <strong>supination<\/strong> and <strong>sensory loss<\/strong> over the lateral forearm.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"532\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/image_aa5c39.png\" alt=\"FRACTURES OF THE HUMERUS\n* (Image of shoulder) Surgical neck of Humerus\n* More frequent in elderly with Osteoporosis (slide of normal bone density vs with Osteoporosis)\n* Indirect trauma \" class=\"wp-image-8477\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/image_aa5c39.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/image_aa5c39.png?resize=300,164 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/image_aa5c39.png?resize=768,419 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient\u2019s left arm x-ray is consistent with a fracture of the surgical neck of the humerus, which is an <strong>injury pattern<\/strong> that occurs below the <strong>greater tubercle <\/strong>and <strong>lesser tubercle<\/strong>, and above the <strong>deltoid tuberosity<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>surgical neck <\/strong>is fractured much more frequently than the <strong>anatomical neck<\/strong> of the humerus and commonly results from a fall on the outstretched hand. It is a fracture seen in <strong>older patients<\/strong> particularly those with osteoporosis. Symptoms include pain over the <strong>proximal shoulder<\/strong> that radiates the arm&#8217;s length and <strong>swelling<\/strong>. The axillary nerve and posterior circumflex humeral artery are the structures that are at most risk of injury with this fracture pattern.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <strong>axillary nerve<\/strong> carries fibers from the C5-C6 branch of the <strong>brachial plexus<\/strong>, where it courses deep to the axilla below the <strong>shoulder joint<\/strong> and the surgical neck of the posterior humerus. Patients with injury to this nerve present with <strong>loss of sensation<\/strong> over the lateral upper arm and <strong>weakness <\/strong>with shoulder abduction (due to denervation of the deltoid muscle). <strong>Damage <\/strong>to the posterior circumflex humeral artery can lead to avascular necrosis of the humeral head.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The surgical neck of the humerus is more frequently fractured than the anatomical neck of the humerus and typically results from a fall on an outstretched hand. It is common in older patients. This <strong>fracture pattern<\/strong> can lead to damage of the axillary nerve and <strong>posterior circumflex humeral artery<\/strong>. Injury to the axillary nerve can lead to loss of sensation and abduction at the shoulder.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Anatomy_clinical_correlates:_Arm,_elbow_and_forearm\">Anatomy clinical correlates: Arm, elbow and forearm<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The spine, pelvis, and extremities. Suneja M, &amp; Szot J.F., &amp; LeBlond R.F., &amp; Brown D.D.(Eds.), (2020). DeGowin\u2019s Diagnostic Examination, 11e. McGraw-Hill.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_GENERAL3_2023.png?w=700\" alt=\"\" class=\"wp-image-5048\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_GENERAL3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_GENERAL3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Get your\u00a0<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>\u00a0and discover why millions of current and future clinicians and caregivers love learning by Osmosis.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 66-year-old man presents with shoulder pain after a fall. Identify which shoulder movements may be limited due to nerve injury in this clinical scenario.<\/p>\n","protected":false},"author":204,"featured_media":8478,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[1808,1811,1813,1809,1225,1815,1814,1812,1810,664],"class_list":["post-8473","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-axillary-nerve","tag-brachial-plexus","tag-clinical-exam","tag-humerus-fracture","tag-nerve-damage","tag-nerve-palsy","tag-orthopedic-injury","tag-shoulder-anatomy","tag-shoulder-injury","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day:\u00a0Axillary nerve injury - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day:\u00a0Axillary nerve injury - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A 66-year-old man presents with shoulder pain after a fall. Identify which shoulder movements may be limited due to nerve injury in this clinical scenario.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2025-11-24T08:01:26+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-07-10T22:00:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/11\/Axillary_nerve_injury_Blog.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-axillary-nerve-injury\"},\"author\":{\"name\":\"Rowan Bell, MD &amp; 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