Peripheral nerve injuries: accessory nerve versus long thoracic nerve: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Peripheral nerve injuries: accessory nerve versus long thoracic nerve

Sample item

After a lymph node biopsy in the posterior triangle of the neck, a woman has a drooping shoulder and cannot shrug. The scapula sits lower and is displaced laterally, with winging that worsens on abducting the arm. Which nerve is injured?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Spinal accessory nerve

The spinal accessory nerve crosses the posterior triangle superficially and is vulnerable to biopsy; its loss paralyses trapezius, causing shoulder droop, weak shrugging and lateral displacement with winging on abduction. Long thoracic nerve palsy causes medial winging that is worse on pushing forward. The distinction guides examination.

Option by option

  • A. Suprascapular nerve

    Suprascapular nerve injury weakens abduction initiation and external rotation without winging.

  • B. Dorsal scapular nerve

    The dorsal scapular nerve supplies the rhomboids and does not cause shrug weakness.

  • C. Spinal accessory nerve (correct)

    Correct. Trapezius paralysis from accessory nerve injury gives lateral winging.

  • D. Long thoracic nerve

    Long thoracic injury produces medial winging that worsens on forward pushing.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Spinal accessory nerve. The spinal accessory nerve crosses the posterior triangle superficially and is vulnerable to biopsy; its loss paralyses trapezius, causing shoulder droop, weak shrugging and lateral displacement with winging on abduction.

Why is "Suprascapular nerve" not the answer?

Suprascapular nerve injury weakens abduction initiation and external rotation without winging.

Why is "Dorsal scapular nerve" not the answer?

The dorsal scapular nerve supplies the rhomboids and does not cause shrug weakness.

Why is "Long thoracic nerve" not the answer?

Long thoracic injury produces medial winging that worsens on forward pushing.

What concept does this question test?

It tests Peripheral nerve injuries: accessory nerve versus long thoracic nerve in Orthopaedics. Long thoracic nerve palsy causes medial winging that is worse on pushing forward. The distinction guides examination.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Peripheral nerve injuries: accessory nerve versus long thoracic nerve?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.