BONES OF THE UPPER LIMB

CLAVICLE
- (collar bone) connects the upper limb to the trunk
-shaft of the clavicle has a double curve in a horizontal plane (medial half is
convex anteriorly, lateral half is concave anteriorly)
-sternal endis enlarged and triangular, articulates with the
manubrium of the sternum at the sternoclavicular (SC) joint
-acromial end- is flat where it articulates with theacromion of the
scapula at the acromioclavicular (AC) joint
-moveable, crane-like strut
-one of the bony boundaries of the cervico-axillary canal (passageway
between the neck and arm), affording protection to the neurovascular bundle
supplying the upper limb
-transmits shocks (traumatic impacts) from the upper limb to the axial
skeleton
-commonly fractured bone that forms the pectoral (shoulder) girdle with the
scapula
-the first bone to begin ossification during fetal development, but it is the last
one to complete ossification, at approximately 21 years of age
-only long bone to be ossified intramembranously
-fractures: -fall on the shoulder or outstretched hand
-by the obstetrician in breech presentation
-when the infant presses against the maternal pubic symphysis
during its
passage through the birth canal
- middle third (the most common fracture site) results in upward
displacement of the proximal
fragment by the sternocleidomastoid muscle and downward displacement of
the distal
fragment by the deltoid muscle and gravity.
SCAPULA
-(shoulder blade) is a triangular flat bone that lies on the posterolateral
aspect of the thorax
1. Spine of the Scapula
- triangular-shaped process that continues laterally as the acromion
-divides into the upper supraspinous and lower infraspinous fossae ,
and also provides
an origin for the deltoid and an insertion for the trapezius.
2. Acromion
-Is the lateral end of the spine and articulates with the clavicle.
-Provides an origin for the deltoid and an insertion for the trapezius.
3. Coracoid Process
-Provides the origin of the coracobrachialis and biceps brachii, the
insertion of the pectoralis minor, and the attachment site for the coracoclavicular,
coracohumeral, and
coracoacromial ligaments and the costocoracoid membrane
4. Scapular Notch

- Is bridged by the superior transverse scapular ligament and

converted into a foramen
that transmits the suprascapular nerve
*** Calcification of the superior transverse scapular ligament may trap
or compress the suprascapular nerve as it passes through the scapular notch
under the superior transverse scapular ligament, affecting functions of the
supraspinatus and infraspinatus muscles
5. Glenoid Cavity
- Is deepened by the glenoid labrum for the head of the humerus .
6. Supraglenoid and Infraglenoid Tubercles
- Provide origins for the tendons of the long heads of the biceps brachii
and triceps brachii muscles, respectively
HUMERUS
1. Head
- Articulates with the scapula at the glenohumeral joint .
2. Anatomic Neck
- indentation distal to the head and provides an attachment for the
fibrous joint
capsule.
3. Greater Tubercle
-Lies just lateral and distal to the anatomic neck and provides
attachments for the
supraspinatus, infraspinatus, and teres minor muscles.
- Fracture occurs by direct trauma or by violent contractions of the
supraspinatus muscle. The bone fragment has the attachments of the
supraspinatus, infraspinatus, and teres minor muscles, whose tendons
form parts of the rotator cuff.
4. Lesser Tubercle
-Lies on the anterior medial side of the humerus, just distal to the
anatomic neck, and
provides an insertion for the subscapularis muscle.
- Fracture accompanies posterior dislocation of the shoulder joint, and
the bone fragment has the insertion of the subscapularis tendon
5. Intertubercular (Bicipital) Groove
-Lies between the greater and lesser tubercles, lodges the tendon of
the long head of
the biceps brachii muscle, and is bridged by the transverse humeral
ligament .
- Provides insertions for the pectoralis major on its lateral lip, the teres
major on it
medial lip , and the latissimus dorsi on its floor.
6. Surgical Neck
- narrow area distal to the tubercles that is a common site of fracture
and is in contact
with the axillary nerve and the posterior humeral circumflex artery.
- Fracture may injure the axillary nerve and the posterior humeral
circumflex artery as they pass through the quadrangular space.
7. Deltoid Tuberosity

- Is a rough triangular elevation on the lateral aspect of the midshaft

that marks the
insertion of the deltoid muscle.
8. Spiral Groove
-Contains the radial nerve, separating the origin of the lateral head of
the triceps above
and the origin of the medial head below
9. Trochlea
-Is a spool-shaped medial articular surface and articulates with the
trochlear notch of
the ulna.
10. Capitulum
-Is the lateral articular surface, globular in shape, and articulates with
the head of the
radius.
11. Olecranon Fossa
- Is a posterior depression above the trochlea of the humerus that
houses the olecranon
of the ulna on full extension of the forearm.
12. Coronoid Fossa
-Is an anterior depression above the trochlea of the humerus that
accommodates the
coronoid process of the ulna on flexion of the elbow.
13. Radial Fossa
-Is an anterior depression above the capitulum that is occupied by the
head of the
radius during full flexion of the elbow joint.
14. Lateral Epicondyle
-Projects from the capitulum and provides the origin of the supinator
and extensor
muscles of the forearm.
15. Medial Epicondyle
- Projects from the trochlea and has a groove on the back for the ulnar
nerve and superior ulnar collateral artery.
- Provides attachment sites for the ulnar collateral ligament, the
pronator teres, and the
common tendon of the forearm flexor muscles.
***
Fracture of the shaft may injure the radial nerve and deep brachial artery in
the spiral groove.
***
Supracondylar fracture is a fracture of the distal end of the humerus; it is
common in children
and occurs when the child falls on the outstretched hand with the elbow
partially flexed and may injure the median nerve.
***
Fracture of the medial epicondyle may damage the ulnar nerve. This nerve
may be compressed
in a groove behind the medial epicondyle funny bone, causing numbness.
RADIUS
-shorter than the ulna and is situated lateral to the ulna.

- characterized by displacement of the hand dorsally and radially when

fractured at its
distal end (Colless fracture) .
1. Head (Proximal End)
-Articulates with the capitulum of the humerus and the radial notch of
the ulna and is
surrounded by the annular ligament .
2. Distal End
-Articulates with the proximal row of carpal bones , including the
scaphoid, lunate, and
triquetral bones but excluding the pisiform bone.
3. Radial Tuberosity
-Is an oblong prominence just distal to the neck and provides an
attachment site for the biceps brachii tendon.
4. Styloid Process
-Is located on the distal end of the radius and is approximately 1 cm
distal to that of the ulna and provides insertion of the brachioradialis
muscle.
-Can be palpated in the proximal part of the anatomic snuffbox
between the extensor
pollicis longus and brevis tendons.
***
Colless fracture of the wrist is a distal radius fracture in which the distal
fragment is displaced (tilted) posteriorly, producing a characteristic bump
described as dinner (silver) fork deformity because the forearm and wrist
resemble the shape of a dinner fork.
***
If the distal fragment is displaced anteriorly, it is called a reverse Colless
fracture (Smiths
fracture). This fracture may show styloid processes of the radius and ulna line
up on a radiograph.
ULNA
1. Olecranon
-Is the curved projection on the back of the elbow that provides an
attachment site for the triceps tendon.
2. Coronoid Process
-Is located below the trochlear notch and provides an attachment site
for the brachialis.
3. Trochlear Notch
-Receives the trochlea of the humerus.
4. Ulnar Tuberosity
-Is a roughened prominence distal to the coronoid process that
provides an attachment site for the brachialis.
5. Radial Notch
-Accommodates the head of the radius at the proximal radioulnar joint.
6. Head (Distal End)
-Articulates with the articular disk of the distal radioulnar joint and has
a styloid process.
CARPAL BONES
-arranged in two rows of four (lateral to medial):

1ST ROW (PROXIMAL) : scaphoid, lunate, triquetrum, pisiform,

2ND ROW (DISTAL) : trapezium, trapezoid, capitate, and hamate
***
mnemonic device: Sandra Likes to Pat Toms Two Cold Hands. (Trapezium
precedes trapezoid
alphabetically.)
SCA-LU-TRI-PI-TRA-TRA-CA-HA! SCA-LU-TRI-PI-TRA-TRA-CA-HA! SCA-LU-TRI-PITRA-TRA-CA-HA!
***
Proximal Row : Except for the pisiform, articulates with the radius and the
articular disk (the ulna has no contact with the carpal bones). The pisiform is
said to be a sesamoid bone contained in the flexor carpi ulnaris tendon.
***
SCAPHOID- boot shaped
LUNATE- moon shaped
TRIQUETRUM- pyramidal
PISIFORM- pea shaped
TRAPEZIUM- four sided
TRAPEZOID- wedge shaped
CAPITATE- head shaped
HAMATE- wedge shaped, with little hook
***
Fracture of the scaphoid- fall on the outstretched hand, shows a deep
tenderness in anatomical snuffbox, and damages the radial artery and cause
avascular necrosis of the bone and degenerative joint disease of the wrist.
***
Fracture of the hamate may injure the ulnar nerve and artery because they
are near the hook of the hamate.
***
Bennetts fracture is a fracture of the base of the metacarpal of the thumb.
Boxers fracture is a
fracture of the necks of the second and third metacarpals, seen in
professional boxers, and
typically of the fifth metacarpal in unskilled boxers
***
Guyons canal syndrome is an entrapment of the ulnar nerve in the Guyons
canal, which causes pain, numbness, and tingling in the ring and little
fingers, followed by loss of sensation and motor weakness. It can be treated
by surgical decompression of the nerve. Guyons canal (ulnar tunnel) is
formed by the pisiform, hook of the hamate, and pisohamate ligament, deep
to the palmaris brevis and palmar carpal ligament and transmits the ulnar
nerve and artery.
METACARPALS
-miniature long bones consisting of bases (proximal ends), shafts (bodies),
and heads (distal ends). Heads form the knuckles of the fist.
PHALANGES
-miniature long bones consisting of bases, shafts, and heads . The heads of
the proximal and middle phalanges form the knuckles.
-fingers (three each) and thumb (two)
JOINT AND LIGAMENTS OF THE UPPER LIMB
Acromioclavicular Joint
-synovial plane joint- gliding movement when the scapula rotates

***Dislocation of the acromioclavicular joint results from a fall on the shoulder with
the impact taken by the acromion or from a fall on the outstretched arm. It is called
a shoulder separation because the shoulder is separated from the clavicle when the
joint dislocation with rupture of the coracoclavicular ligament occurs.
Sternoclavicular Joint
-double synovial plane (gliding) joint and united by the fibrous capsule.
-Allows elevation and depression, protraction and retraction,
circumduction of the
Shoulder

and

Shoulder (Glenohumeral) Joint

-synovial ball-and-socket joint between the glenoid cavity of the scapula and
the head
of the humerus. Both articular surfaces are covered with hyaline cartilage.
-innervated by the axillary, suprascapular, and lateral pectoral nerves.
-Receives blood from branches of the suprascapular, anterior and posterior
humeral circumflex, and scapular circumflex arteries.
-subject to inferior or anterior dislocation
Rotator (Musculotendinous) Cuff
-supraspinatus, infraspinatus, teres minor, and subscapularis (SITS); fuses
with the joint capsule; and provides mobility.
- Keeps the head of the humerus in the glenoid fossa during movements and
thus stabilizes the shoulder joint.
***Rupture of rotator cuff - chronic wear and tear or an acute fall on the
outstretched arm and is manifested by severe limitation of shoulder joint motion,
chiefly abduction.
Elbow Joint
synovial hinge joint , consisting of the humeroradial and humeroulnar
joints , and allows flexion and extension.
includes the proximal radioulnar (pivot) joint
innervated by the musculocutaneous, median, radial, and ulnar nerves.
Receives blood from the anastomosis formed by branches of the brachial
artery and recurrent branches of the radial and ulnar arteries.
reinforced by the following ligaments:
Annular Ligament
fibrous band that forms nearly four-fi fths of a circle around the head of the
radius; the radial notch forms the remainder.
Encircles the head of the radius and holds it in position and fuses with the
radial collateral ligament and the articular capsule.
Lifting a child by the childs forearm may dislocate head of the radius from
the annular ligament.
Radial Collateral Ligament

Extends from the lateral epicondyle to the anterior and posterior margins
of the
radial notch of the ulna and the annular ligament of the radius.
Ulnar Collateral Ligament
Is triangular and is composed of anterior, posterior, and oblique bands.
Extends from the medial epicondyle to the coronoid process and the
olecranon of
the ulna.
Proximal Radioulnar Joint
synovial pivot joint in which the head of the radius articulates with the radial
notch of the ulna and allows pronation and supination , by permitting the
head of radius to rotate within the encircling annular ligament.
Distal Radioulnar Joint
synovial pivot joint between the head of the ulna and the ulnar notch of the
radius
and allows pronation and supination .
Wrist (Radiocarpal) Joint
synovial condylar joint formed superiorly by the radius and the articular disk
and inferiorly by the proximal row of carpal bones (scaphoid, lunate, and
rarely triquetrum).
Its capsule is strengthened by radial and ulnar collateral ligaments and dorsal
and palmar
radiocarpal ligaments, and it allows flexion and extension, abduction and
adduction, and circumduction.
Midcarpal Joint
synovial plane joint between the proximal and distal rows of carpal bones
and
allows gliding and sliding movements.
Carpometacarpal Joints
synovial saddle (sellar) joints between the carpal bone (trapezium) and the
first
metacarpal bone, allowing flexion and extension, abduction and adduction,
and circumduction.
form plane joints between the carpal bones and the medial four metacarpal
bones, allowing a simple gliding movement.
Metacarpophalangeal Joint
condyloid joints
that allow flexion and extension, and abduction and
adduction.
Interphalangeal Joints
hinge joints that allow flexion and extension.