C9: UE BONES & JOINTS

Files

Term

Upper Limbs
- Or upper extremities
- Is a multijointed lever the is freely movable in the trunk at the shoulder joint
- A components of the appendicular skeleton
- Primary function: maneuver the hand into positions where it can manipulate objects
- Shoulder, arm, cubital fossa, forearm, wrist & hand
- Bones: clavicle, scapula, humerus, radius, ulna, carpal bones, metacarpal bones, &
phalanges

Hand
- Highly evolved organ with the unique ability to grasp items in both coarse and fine
ways
- Importance: centers on the pincer-like opposable action of the thumb, which
enables the tip of thumb to contact tips of other digits
Clavicle & Scapula – form the shoulder girdle
Humerus – defines the arm
Radius & Ulna – delineate the forearm
Carpal bones – form the wrist
Metacarpal bones & Phalanges – constitute the hand

Clavicle
―collar bone
- Horizontally bet. the sternum and shoulder (acromion specifically)
- Roughly s-shaped & resembles a large old key
- Serves as a strut in the shoulder (lateral strut) that allows the limb to move freely
from the trunk
- If absent, shoulder can meet in front
- First one to begin ossification
- Forms only two joints; sternoclavicular joint & acromioclavicular joint
- Palpable on anterior chest area

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 - Attached to the sternum (manubrium, body / gladiolus, & xiphoid process / xiphy
sternum)

Ossification – bone formation, new bone is produced

TWO ENDS OF CLAVICLE

Sternal End / Extremity
- Blunt, thickened, proximal (medial)
end of the clavicle
- Attached to the sternum, located
medially
- Articulates w/ the clavicular notch of
the sternum through a compound
synovial joint containing an articular
disc

Acromial End / Extremity

- Located laterally
- Flattened distal (lateral) end
- Articulates w/ the acromion process of
the scapula

DIVISIONS OF A CLAVICLE

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 - Medial third , Middle third, & Lateral third
- Divided because some of the muscles will be attached on the divisions (i.e the
deltoid and trapezius will have attachments on the lateral
third of the clavicle)
- Named to identify the attachments of the muscles (deltoid & trapezius)

TWO JOINTS OF THE CLAVICLE

Sternoclavicular joint Acromioclvicular joint

- Articulated bet. Sterna end of clavicle
(medial), manubrium of stern, &
- Articulated bet. Acromion of scapula &
acromial end of the clavicle
Conoid Tubercle
- Underneath the lateral third
- Small bukol, named based on the
ligament attached to it

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 - On inferior surface, near acromial end
attachment area for conoid ligament
part of coracoclavicular ligament

1st costal cartilage

Convex (clavicle)
- Palpate medially, slightly rounded in front
Concave (clavicle)
- Palpate laterally, there is a depression
Convexity
- Serves as the passageway to important vessels
& nerves that would supply the upper extremities

Scapula
―Shoulder blade‖
- Large, flat, triangular bone
- On the posterior chest wall bet. 2nd & 7th ribs
- Articulates w/ acromial end of clavicle & head of humerus
- 3 sides; superior, medial, lateral & 3 angles ; superior, inferior, lateral

THREE BORDERS

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 Medial (vertebral) Lateral (axillary) Superior border
border border
- Faces above, at the
- Faces the mid-line - Faces outside highest level
- Long, medial edge of laterally - Thin, short, superior
the scapula, located - Thickened, lateral edge of the scapula
closest to vertebral edge of the scapula,
column closest to the axilla
- Two muscles are
attached; teres major &
minor

THREE ANGLES

Superior angle Inferior angle Lateral angle

- Upper, located above - Lower, located below, - Formed by the junction

- Formed by the junction palpable of superior a& lateral
of superior & medial - Formed by junction of borders
borders medial & lateral - Comprises the glenoid
borders cavity (fossa)
- Marks level of 7th rib
& spine of the thoracic
vertebra

Spine of scapula

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 - Blade, projects backward, on posterior surface
- To know / indicator that the scapula is posterior (back)
- Contributes to the landmark by dividing the posterior part of scapula, upper fossa,
& lower fossa

T W O S U R FA C E S

Dorsal (posterior) surface

- Divided into two unequal-sized regions by the spine of the scapula; supraspinous
fossa & infraspinous fossa

Supraspinous Fossa Infraspinous Fossa

- Located above / upper fossa, superior
to the spine of scapula (supraspinatus
fossa)
- Small, trough-like
- muscle that originates is
supraspinatus
- larger
- located below / lower fossa
(infraspinatus fossa)
- origin muscle is infraspinatus

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 Costal (ventral, anterior) surface

- Lies against the posterior aspect of ribcage

- Large part of this surface forms a shallow concavity – subscapular fossa
Subscapular Fossa

- Located (anteriorly) in front, (posteriorly) below

- Hidden beneath the ribs & scapula
- Articulates w/ subscapularis (broad & flat muscles) __ bigger
- Contracts – internally rotates the shoulder
- Basic function: important internal rotator
- Innervations; large & flat ( 2 verve supplies)

THREE LARGE BONY PROCESSES

Spine process
- Large, triangular ridge, lateral from the medial border of scapula to merge into the
acromion process

Spinoglenoid

- Greater scapular notch

- Notch-like passageways, lateral border of the spine that blends into the neck of
the spine
- Connects the supraspinous fossa w/ the infraspinous fossa
Which allows suprascapular nerve & vessels to pass in between

Acromion process

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 - From the spine of the scapula, ends laterally (moves laterally / lateral extension)
- Articulates w/ clavicle, at the acromial end
- Broad, flat, forms the palpable tip of the shoulder
- Partly roots over the glenoid cavity
- Forms when the lateral end of the scapula is free

Deltoid

- Attached to the spine of the scapula up to the acromion

- Responsible for the roundness of shoulder
Suprascapular notch
- Slight depression
- On the lateral aspect of the superior border
- Near base of the coracoids process
- Bone only & without the ligament
- Site of compression
Suprascapular foramen
- With the presence superior transverse ligament which bridges the notch
Suprascapular artery
- Passes superior (above)
Suprascapular nerve
- Passes inferior (below)
- Supplies the supraspinatus & infraspinatus muscle
Coracoid process

- On superior border, protrudes

- Ends up laterally from superior (anterolaterally)
- Continues laterally
- Thick, beaklike structure
- Muscle attached: coracobrachialis

Glenoid Fossa

- Pear-shaped, superolateral angle of the scapula

- Articulates w/ the head of humerus at the shoulder joint / glenohumeral joint
- Covered by a cartilage – glenoid labrum
- Where the medial & superior border meets

THREE IMPORTANT SHOULDER JOINTS:

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 1. Sternoclavicular joint – only attachment of UE in the trunk
2. Acromioclavicular joint
3. Glenohumeral joint
TWO TYPES OF TUBERCLES

Supraglenoid tubercle Infraglenoid tubercle

- Located above the glenoid fossa - Lower part of the glenoid fossa
- Named part of the glenoid - Roughened area
- Highest point, attachment to biceps - Muscle attached: triceps

Glenoid labrum
- Fibrocartilage ring, rims the margin of the glenoid cavity
- Broadens & deepens the joint cavity

Humerus
- Long and hard bone, located in the arm
- Longest bone of the upper limb
- Proximally, articulates w/ the glenoid fossa of the scapula at the glenohumeral joint
- Distally, articulates / the head of the radius & trochlear notch of the ulna

THREE MAIN REGIONS

Proximal extremity

Humeral head
- Or head of humerus, proximal part
- Round, smooth, proximal end of the humerus
- Forms about 1/3 of a sphere
- Oriented medially, superiorly, and posteriorly

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 - Articulates w/ the glenoid cavity at the glenohumeral joint
- Two necks; anatomical & surgical

Anatomical neck
- Slightly constricted region surrounding the articular surface of the head
- Articular surface of the glenohumeral joint
- Attaches along the inferior edge
- Fractures (rare), frequent on old people

Surgical neck
- Constricted area
- Immediately inferior to the greater & lesser tubercles
- Forms the interface between proximal extremity & shaft of the humerus
- Fractures are common

Greater Tubercle
-―big bukol, large, roughened elevation on the lateral proximal end of the
humerus
- Lateral to the head, below anatomical neck

Lesser Tubercle
-―small bukol‖, small, roughened elevation on the anterior proximal end, inferior
to the head
- Medial to greater tuberosity, below the anatomical neck
Intertubercular groove
- Or bicipital groove
- Depression in bet. the two tuberosities
- A tendon (biceps long head tendon) passes through
- Forms two borders; lateral & medial lip

Lateral lip
- Serves as attachment of the pectoralis major
(inserts)

Medial lip
- Serves as attachments / insertion of teres major

Latissimus dorsi
- Muscle
- Attaches to the floor of the bicipital groove

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 Body/Shaft
- After the surgical neck, part of humerus
- Continues downward
- Slight protrusion,laterally
Deltoid tuberosity
- Or tuberosity of deltoid
- Attachment of deltoid muscle
- Roughened, triangular elevation on the anterolateral surface of the midshaft of
the humerus
Radial groove (sulcus)
- Or groove for the radial nerve/ radial groove/ spiral groove
- Shallow depression, spirals around posterior & lateral aspects of midshaft
- Posterior edge of the tuberosity
- Distinct, bet. deltoid tuberosity & upper end of the lateral supracondylar ridge

Distal extremity
- Comprises the elbow
- Articulates w/ the radius and ulna
- Two protrusions (bukol-bukol); medial & lateral epicondyle

Medial epicondyle
- Palpated medially, bony prominence ( more prominent)
- Large, knoblike projection on the distal, medial side of the humerus
- Forms important landmarks in the arm

Lateral epicondyle
- Coverd by muscles
- Small, roughened projection on the distal, lateral side proximal to the capitulum
- Readily palpable
*both serves as common attachments of the muscles that are responsible for
movement of the wrist and hand, particularly flexors and extensors

Ridge
- Sharpened edges
- Two ridges; lateral supracondylar ridge & medial supracondylar ridge
Medial supracondylar ridge
- Narrow ridge, runs proximally from the medial epicondyle forming the lower
medial border
Lateral supracondylar ridge
- From the lateral epicondyle, forming lower lateral border

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 - Most important, lateral side
- Attachment of 2 important muscles; brachioradialis & extensor carpi radialis
longus

Capitulum
- Rounded end, ―little head‖
- Articulates w/ the radius
- Half-spherical, articular process at the distal, lateral end of the hurmerus
- Shape allows flexion / extension
- Articulates w/ head of humerus

Radius

Trochlea
- Hourglass end; articular process at the distal, medial end of the humerus
- Pulley-shaped
- Medial to the capitulum
- Articulates w/ the trochlear notch of ulna
- Shape – limits the lateral movements of the ulna (hinge action)
Troclear notch
- Groove, c-shaped notch (cut) which articulates with the trochlea of the
humeraus to form the elbow joint
Radial fossa
- Depression above the capitulum
- Receives the head of radius (flexion)

Coronoid fossa
- Depression above the trochlea
- Receives the coronoid process of the ulna (flexion)
Olecranon fossa
- Deep depression on posterior end of the humerus (at the back)
- Proximal to the trochlea
- Holds the apex (tip) of the olecranon process of ulna (extension)

Radial head – radius , radial fossa – humerus

Corocoid process – ulna, corocoid fossa –humerus
Olecaranon process - ulna, Olecranon fossa –humerus

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 Radius
- Bone on the lateral side of the forearm (anterbrachium)
- Proximally, articulates w/ both the capitulum of the humerus &radial notch of rhe
ulna
- Distally, articulates w/ the head of the ulna & scaphoid and lunate bones (wrist)
During pronation & supination
- Radius rotates about its long axis at its proximal end & circumducts ulna at
its distal end
Head of radius
- Expanded, roumd, proximal end of radius
- Proximal surface, a shallow concavity for articulation w/ the capitulum of the
radius
- Peripherary, articulates with the radial notch of ulna
- Held in place against the ulna by – encircling anular ligament
Neck of radius
- Constricted area, distal to the head
Radial tuberosity
- Raised, mostly roughened area on the anteromedial proximal aspect of the
radius
- Distal to the neck (below)
- Insertion site of biceps brachii muscle

Body of radius
- Or shaft of radius
- Elongated midportion of radius
- Widens along its proximal or distal extent
Interosseous border
- Medial border of the shaft
- Forms a sharp crest for attachments of interosseous membrane
- Or margin, in bet. radius and ulna
Interosseous membrane
- Binds radius and the ulna together
Ulnar notch
- Articular surface for the head of ulna
- Shallow depression on the distal, medial aspect of the radius

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 Styloid process
- Distal projection from the lateral, distal aspect of the radius
- Extends lateral to the proximal row of carpal bones
Carpal articular surface
- Forms the distal surface of the radius
- Articulates w/ scaphoid (laterally) and lunate (medially) bones
Ulna
―elbow or ―cubital
- On the medial side of the forearm
- Proximally, articulates w/ both the trochlea of ulna & head of radius
- Distally, articulates w/ ulnar notch of radius

Olecranon
- Or olecranon process
- Easily palpable proximal end of the ulna
- Forms the ―point‖ of the elbow
- Insertion site of triceps brachii muscle
- Beaklike tip, fits olecranon fossa (extension)

Trochlear notch
- Crescent-shaped, anterior aspect of proximal end of the ulna
- Formed by the articular surfaces of olecranon & coronoid process
- Articulates w/ the trochlea of the humerus

Coronoid process
- anterior projection
- Forming the inferior end of the hook-like proximal end of the ulna
- Contributes in forming the trochlear notch
Radial notch
- Shallow notch on the lateral side of the coronoid process
- Distal to the trochlear notch
- Articular surface for the head of the radius
Ulnar tuberosity
- Anterior, distal roughened, aspect of the coracoid process
- Insertion area of brachialis muscle

Body of ulna
- Or shaft of ulna
- Elongated mid-portion of the ulna
- Contradistinction to radius

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 - Tapers along its proximal, distal length
- Posteriorly, rounded & subcutaneous, easily palpable
- Lateral border, forms the interosseous border
Interosseous border
- Lateral border of ulna, c-shaped

Head of ulna
- Small, round distal end
- Articular surface on lateral side for contact w/ ulnar notch & radius
- Distal end, separated & excluded from the wrist joint by an articular disc

Styloid process
- Small projection from posteriolateral
- Distal end
- Easily palpated
- In line w/ 5th metacarpal (pinky side)
Cubital tunnel
- Where the ulnar nerves passes through *biring if mabunggo (funny bone)
- Bordered by the medial epicondyle (medially) of the humerus & olecranon
process (laterally) of the ulna
Foramen – whole (buho ; Fossa – depression (gupi)

Carpal bones
- Eight small bones comprising the wrist
- Arranged proximal & distal; 2 rows & 4 bones on each row
- Arrangement forms the carpal tunnel

Carpal tunnel
- Deep concave groove on the ventral aspect of the wrist
- Groove is roofed by the flexor retinaculum
- Conveys several flexor tendons & median nerves into the hand
Flexor retinaculum
- Strong ligamentous band
Carpal tunnel syndrome
- Caused by the compression of the space and / or trauma to its section
*bones of the hand are cartilaginous at birth
*capitates begins to ossify at the 1st year, other begin to ossify at intervals, then
until 12th year all bones are ossified

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 Mnemonic
- Helpful for remembering the carpal bones
“Some Lovers Try Positions That They Cannot Handle” (proximal-distal & lateral-
medial)

Proximal row
- Lateral to medial
- Scaphoid, lunate, triquetrum, & pisiform
Scaphoid
- Largest, most lateral carpal bone
- In the floor of the anatomical snuffbox
- Fractured frequently by the impact on base of hand – when wrist is
hyperextended & abducted

Lunate
- Roughly semilunar-shaped carpal bone
- Between scaphoid and triquetrum

Triquetrum
- Roughly pyramidal-shaped
- Most medial bone in proximal carpal row

Pisiform
- Small, pea-shaped sesamoid bone formed in the
tendon of flexor carpi ulnaris muscle

Distal row
- Lateral to medial
- Trapezium, trapezoid, capitates, & hamate

Trapezium
- Most lateral carpal bone of the distal row
- Forms a saddle joint w/ first metacarpal bone –allows great mobility of
thumb―the thumb swings on the trapezium

Trapezoid

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 - Bone between trapezium & capitates
- Named for its trapezoid shape

Capitate
- Central & largest carpal bone
- Bet. trapezoid & hamate
- Named for its rounded head which sits in the concavity
- Formed by the scaphoid & lunate bones

Hamate
- Most medial bone in the distal carpal row
- Distinguishing feature; hamulus (hook)
Hamulus – one of the attachment points of flexor retinaculum
*forces generated in the hand (punching blow of fist) are transmitted through
the 3rd metacarpal bone to the capitates, then proximal through the lunate,
and to the
radius

Metacarpal bones
- Five bones bet. carpal bones & phalanges
- Comprise the body of the hand
- Bones are identified from 1-5; lateral to medial unit
- Each bone has a base, body and head

Base
- Expanded proximal end of the bone
- Articulates with the distal row of carpal bones
Body
- Elongate, slender, mid-portion of the bone
- Shaft of each is slightly concave anteriorly & triangular in the transverse section
- Has posterior, lateral, & medial surfaces
Head
- Rounded, distal end of the bone
- Articulates w/ proximal phalanx or corresponding digit
- Forms a knuckle of the hand

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 1st metacarpal bone: thumb, shortest, & most mobile
2nd metacarpal bone: in line w/ the index finger
3rd metacarpal bone: in line w/ the middle finger
4th metacarpal bone: in line w/ the ring finger
5th metacarpal bone: n line w/ the pink/ little finger

Phalanges
- bones that comprise the digits of the hands
- Classified as long bones; phalanx (singular)
- Thumb (2); proximal & distal | others (3) ; proximal, middle, & distal
- Also has a base, body, and head
Base of each proximal phalanx
- Articulates w/ head of the corresponding metacarpal bone
Base of middle or distal phalanx
- Articulates w/ head of the next most proximal phalanx

Body of each distal phalanx

- Is very short
Head of each proximal &middle phalanx
- Articulates w/ the base of the next most distal phalanx

Joints
- A site where two or more bones attach or come together

3 IMPORTANT JOINTS OF THE SHOULDER COMPLEX

a. True joints
1. Sternoclavcular joint
2. Acromioclavicular joint
3. Glenohumeral joint
b. Pseudo joints
- Or false joints
- Joint in appearance but they do not possess the basic characterstics of a typical
joint

Sternoclavicular joint
- Only attachment of the upper extremity of trunk to the thorax

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 Articulation: between the sternal end of the clavicle, the manubrium sterni, and the
1st costal cartilage
Type: Synovial double-plane joint
Capsule: This surrounds the joint and is attached to the margins of the articular
surfaces.
Ligaments: sternoclavicular ligaments
Articular disc: This flat fibrocartilaginous disc lies within the joint and divides the
joint’s interior into two compartments Its circumference is attached to the interior of
the capsule, but it is also strongly attached to the superior margin of the articular
surface of the
clavicle above and to the first costal cartilage below.
Accessory ligament: costoclavicular ligament
Synovial membrane: lines the capsule and is attached to the margins of the cartilage
covering the articular surfaces.
Nerve supply: The supraclavicular nerve and the nerve to the subclavius muscle

Movements
→ Forward and backward movement of the clavicle takes place in the medial
compartment. → Elevation and depression of the clavicle take place in the lateral
compartment
Acromioclavicular Joint

Articulation: between the acromion of the scapula and the lateral end of the clavicle
Type: Synovial plane joint
Capsule: This surrounds the joint and is attached to the margins of the articular
surfaces
Ligaments: Superior and inferior acromioclavicular ligaments
Accessory ligament: coracoclavicular ligament
Synovial membrane: This lines the capsule and is attached to the margins of the
cartilage covering the articular surfaces.
Nerve supply: The suprascapular nerve
Movements
→ A gliding movement takes place when the scapula rotates or when the clavicle is
elevated or depressed
Glenohumeral Joint
Articulation: between the rounded head of the humerus and the shallow, pear-

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 shaped glenoid cavity of the scapula. articular surfaces are covered by hyaline
articular cartilage, and the glenoid cavity is deepened by the presence of a
fibrocartilaginous rim
called the glenoid labrum
Type: Synovial ball-and-socket joint
Capsule: This surrounds the joint and is attached medially to the margin of the
glenoid cavity outside the labrum; laterally, it is attached to the anatomic neck of the
humerus. The capsule is thin and lax, allowing a wide range of movement. It is
strengthened by fibrous slips from the tendons of the subscapularis, supraspinatus,
infraspinatus, and teres minor muscles (the rotator cuff muscles).
Ligaments: glenohumeral ligaments, transverse humeral ligament, & coracohumeral
ligament
Accessory ligaments: coracoacromial ligament
Synovial membrane: This lines the capsule and is attached to the margins of the
cartilage covering the articular surfaces. It forms a tubular sheath around the tendon
of the long head of the biceps brachii. It extends through the anterior wall ofthe
capsule to form the subscapularis bursa beneath the subscapularis muscle
Nerve supply: The axillary and suprascapular nerves
Movements
Flexion, extension, adduction, lateral rotation, medial rotation, circumduction
Elbow Joint

Articulation: between trochlea & capitulum of humerus, trochlear notch of ulna, and
head of the radius
Type: Synovial hinge joint
Capsule: (anteriorly) attached above the humerus along the upper margins of the
coronoid & radial fossa, front of medial 7 lateral epicondyles, below margin of
coronoid process & to the annular ligament, which surrounds the head of radius.
(posteriorly) attached above to margins of olecranon process & to annular ligament
Ligaments: lateral (radial collateral ligament, annular ligament, medial (ulnar)
collateral ligament; anterior, posterior, & transverse bundles
Synovial membrane: lines the capsule and covers fatty pads in the floor of the
coronoid, radial, & olecranon fossa. Continuous below with the synovial membrane
of the proximal radioulnar joint
Nerve supply: median, ulnar, musculocutaneous, & radial nerves
Movements
→ Flexion & extension

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