The bones of the upper limb

(Nomenclature: Terminologia Anatomica, 1998;

names denoted with asterisk are from BNA)

Professor Dr. András Mihály, MD

Edition and figure legends: Dr. András Mihály, MD, PhD, DSc. & Dr. Roland Weiczner, MD,
PhD.
Photographs: Mr. M. Dezső.
Bones: collection of the Anatomy Department, Szeged.
Atlas pictures: Sobotta Atlas

Dept. of Anatomy, Histology and Embryology

Faculty of Medicine, University of Szeged
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 Bones of the upper limb
Pectoral girdle (shoulder girdle)
Scapula + Clavicle
Free part of upper limb
Upper arm: Humerus
Forearm: Radius + Ulna
Hand: Carpal bones (8)
Metacarpal bones (5)
Phalanges (14)
2
 Superior
(Deltoid angle
tubercle) Acromion

(Spinal Acromial
trigone*) angle Glenoid
cavity

Neck of
Lateral
scapula
angle
M L
Infraglenoid
tubercle

SCAPULA
Dorsal view
Inferior 3
angle
 Superior
Acromion Suprascapular notch angle
Coracoid
process

Glenoid
cavity Subscapular
Lateral fossa
angle
L M
Infraglenoid
Muscular
tubercle
lines*

SCAPULA
Ventral view
Inferior 4
angle
 P
SCAPULA
Superior view
Acromial
angle
Spine of scapula

Clavicular facet of acromion

L Acromion M
Supraspinous fossa

Glenoid
cavity Superior border Superior
angle

Suprascapular
notch
A 5
 Coracoid
Acromion
process

Supraglenoid
tubercle

P A
Glenoid
cavity
Infraglenoid
tubercle

Lateral angle
SCAPULA
Lateral view 6
 A CLAVICLE
Superior view

M Acromial
facet
Sternal end

Acromial end

Sternal
facet L
P
7
 P CLAVICLE
Inferior view
M
Subclavian groove Conoid L
tubercle
Nutrient foramen

Impression for
Trapezoid line
costoclavicular ligament

Acromial facet
Sternal facet
A
8
 HUMERUS
Ventral view
L
Body of humerus

Deltoid tuberosity
Proximal epiphysis Distal epiphysis

M
9
 HUMERUS
Posterior view
M
Body of humerus

Radial groove
Proximal epiphysis Distal epiphysis

L
10
 Anatomical Greater
neck tubercle
Lesser
tubercle
M L
Crest of lesser
tubercle

HUMERUS Crest of greater

Proximal epiphysis, tubercle
anterior view 11
 Head of
Greater tubercle Anatomical
humerus
neck

L M

Surgical neck
HUMERUS
Proximal epiphysis, Body of
posterior view humerus Deltoid
tuberosity
12
HUMERUS Lateral
supra(epi)condylar
Distal epiphysis, ridge
anterior view
Medial
supra(epi)condylar
ridge
Radial fossa
Coronoid fossa

M L
Medial
Capitulum
epicondyle Trochlea of Lateral
of humerus
humerus epicondyle
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 HUMERUS
Distal epiphysis,
posterior view

L Groove for ulnar nerve M

Lateral
epicondyle Olecranon Medial
fossa epicondyle

Trochlea
of humerus 14
 (Anterior oblique line* RADIUS
and Anterior border) M Anterior view
(Pronator
tuberosity) Interosseous border

Proximal Body of radius Distal

epiphysis epiphysis

L 15
RADIUS
Proximal epiphysis, M
Anterior view
Radial tuberosity
Head of radius

Articular
facet

Neck of radius

Articular circumference
L 16
RADIUS M
Distal epiphysis, Ulnar notch
Anterior view
Carpal
articular
surface

(Anterior border)

Radial styloid process

L 17
RADIUS L
Distal epiphysis, Radial styloid process

Posterior view
(Posterior border)

(Groove for
extensor
muscle
tendons)

Interosseous border

M Ulnar notch 18
 ULNA
M Anterior view

Body of ulna

Proximal Distal
epiphysis epiphysis

L 19
ULNA A
Proximal epiphysis, Coronoid process
Lateral view
Radial notch
Trochlear notch Tuberosity of ulna

Interosseous border

Olecranon
(Supinator crest) P 20
 L ULNA
Distal epiphysis,
Anterior view
Head of ulna
Interosseous border

Articular circumference

Ulnar styloid process

M 21
 L
BONES OF HAND
Dorsal view
Index finger = Index

Middle finger = Digitus medius

Carpal bones (8)

Phalanges (14) Metacarpal bones (5)
M 22
 CARPAL BONES
Proximal carpal bones (in radioulnar order)

Scaphoid Lunate Triquetrum Pisiform

Distal carpal bones (in radioulnar order)

Trapezium Trapezoid Capitate Hamate23

BONES OF HAND Ulnar carpal eminence
Palmar view
M Hook of
hamate Pisiform

Tubercle of
Tubercle of scaphoid
trapezium

L Radial carpal eminence

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 METACARPALS (palmar view)
Head of
metacarpal

Body of metacarpal
IV V
I II III

Base of
metacarpal
Shape of base: tuberosity
”swallow- Styloid no specific mark
saddle surface
tailed” process 25
Tuberosity of distal phalanx
PHALANGES
(BNA: Unguicular tuberosity*) Palmar view

Distal
Middle
phalanx Proximal
phalanx
phalanx

Base of phalanx
Head of phalanx
Body of
(with Trochlea of
phalanx prox.
phalanx)
dist. L 26
 Articulations
of the
upper limb

Professor Dr. András Mihály, MD

Pictures: Sobotta Atlas (Putz & Pabst, Elsevier)

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 Sternoclavicular joint
Articular disc
Interclavicular lig.

Costoclavicular lig.
Sternoclavicular lig.

2nd rib
Double plane (gliding) joint: small
movements in three axis 28
 Acromioclavicular joint
• Articular surfaces of the clavicle and
acromion
• Articular disc
• Surfaces are covered by fibrocartilage
• Acromioclavicular lig.
• Coracoclavicular lig.

• Plane joint 29
Scapular ligaments

Coracoclavicular lig.

Superior transverse
scapular ligament

Coracoacromial lig.
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Shoulder girdle movements I.
1. elevation ↔ depression (sagittal axis )
2. protraction ↔ retraction (vertical axis)

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 Shoulder girdle movements II.
3. rotation (external ↔ internal)
(cca. 35°; rotation axis)
4. circumduction

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 Articulations of the
free upper limb
• Glenohumeral joint (shoulder joint)
• Elbow joint
• Distal radioulnar joint
• Radiocarpal joint (wrist joint)
• Intercarpal joints
• Carpometacarpal joints
• Intermetacarpal joints
• Metacarpophalangeal joints
• Interphalangeal joints 33
 Articulatio humeri (glenohumeral
joint, shoulder joint)

• Caput humeri cavity:caput = 1:6

• Glenoid cavity
• Glenoidal labrum (fibrocartilage)
• Coracoacromial lig. (fornix humeri)
• Coracohumeral lig.
• Glenohumeral ligaments: bands of the joint
capsule (upper, middle, inferior – this is
strongest)
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 Shoulder joint
(additional structures)
• Glenoidal labrum: fibrocartilage enlarging glenoid cavity
• Synovial tendon sheath of the biceps tendon (in the
intertubercular groove): the tendon is fixed by the
transverse humeral ligament. Tendon originates inside
the joint.
• Bursae: synovial sacs around muscle attachments,
between the tendon/muscle and the joint capsule.
Calcium deposits in these bursae cause bursitis: a
painful condition in the shoulder. Most important bursae:
subacromial bursa, subdeltoid bursa, subscapular bursa
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 Subacromial bursa Coracohumeral lig.

Tendon of the long

head of biceps

Synovial tendon
sheath of biceps
tendon
Axillary recess of the
joint capsule
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 Shoulder
joint I.

Spheroid joint (ball-and-socket)

1.anteflexion ↔ retroflexion (transverse axis)
2.abduction ↔ adduction (sagittal axis)
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 Shoulder
joint II.

Spheroid joint (three axis)

3. Medial rotation ↔ lateral rotation (axis of the
arm)
4. circumduction (=1+2+3): combination of the
previous movements
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 Articulatio cubiti: Elbow joint
1. Humeroulnar joint
Trochlea humeri + trochlear notch of ulna
Ginglymus (hinge)
2. Humeroradial joint
Capitulum humeri + Fovea capitis radii
Spheroid
3. Proximal radioulnar joint
Articular circumference (radius) +
radial notch (ulna)
Trochoid-pivot

• Collateral ligaments (ulnar, radial)

• Annular ligament of the radius
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Articulatio cubiti

Annular lig. of radius

Ulnar collateral ligament 40

 Elbow joint movements
Functionally: the joint is a trochoginglymus.
1. Flexion ↔ extension (transverse axis - ginglymus).
These are movements of the humeroulnar joint. The
joint is a hinge, with a transverse axis, allowing flexion
and extension of the forearm.
2. Pronation ↔ supination (pivot; axis of the forearm).
This is the movement in the radioulnar joints (proximal
and distal). The axis of this movement is the axis of
the upper limb (black line on the next slide). This axis
is running through the head+neck of radius, obliquely
crossing the forearm and coming through the
capitulum of the ulna. During pronation and supination
the radius is rotating around the ulna.
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Carrying angle and axis of the UL
The axis of the trochlea humeri is slightly oblique,
therefore the forearm displays a „physiological abduction”.

Physiological
abduction or
carrying
angle: 170°

Black line: axis of pronation

and supination.

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Radioulnar syndesmosis
Chorda obliqua
Interosseous membrane

43
 Distal radioulnar joint: pivot
• Articular circumference of the head of ulna
• Ulnar notch of the radius
• Trochoid joint (pivot)
• Pronation ↔ supination
Proximal radioulnar joint: pivot
The two joint move together in pronation and supination.

44
 Radiocarpal, or wrist joint
• Scaphoid + Lunate + Triquetrum
• Carpal articular surface of the radius
• Articular disc (fibrocartilage) Ellipsoid joint.
Radial and ulnar
collateral ligaments.
Dorsal and palmar
radiocarpal and
ulnocarpal ligaments.

45
Radiocarpal joint: palmar surface

Carpal groove

Ligaments are stained bluish-gray

46
 Wrist joint movements (ellipsoid joint)
1. dorsalflexion ↔ palmarflexion (radioulnar axis)
2. ulnar abduction ↔ radial abduction (dorsovolar axis)

47
 Intercarpal joints: articulations
between the carpal bones (plane
and ellipsoid joints)
• Intercarpal joint: between
scaphoid+lunate+triquetrum and head of capitate+
hamate; ellipsoid).
• Plane joint between the scaphoid and
trapezium+trapezoideum.
• Articulation of the pisiform (plane; amphiarthrosis).
• Ligaments: dorsal, palmar and interosseous
intercarpal ligaments (short, strong ligaments).
48
 Carpometacarpal joints
(II-V are plane joints)
• Dorsal and palmar ligaments are strong
and short – no active movements
possible.

• Amphiarthrosis (stiff / tight joint)

• Except: the carpometacarpal joint of the

thumb, which is a saddle joint.
49
Intermetacarpal and carpometacarpal joint surfaces are blue.
Intercarapal joints are red.
50
Wrist joint is yellow.
 Carpometacarpal joint of the thumb
(saddle joint)
• Os trapezium + Base of the first metacarpus
• Saddle joint (two axes)
• Flexion ↔ Extension (oblique axis: „b” on the
drawing)
• Abduction ↔ Adduction (axis is dorso-palmar,
„a”)
• Opposition ↔ Reposition
this is a medial rotation of the
thumb.
• Muscles perform these actions. 51
 Metacarpophalangeal joints
(ellipsoid/condyloid joints)
• Deep transverse metacarpal ligament.
• Strong, short palmar ligaments for
the support of tendons.
• Collateral ligaments
• Relatively free joints: condyloid joints
• except:
metacarpophalangeal
joint of the thumb
(red symbol; ginglymus - hinge)

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 Movements in
metacarpophalangeal joints

1. Flexion ↔ Extension
2. Abduction ↔ abduction (fingers close or open)
3. Movements are done by the flexors and
extensors of forearm, the interossei and the
lumbrical muscles

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 INTERPHALANGEAL JOINTS
• Ginglymus (hinge)
• Collateral ligs;
• Flexion ↔ extension
(transverse axis).

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