BONES OF UPPER LIMB

CLAVICLE
PARTS OF THE CLAVICLE:
As any long bone, the clavicle has a shaft and 2 ends.
SHAFT:
Its medial 2/3 is cylindrical are convex forward while its lateral 1/3 is flat and is convex
backward .
The surfaces of the shaft are as follows:
1. Superior surface:
* It is smooth.
2. Inferior surface::
* Rough medially: for the costoclavicular ligament.
* Rough laterally: the conoid tuberde and the trapezoid ridge. for the coracoclavicular ligament
* The groove in its middle: 1/3 for the subclavius muscle
3. Anterior surface:
* It is convex in its medial 2/3 and concave in its lateral 1/3.
* The deltoid tubercle at its lateral 1/3 .
4. Posterior surface:
* Its curves are the reverse of those of the anterior surface (concave in its medial 2/3 and convex
in its lateral 1/3).It is smooth.
MEDIAL (STERNAL) END:
* It is quadrangular in shape.
* It articulates with the manubrium sterni to form the sternoclavicular joint.
LATERAL (ACROMIAL) END:
* It is flattened.
* It articulates with the acromion to form the acromioclavicular joint
SURFACE LANDMARKS:
The clavicle can readily be felt beneath the skin throughout its length (the 2 ends and the shaft).
Therefore, a fracture or swelling in the clavicle can directly be palpated beneath the skin.
TO IDENTIFY THE CLAVICLE RIGHT OR LEFT:
Put the bone in the anatomical position with reference to your body.
1. The medial end is rounded and thick, while the lateral end is flat.
2. The anterior surface is convex in its medial 2/3, but concave in its lateral 1/3.
3. The superior surface is smooth, while the inferior surface is rough
. FUNCTIONS:
1. It carries the weight of the limb.
2. It transmits the weight of the upper limb to the trunk through its articulation with the sternum.
APPLIED ANATOMY

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* The weakest point of the clavicle corresponds to the junction of its 2 curves (i.e. at the junction of the medial 2/3 with the lateral 1/3).
This is a common site for fracture of the clavicle.
* In fracture of the clavicle medial to the coraco-clavicular ligament, the lateral segment (lateral to the fracture) falls down by the weight
of the limb because the scapula is attached to this segment.

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 SCAPULA
It is triangular in shape having :
Three BORDERS:
1)Upper border:
* It has the suprascapular notch
2) Medial (vertebral) border:
* It extends from the superior angle to the inferior angle (opposite the ribs from the 2nd to the
7th).
3) Lateral (axillary) border:
* It is directed towards the axilla and extends from the glenoid cavity to the inferior angle.
Two SURFACES:
1) Anterior surface:
* It is concave with faint ridges, and is called subscapular fossa.
2) Posterior surface:
* It is marked by the spine of scapula which divides the surface into a supraspinous fossa
(above)and an infraspinous fossa (below). Theroot of the spine lies opposite the 3rd
thoracic spine..
SPINE OF SCAPULA:
* It projects as a shelf on the posterior surface of the scapula and its posterior surface is called
the crest of the spine. This crest has an upper lip and a lower lip. It also has a tubercie near its
medial triangular end.
* Its lateral border is free, and bounds the spinoglenoid notch.
GLENOID CAVITY:
* It is a pear-shaped concayity which is shallow and smooth. Just above it there is the
supraglenoid tubercie and just below it there is the infraglenoid tubercie .
* The glenoid cavity is directed upwards, forwards and laterally to articulate with the head of
the humerus to form the shoulder joint.
ACROMION:
* It is the lateral extension of the spine of the scapula.
* It projects forwards and has 2 borders: lateral and medial.
* The lateral border forms an angle with lower lip of spine of scapula called acrornial angle
* The medial border is short and has a facet for the acromio-clavicular joint.

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CORACOID PROCESS:
* It projects above the glenoid cavity and is directed mainly forwards.

ARTICULATIONS OF SCAPULA:
I) Shoulder joint: between the glenoid cavity and the head of the humerus
2) Acromlo-clavicular joint: between the acromion and lateral end of the clavicle..

TO IDENTIFY THE SCAPULA RIGHT OR LEFT:

I) The dorsal surface has the spine, the supraspinous fossa and the infraspinoug fossa
2) The lateral angle bears the glenoid cavity (head of scapula).
3) The upper border has the suprascapular notch.

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 HUMERUS
UPPER END:
* The upper end consists of the following parts:
1) Head:. It is directed backwards, medially and upwards.
2) Lesser tuberosity(tubercle) :is directed anteriorly.
3) Greater tuberosity(tubercle): is directed laterally. It shows 3 impressions: upper one on the
tip while middle and lower impressions on the back.

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 4) Intertubercular (bicipiltal) groove: is directed anteriorly. It lies between the lesser and greater
tuberdes. The groove has, a floor surrounded by a medial lip and a lateral lip.
5) Anatomical neck: is the line which immediately adjoins the head
6) SURGICAL NECK:
It is the uppermost part of the shaft just below the 2 tubercies.
It is called surgical because it is more affected by fractures than the anatomical neck.

SHAFT:
It is cylindrical in its upper 1/2 but is triangular in its lower 1/2. It has 3 borders (anterior,
medial, and lateral), and 3 surfaces (anteromedial, anterolateral and posterior).
BORDERS:
* Anterior border:.
* Medial border:
It extends upwards from the medial supracondylar ridge (above the medial epicondyle)
* Lateral border:

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 It extends upwards from the lateral supracondylar ridge (above the lateral epicondyle)
SURFACES:
* Deltoid tuberosity:
It is a rough area situated on the anterolateral surface of the shaft at about its middle.
* Spiral groove ( redial ) :
- It lies on the back of the middle 1/3 of the shaft. It runs downwards and laterally in a spiral
manner.

LOWER END OF HUMERUS:

It has an articular part and a non-articular part:
A)ARTICULAR PART:
It consists of the trochlea and capitulum, both of which share in the elbow joint:
1. Trochlea: is medial (trochlea = pulley).
2. Capitulum: is lateral
N.B: The oblique long axis of the trochlea is responsible for the "carrying angle" between the arm and the extended
supinated forearm (See the elbow joint for more details on the carrying angle).

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 B) NON-ARTICULAR PART:
It consists of medial and lateral epicondyles as well as of 3 fossae.
1. Medial epicondyle:
It is more prominent than the lateral epicondyle and
2. Laterai epicondyle:
3.Fossae:
These are 3 fossae situated just above the articular surface but are surrounded by the capsule of
the elbow joint, i.e. lie intra capsular.
a) Coronoid fossa: on the anterior surface just above the trochlea.
b) Radial fossa: on the anterior surface just above the capitulum.
c) Olecranon fossa: on the posterior surface just above the trochlea. It is the deepest
NERVES IN CONTACT WITH THE HUMERUS:
1. Radial nerve: in the spiral groove (injured in fracture of middle 1/3 of the humerus).
2. AxIllary nerve: winds round the surgical neck of humerus (injured in fracture of upper 1/3 of the humerus).
3. Ulnar nerve: behind the medial epicondyle (injured in supracondylar fracture).
TO IDENTIFY THE HUMERUS RIGHT OR LEFT:
1. The head is directed medially.
2. The intertubercular groove faces forwards.
3. The deep olecranon fossa indicates the posterior aspect, while the coronoid and radial fossae lie on the
anterior aspect.

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 The Carrying angle
The medial margin of the trochlea projects downwards more than the lateral margin
producing an angle between the long axis of the humerus and the long axis of the
supinated forearm when the elbow is fully extended . This angle is about 15 degrees
and is 20 degrees in females.
Clinical importance:
It allows the forearm to move away from the pelvis especially in the female who has a
wider pelvis. This angle disappears when the forearm is pronated or the elbow is flexed.

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 RADIUS
It is the lateral bone of the forearm.
UPPER END:
It consists of the head, neck and tuberosity.
1) Head and neck:
* The head articulates with 2 bones:
- By its upper surface: it articulates with the capitulum of the humerus in elbow joint .
By its medial surface: it articulates with the radial notch of the ulna to form the superior
radio. ulnar joint.
2) Radial tuberosity:
* It is directed medially.* It ihas rough posterior part and smooth anterior part.
SHAFT:
It has 3 borders ,and 3 surfaces (anterior, lateral and posterior):
* Anterior border:
Its upper 1/3 runs obliquely downwards and laterally from the radial tuberosity towards the
maximum convexity of the shaft. This is called anterior oblique line
* Interosseous border: - It is sharp and directed medially
* Anterior surface
* Lateral surface:
At its middle at the maximum convexity there is the pronator tuberosity.
* Posterior surface:.
LOWER END:
It is broader than the upper end and has the styloid process projecting downwards from its lateral
surface. It has 5 surfaces (anterior, posterior, lateral, medial and inferior), as follows:
1) Anterior surface:
It is smooth and concave
2) Posterior Nurface:
It shows the dorsal tubercie of Lister
3) Lateral surface:
It is continued downwards as the styloid process.
4) Medial surface:
Shows ulnar notch which articulates with head of the ulna to form inferior radio-ulnar joint.
5) Inferior surface: It shows 2 articular facets
1. A lateral triangular facet: for the scaphoid. 2. A medial quadrangular facet: for the lunate.
TO IDENTIFY THE RADIUS RIGHT OR LEFT:
A) From upper end:
1. The radial tuberosity is directed medially, and its anterior part is smooth, while its posterior part is rough.
2. The medial side of the circumference of the head is the widest.

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B) From lower end: (more suitable)
I. The anterior surface is smooth and concave.
2. The posterior surface shows ridges and grooves.

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 ULNA
It is the medial bone of the forearm.
UPPER END:
* It shows 2 processes (olecranon and coronoid) and 2 notches (trochlear and radial).
1. Olecranon: is the uppermost part and projects forwards above the trochlear notch
2. Coronoid process: is directed forwards below the trochlear notch. Its anterior surface has a
rough area called tuberosity of ulna.
3. Trochlear notch: is directed forwards It articulates with the trochlea of the humerus to form
the elbow joint.
4. Radial notch: is directed laterally and articulates with the head of the radius to form the
superior radio-ulnar joint.Note that the depression just below the radial notch is called the
supinator fossa which is bounded posteriorly by a ridge called the supinator crest.

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SHAFT:
* It has 3 borders (anterior, posterior and interosseous), and 3 surfaces (anterior, posterior and
medial).

LOWER END:
It is smaller than the upper end, and consists of the head (laterally) and the styloid process
(medially).
1) Head:
* On the back of the lower end, a groove separates the head from the styloid process
2) Stylold process: shorter than that of radius by 1.5 cm

TO IDENTIFY THE ULNA RIGHT OR LEFT:

1. The trochicar notch is directed forwards.

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2. The radial notch is directed laterally
3. The styloid process is medial to the head.

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 SKELETON OF THE HAND
CARPAL BONES
ARRANGEMENT:
The carpal bones form the carpus which consists of 8 carpal bones arranged in 2 rows: proximal
and distal.
1. Proximal row: consists of 4 bones named scaphoid (boot like), lunate(luner), triquetral (has 3
surfaces) and pisiform (pea like )from lateral to medial. Note the following:
- Scaphoid bone :largest bone of proximal raw , it has a tubercle on its anterior surface
It commonest bone of carpal bone liable to fracture. Avascular necrosis is common in its
proximal part with fracture
-Lunate bone articulate It commonest bone of carpal bone liable to dislocation
- Triquetrum bone
- The pisiform bone lies in front of the triquetrum (it is a sesamoid bone ).
2. Distal row: consists of 4 bones named from lateral to medial.:
- Trapezium( has 4 surfaces) has a groove and crest on its anterior surface
- Trapezoid similar to trapezium but smaller
- Capitate ( has a large head) ,largest carpal bone and
- Hamate ( has a hook which projects forwards)

METACARPAL BONES
* There are 5 metacarpal bones each of which has a head, shaft and base ,arranged from lateral to
lateral I,II,III,IV,V
* They lie side by side except the 1st metacarpal (for thumb) which lies on a more anterior plane.
This position of the 1st metacarpal allows the thumb to oppose the other fingers.
Longest is second metacarpal and the shortesr is first metacarpal

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 PHALANGES
Each digit has 3 phalanges: proximal phalanx, middle phalanx and distal phalanx. However, the
thumb has only 2 phalanges.
N.B.: The names of the fingers (from lateral to medial) are as follows:
- 1st: thumb (pollex).
- 2nd: index finger.
- 3rd: middle finger.
- 4th: ring finger.
- 5th: litfie finger.

NB:
The capitate is first carpal bone to be ossified at 1st year after birth while pisiform is the last
carpal bone to be ossified at 12 years old

NB. Carpal bones forms the carpal arch

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