BONES OF THE UPPER LIMB

THE CARPAL BONES

THE METACARPAL BONES
THE PHALANGES
SESAMOID BONES

by
Dr Femi Oyeniyi
Department of Anatomy
Bingham University
 CASE STUDY
A 23-year-old male reports that during a game
of basketball, he tripped while driving the ball
to the basket and fell on his outstretched right
hand with the palm down. Two days later, he
phoned his anatomist father and related that
his right wrist was painful.
Later that day, he visited his father, who noted
that the wrist was slightly swollen and tender
but without deformity.
 CASE STUDY
He instructed his son to extend the right thumb,
thereby accentuating the anatomical “snuffbox,”
which is extremely tender to deep palpation. His
father advised him to get his hand and
wrist x-rayed.

 What is the most likely diagnosis?

 What is the most likely anatomic defect?
THE CARPAL BONES

 The carpus (L, “wrist”)

 Composed of 8 carpal bones
 Arranged in proximal and distal rows of
four each.
 Located between the forearm and hand
 Form a semicircle, convex proximally, the
diameter of the semicircle is distal.
THE CARPAL BONES cont’d

 Flexor surface is deeply concave to

accommodate the flexor tendons
 The extensor surface is convex, over
which the extensor tendons pass.
THE CARPAL BONES cont’d

Proximal row (lateral to medial)

 Scaphoid
 Lunate
 Triquetral
 Pisiform
THE CARPAL BONES cont’d

Distal row (lateral to medial)

 Trapezium
 Trapezoid
 Capitate
 Hamate
THE CARPAL BONES cont’d

Scaphoid
 boat-shaped
 largest bone in the proximal row
 articulates proximally with the radius
 scaphoid tubercle - blunt prominence to
the radial side of the distal surface
THE CARPAL BONES cont’d

Lunate
 moon-shaped bone
 between the scaphoid and triquetral
bones
Triquetral
 Pyramidal bone on the medial side of
the carpus
 Articulates proximally with the articular
disc of the distal radio-ulnar joint.
THE CARPAL BONES cont’d

Pisiform
 small, pea-shaped bone
 lies on the palmar surface of the
triquetrum
Trapezium
 Four-sided bone on the lateral side of
the carpus
Trapezoid
 wedge-shaped bone.
THE CARPAL BONES cont’d

Capitate
 head-shaped bone
 largest of the carpal bones
Hamate
 wedge-shaped bone on the medial side
of the hand
 Hook of the hamate extends anteriorly.
THE CARPAL BONES cont’d

Articulations
 scaphoid: Radius, lunate, trapezium,
trapezoid and capitate
 lunate: Radius, articular disc, scaphoid,
capitate and triquetral
 triquetral: Pisiform, lunate, hama te and
articular disc of the inferior radioulnar
joint
 pisiform: Articulates with the triquetral
THE CARPAL BONES cont’d

Articulations
 Trapezium: Scaphoid, 1st and 2nd
metacarpals and trapezoid.
 trapezoid: Scaphoid, trapezium, 2nd
metacarpal and capitate.
 capitate: Scaphoid, lunate, hamate, 3rd
and 4th metacarpals and trapezoid.
 hamate: Lunate, triquetral, capitate, and
4th and 5th metacarpals.
THE CARPAL BONES cont’d

Clinical Anatomy
 Fracture of the scaphoid: Results from a
fall on the outstretched hand. Possible
complication: avascular necrosis of the
bone.
 Dislocation of the lunate
 Fracture of the hamate: injury to the
ulnar nerve and artery
METACARPAL BONES

 Form the skeleton of the palm of the

hand between the carpus and
phalanges.
 Composed of five metacarpal bones
numbered lateral to medial.
 Each consists of a head (distal end), a
shaft and a base (proximal end)
METACARPAL BONES cont’d

 The bases of the metacarpals articulate

with the carpal bones.
 The heads of the metacarpals articulate
with the phalanges forming the knuckles
of the hand.
 The 1st metacarpal is the thickest and
shortest.
 The 3rd metacarpal has a styloid process
on the lateral side of its base
METACARPAL BONES cont’d

Articulations at the Bases

1st: With the trapezium
2nd: With the trapezium, the trapezoid, the
capitate and the 3rd metacarpal.
3rd: With the capitate and the 2nd and 4th
metacarpals.
4th: With the capitate, the hamate and the
3rd and 5th metacarpals.
5th: With the hamate & the 4th metacarpal.
METACARPAL BONES cont’d

Clinical Anatomy
 Bennett fracture is a fracture of the base
of the metacarpal of the thumb.
 Boxer’s fracture: fracture of the necks of
the second and third metacarpals.
PHALANGES

 There are 14 phalanges: The thumb has

2, other digits have 3 each
 Each phalanx has a base (proximally), a
shaft (body), and a head (distally)
PHALANGES cont’d

Base
 proximal phalanx : concave oval facet
 middle & distal phalanges: 2 small
concave facets separated by a ridge.
Shaft
 The shaft tapers towards the head.
 Dorsal surface: convex from side to side
 Palmar surface: flattened from side to
side, but concave in its long axis.
PHALANGES cont’d

Head
• Proximal and middle phalanges: pulley-
shaped articular surface.
• Distal phalanges: the head is non-
articular. Supports the pulp of the finger
tip.
PHALANGES cont’d

Clinical Anatomy
 Commonest fracture: distal phalanx of
middle finger. Treated by splinting to the
adjacent normal finger.
Attachments
Attachments
SESAMOID BONES OF THE UPPER LIMB

 Sesamoid bones (seed-like)

 Small rounded masses of bones located
in some tendons at points where they
are subjected to great pressure.
 They are variable in their occurrence
SESAMOID BONES OF THE UPPER LIMB

Sesamoid bones:
 Pisiform: sesamoid bone within the
tendon of the flexor carpi ulnaris.
 Two sesamoid bones on the palmar
surface of the head of the 1st
metacarpal bone (tendon of flexor
pollicis Brevis and adductor pollicis)
SESAMOID BONES OF THE UPPER LIMB

 One sesamoid bone: capsule of the

interphalangeal joint of the thumb (75%
of individuals)
 One sesamoid bone: capsule of the 5th
metacarpophalangeal joint (75% of
individuals)
 Occasionally, one sesamoid bone:
metacarpophalangeal joint of the index
finger.
OSSIFICATION

 Carpal bones are all cartilaginous at

birth.
 The capitate, ossifies first - 1st year
 The entire carpus (except pisiform) is
ossified by the 7th year
 The pisiform, ossifies last – 10th year
OSSIFICATION cont’d

 The shafts of all the metacarpals and

phalanges ossify in utero.
 The phalanges and 1st metacarpal:
Secondary centres of ossification
develop at the bases
 The 2nd, 3rd, 4th and 5th metacarpals:
secondary centres develop at the heads
 The sesamoids ossify generally after
puberty
 CASE STUDY
Summary: A 23-year-old male trips while playing
basketball and suffers trauma to
the right wrist. The wrist is slightly swollen, tender,
but not deformed. However,
deep palpation of the anatomical snuffbox elicits
extreme tenderness.

• Most likely diagnosis: Wrist fracture

• Most likely anatomical defect: Fracture of the
narrow middle portion of the scaphoid carpal
bone
The victim of an automobile accident has a
destructive injury of the proximal row of carpal
bones. Which of the following bones is most likely
damaged?
(A)Capitate
(B) Hamate
(C) Trapezium
(D) Triquetrum
(E) Trapezoid