OSTEOLOGY OF THE

UPPER LIMB

Department of Anatomy
Faculty of Basic Medical Sciences
Alex Ekwueme Federal University Ndufu-
Alike Ikwo (AE-FUNAI),
Ebonyi State
 OBJECTIVES

At the end of this lecture, students should be able

to:
List the different bones of the Upper limb.
 List the characteristic features of each of the
bones.
Differentiate between the bones of the right and
left sides.
List
the articulations between the different
bones.
INTRODUCTION
 The upper limb is a multi-jointed lever that is freely movable
on the trunk at the shoulder joint.
 At the distal end of the upper limb is the important organ,
the hand.
 Much of the importance of the hand depends on the pincer-
like action of the thumb, which enables one to grasp objects
between the thumb and index finger.
 The upper limb is made up of four (4) basic parts:
 Shoulder (made up of pectoral, axilla and scapular regions)
 Arm (brachium)
 Forearm (antebrachium)
 Hand (manus) made up of wrist (carpus),metacarpus and
digits (thumb and fingers)
Bones of the upper limb
 Out of 206 total bones in the human
body, the upper limbs contain as
many as 64 bones with each side
consisting of 32 bones
 The bones of the upper limb are:
 Shoulder region: clavicle and scapula
 Arm: humerus
 Forearm: radius and ulna
 Hand: carpal bones, metacarpals and
phalanges
 CLAVICLE
 The clavicle is a long, slender bone that
lies horizontally across the root of the
neck just beneath the skin.
 It articulates with the sternum and 1st
costal cartilage medially and with the
acromion process of the scapula
laterally.
 The clavicle acts as a strut that holds
the arm away from the trunk.
 It receives weight of upper limb via
lateral one-third through
coracoclavicular ligament
 transmits weight of upper limb to the
axial skeletal via medial two-thirds part
and provides attachment for muscles.
Peculiarities of the clavicle
 It is the only long bone that lies horizontally.
 It is subcutaneous throughout.
 It is the first bone to start ossifying.
 It is the only long bone which ossifies in membrane.
 It is the only long bone which has two primary
centres of ossification.
 There is no medullary cavity.
 It is occasionally pierced by the middle
supraclavicular nerve.
Clavicle
It has Two Ends:
Medial (Sternal) : enlarged & triangular.
Lateral (Acromial) : flattened.
Body (shaft):
 Its medial 2/3) is convex forward.
 Its lateral 1/3 is concave forward.
 Surfaces:

 Superior : smooth as it lies just deep to

the skin.
 Inferior: rough because strong
ligaments bind it to the 1st rib.
Articulations of the
clavicle
Medially with the
manubrium of sternum at
the Sternoclavicular joint .
Laterally with the Scapula
at the Acromioclavicular
joint
Inferiorlywith the 1st rib at
the Costoclavicular Joint
Ossification of the clavicle
 The clavicle is the first bone in the body to ossify
 Except for its medial end, it ossifies in membrane.
 Itossifies from two primary centres and one
secondary centre.
 The two primary centres appear in the shaft
between the fifth and sixth weeks of intrauterine
life, and fuse about the 45th day.
 The secondary centre for the medial end appears
during 1,5-17 years, and there may be a
secondary centre for the acromial end.
 Clinical anatomy of the clavicle
 The clavicle is commonly fractured especially in children
as forces are impacted to the outstretched hand during
falling.
 The weakest part of the clavicle is the junction of the
middle and lateral thirds.
 After fracture, the medial fragment is elevated (by the
sternocleidomastoid muscle), the lateral fragment drops
because of the weight of the Upper Limb.
 It may be pulled medially by the adductors of the arm.
 The sagging limb is supported by the other.
 The clavicles may be congenitally absent, or
imperfectly developed in a disease called
cleidocranial dysostosis. In this condition, the
shoulders droop, and can be approximated
anteriorly in front of the chest
 SCAPULA
 It is a triangular Flat bone.
 Extends between the 2nd to 7th ribs.
 It has :
 Three Processes:
 (1)Spine:a thick projecting ridge of bone that
continues laterally.
 (2) Acromion : forms the subcutaneous point
of the shoulder.
 (3) Coracoid: a beak-like process.
 Itresembles in size, shape and direction a
bent finger pointing to the shoulder.
 Three Borders: Superior, Medial (Vertebral)
& Lateral (Axillary) (the thickest) part of the
bone, it terminates at the lateral angle .
Scapula
 Three Angles :
 Superior.

 Lateral (forms the Glenoid cavity) : a shallow concave

oval fossa that receives the head of the humerus.
 Inferior.

 Two Surfaces:
1. Convex Posterior : divided by the spine of the scapula
into the
Smaller Supraspinous Fossa
 (above the spine) and the
 larger Infraspinous Fossa
 (below the spine).
2.Concave Anterior (Costal) : it forms the large
Subscapular Fossa.
 Functions of the scapula
 Gives attachment to muscles.
 Has a considerable degree of
movement on the thoracic wall
to enable the arm to move
freely.
 The glenoid cavity forms the
socket of the shoulder joint.
 Because most of the scapula is well
protected by muscles and by its
association with the thoracic wall ,
most of its fractures involve the
protruding subcutaneous Acromion.
 Ossification of the scapula
 The scapula ossifies from one primary centre and seven secondary
centres.
 The primary centre appears near the glenoid cavity during the eighth
week of development.
 The first secondary centre appears in the middle of the coracoid
process during the first year and fuses by the 15th year.
 The subcoracoid centre appears in the root of the coracoid process
during the 10th year and fuses by the 16th to 18th years.
 The other centres, including two for the acromion, one for the lower
two-thirds of the margin of the glenoid cavity, one for the medial
border and one for the inferior angle, appear at puberty and fuse by
the 25th year.
 Clinical anatomy of the
scapula
 WINGED SCAPULA
 It will protrude posteriorly.
 The patient has difficulty in raising the arm above
the head (difficult in rotation of the scapula).
 It is due to injury of the long thoracic nerve (as
in radical mastectomy) which causes paralysis
of serratus anterior muscle
 The medial border and inferior angle of the
scapula will no longer be kept closely applied to
the chest wall
 SCAPHOID SCAPULA
 The scaphoid scapula is a developmental
anomaly, in which the medial border is concave.
HUMERUS
 A typical Long bone.
 It is the largest bone in the Upper Limb
 Proximal End :
 Head, Neck, Greater & Lesser Tubercles.
 Head: Smooth
 itforms 1/3 of a sphere, it articulates with the glenoid
cavity of the scapula.
 Greater tubercle: at the lateral margin of the humerus.
 Lesser tubercle: projects anteriorly.
 Thetwo tubercles are separated by Intertubercular
Groove (bicipital groove).
 Anatomical neck: formed by a groove separating the
head from the tubercles
 Surgical Neck: a narrow part distal to the tubercles.
 Humerus
 Shaft (Body):
 Has two prominent features:
 1. Deltoid tuberosity:
 A rough elevation laterally for the attachment of
deltoid muscle.
 2. Spiral (Radial) groove:
 Runs obliquely down the posterior aspect of the shaft.
 It lodges the important radial nerve & vessels.
 Distal End:
 Widens as the sharp medial and lateral Supracondylar
Ridges and end in the Medial (can be felt) and Lateral
Epicondyles.
 They provide muscular attachment
 Humerus
 Structures at Distal end:

 Anteriorly:

 Trochlea: (medial) for articulation with the

ulna
 Capitulum: (lateral) for articulation with the
radius.
 Coronoid fossa :above the trochlea.
 Radial fossa: above the capitulum.
 Posteriorly:

 Olecranon fossa : above the trochlea.

 Ossification of the humerus
 The humerus ossifies from one primary centre and 7 secondary centres.
 The primary centre appears in the middle of the diaphysis during the 8th week of
development.
 The upper end ossifies from 3 secondary centres on for the head (first year), one
for the greater tubercle (second year), and one for the lesser tubercle (fifth year).
 The 3 centres fuse together during the sixth year to form one epiphysis, which fuses
with the shaft during the 20th year. The lower end ossifies from 4 centres which
form 2 epiphyses.
 The centres include one for the capitulum and the lateral flange of the trochlea
(first year), one for the medial flange of the trochlea (9th year), and one for the
lateral epicondyle (12th year):
 All three fuse during the 14th year to form one epiphysis, which fuses with the
shaft at about 1-6 years.
 The centre for the medial epicondyle appears during 4-6 years, forms a separate
epiphysis, and fuses with the shaft during the 20th year.
 Clinical anatomy of the humerus
 FRACTURES OF HUMERUS
 Most common fractures are of the Surgical
Neck especially in elderly persons with
osteoporosis.
 The fracture results from falling on the hand
(transition of force through the bones of forearm
of the extended limb).
 In younger people, fractures of the greater
tubercle results from falling on the hand when
the arm is abducted .
 The body of the humerus can be fractured by a
direct blow to the arm or by indirect injury as
falling on the oustretched hand
Nerves affected by
fractures of the humerus

Surgical neck: Axillary nerve

Radial groove: Radial nerve.
Distal end of humerus:
Median nerve.
Medial epicondyle : Ulnar
nerve.
 ULNA
 It is the stabilizing bone of the forearm.
 It is the medial & longer of the two bones of the forearm.
 Proximal End
 1. Olecranon Process :
 projects
proximally from the posterior aspect(forms the
prominence of the elbow).
 2. Coronoid Process :
 projects anteriorly.
 3.Tuberosity of Ulna:
 inferior to coronoid process.
 4.Trochlear Notch:
 articulates with trochlea of humerus.
 5.Radial Notch :
a smooth rounded concavity lateral to coronoid process.
 Ulna
Shaft :
Thick & cylindrical superiorly but
diminishes in diameter inferiorly
Ithas Three Surfaces (Anterior,
Medial & Posterior).
Sharp Lateral Interosseous border.
Distal End: Small rounded
1. Head: lies distally at the wrist. .
2. Styloid process: Medial.
 Ossification of the ulna
 Theshaft and most of the upper end ossify from a
primary centre which appears during the 8th week of
development.
 The superior part of the olecranon process ossifies from
a secondary centre which appears during the 10th year.
It forms a scale-like epiphysis which joins the rest of the
bone by 1-6th year.
 Thelower end ossifies from a secondary centre which
appears during the 5th year, and joins with the shaft by
18th year.
 Clinical anatomy of the ulna
 FRACTURE OF THE ULNA
 The shaft of the ulna may fracture either alone or along
with that of the radius.
 Cross-unionbetween the radius and ulna must be
prevented to preserve pronation and supination of the
hand.
 FRACTURE OF THE OLECRANON AND CORONOID PROCESS
 Fracture of the olecranon is common and is caused by a
fall on the point of the elbow.
 Fracture of the coronoid process is uncommon, and
usually accompanies dislocation of the elbow.
 Clinical anatomy of the ulna
 DISLOCATION
 Dislocationof the elbow is produced by a fall on the
outstretched hand with the elbow slightly flexed.
 The olecranon shifts posteriorly and the elbow is fixed in
slight flexion.
 MADELUNG’S DEFORMITY
 Madelung's deformity is dorsal subluxation (displacement)
of the lower end of the ulna due to retarded growth of
the lower end of the radius
 RADIUS
 Itis the shorter and lateral of the two
forearm bones.
 Proximal End:
 1. Head: small & circular
 Itsupper surface is concave for
articulation with the Capitulum.
 2. Neck.
 3.Radial (Bicipital) Tuberosity :
medially directed and separates the
proximal end from the body.
 Shaft:

 Has a lateral convexity.

 It gradually enlarges as it passes distally.
 Radius
Distal(Lower) End: It is
rectangular
1. Ulnar Notch : a medial concavity
to accommodate the head of the
ulna.
2.Radial Styloid process: extends
from the lateral aspect.
3.Dorsal tubercle: projects dorsally.
Ossification of the radius
 Theshaft ossifies from a primary centre which
appears during the 8th week of development.
 Thelower end ossifies from a secondary centre
which appears during the first year and fuses
at 20 years; it is the growing end of the bone.
 Theupper end (head) ossifies from a
secondary centre which appears during the 4th
year and fuses at 18 years
 Clinical anatomy of the radius
 Because the radius & ulna are firmly bound by
the interosseous membrane, a fracture of one
bone is commonly associated with dislocation of
the nearest joint.
 Colles’ Fracture (fracture of the distal end of
radius) is the most common fracture of the
forearm.
 Itis more common in women after middle age
because of osteoporosis.
 It causes dinner fork deformity.
 Itresults from forced dorsiflexion of the hand as
a result to ease a fall by outstretching the upper
limb.
Clinical anatomy of the radius

 The typical history of the fracture includes slipping.

Because of the rich blood supply to the distal end of the
radius, bony union is usually good.
 Ifthe distal fragment gets displaced anteriorly, it is
called Smith's fracture
A sudden powerful jerk on the hand of a child may
dislodge the head of the radius from the grip of the
annular ligament. This is known as subluxation of the
head of the radius (pulled elbow)
 WRIST (CARPUS)
 Composed of Eight Carpal ( short bones)
arranged in two irregular rows, Four each.
 These Small bones give flexibility to the
wrist.
 The carpus presents Concavity on their
Anterior surface & Convex from side to
side Posteriorly.
 Proximal row (from lateral to medial):
 Scaphoid, Lunate, Triquetral & Pisiform
bones.
 Distal row (from lateral to medial):
 Trapezium, Trapezoid, Capitate & Hamate.
 Identifying features of carpal bones
 The scaphoid is boat-shaped and has a tubercle on its lateral side.
 The lunate is half-moon-shaped or crescentic.
 The triquetral is pyramidal in shape and has an isolated oval facet
on the distal part of the palmar surface.
 The pisiform is pear-shaped and has only one oval facet on the
proximal part of its dorsal surface.
 The trapezium is quadrangular in shape, and has a crest and a
groove anteriorly. It has a sellar (concavoconvex) articular surface
distally.
 The trapezoid resembles the shoe of a baby.
 The capitate is the largest carpal bone, with a rounded head.
 The hamate is wedge-shaped with a hook near its base
 General features of carpal bones
 The proximal row is convex proximally, and concave distally.
 The distal row is convex proximally and flat distally.
 Each bone has 6 surfaces.
i. The palmar and dorsal surfaces are non-articular, except for the
triquetral and pisiform.
ii. The lateral surfaces of the two lateral bones (scaphoid arid
trapezium) are nonarticular.
iii. The medial surfaces of the three medial bones (triquetral,
pisiform and hamate) are nonarticular.
 The dorsal nonarticular surface is always larger than the palmar
nonarticular surface, except for the lunate, in which the palmar
surface is larger than the dorsal
 Clinical anatomy of carpal bones
FRACTURE OF THE SCAPHOID
It is the most commonly fractured carpal bone and it is
the most common injury of the wrist.
It is the result of a fall onto the palm when the hand is
abducted.
Pain occurs along the lateral side of the wrist especially
during dorsiflexion and abduction of the hand.
 Thus, during scaphoid fracture, pain is felt in the
anatomical snuff box.
Union of the bone may take several months because of
poor blood supply to the proximal part of the scaphoid.
 DISLOCATION OF LUNATE
 Dislocation of the lunate may be produced by a fall on
the acutely dorsiflexed hand with the elbow joint flexed.
 This displaces the lunate anteriorly, also leading to
carpaltunnel syndrome like features
 METACARPUS
 Itis the skeleton of the hand between the
carpus and phalanges.
 Itis composed of Five Metacarpal bones,
each has a Base, Shaft, and a Head.
 They are numbered 1-5 from the thumb.
 The distal ends (Heads) articulate with the
proximal phalanges to form the Knuckles
of the fist.
 The Bases of the metacarpals articulate
with the carpal bones.
 The1st metacarpal is the shortest and most
mobile.
 DIGITS
 Each digit has Three Phalanges
 Except the Thumb which has only
Two
 Each phalanx has a Base Proximally,
a Head distally and a Body between
the base and the head.
 The proximal phalanx is the largest.
 The middle ones are intermediate in
size.
 The distal ones are the smallest, its
distal ends are flattened and expanded
distally to form the nail beds.
 Fracture of metacarpals

 Fracture of the base of the first metacarpal is called

Bennett's fracture.
 Itinvolves the anterior part of the base, and is caused by a
force along its long axis.
 The thumb is forced into a semi-flexed position and cannot
be opposed.
 The fist cannot be clenched
 The other metacarpals may also be fractured by direct or
indirect violence.
 Directviolence usually displaces the fractured segment
forwards.
 Indirect violence displaces them backwards
 Clinical anatomy of the metacarpals and
phalanges
 Tubercular or syphilitic disease of the metacarpals or phalanges in a child is
located in the middle of the diaphysis rather than in the metaphysis
because the nutrient artery breaks up into a plexus immediately upon
reaching the medullary cavity.
 In adults, however, the chances of infection are minimized because the
nutrient artery is replaced (as the major source of supply) by periosteal
vessels.
 When the thumb possesses three phalanges, the first metacarpal has two
epiphyses one at each end.
 Occasionally, the first metacarpal bifurcates distally. Then the medial
branch has no distal epiphysis, and has only two phalanges. The lateral
branch has a distal epiphysis and three phalanges. Total digits are six in
such case
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