Upper Extremities Anatomy

King Saud Bin Abdul-Aziz University of Health Sciences

Radiological Sciences Program
Cross-Sectional Anatomy (RADC-411)
4th Year
 Lecture Highlights

• Upper Extremity Bones:

1. Scapula
2. Clavicles
3. Humerus
4. Ulna/Radius
5. Bones of the hand

• Upper Extremity Muscles.

1. Pectoral region
2. Shoulder region
3. Upper arm
 Scapula & Its Function

• The scapula is also known as the shoulder

blade. 
• It articulates with the humerus at the
glenohumeral joint, and with the clavicle at
the acromioclavicular joint.
• In doing so, the scapula connects the upper
limb to the trunk.
• It is a triangular, flat bone, which serves as a
site for attachment for many muscles.
 Scapular Surfaces
• Anterior Side:

– The anterior surface of the scapula is termed ‘costal’, this is because it

is the side facing the ribcage.

– This side of the scapula there is a fossa called the subscapular fossa.

– Coracoid process-Originating from the superiolateral surface of the

costal scapula.

• Lateral Side:

– The lateral surface of the scapula faces the humerus.

– Glenoid fossa –  A shallow cavity, which articulates with the humerus

to form the glenohumeral joint.

– Supraglenoid tubercle – A roughening immediately superior to the

glenoid fossa, this is the place of attachment of the long head of the

biceps brachii.

– Infraglenoid tubercle – A roughening immediately inferior to the

glenoid fossa, this is the place of attachment of the long head of the

triceps brachii.
 Scapular Surfaces
• Posterior Side:

1. Spine – The most prominent feature of the posterior scapula.

It runs transversely across the scapula, dividing the surface

into two parts.

2. Infraspinous fossa – The area below the spine of the scapula,

it displays a convex shape. The infraspinatus muscle

originates from this area.

3. Supraspinous fossa – The area above the spine of the

scapula, it is much smaller than the infraspinous fossa, and is

more convex in shape. The supraspinatus muscle originates

from this area.

4. Acromion – projection of the spine that arches over the

glenohumeral joint and articulates with the clavicle.

Scapula
CT of Scapula
 Clavicle & Its Function
• The clavicle (collarbone) extends between
the sternum and acromion of the scapula.
• It is classified as a long bone, and can be
palpated under the skin, along its length.
• The clavicle has three main functions:
1. Attaches the upper limb to the trunk.
2. Protects the underlying neurovascular structures
supplying the upper limb.
3. Transmits force from the upper limb to the
axial skeleton.
 Clavicle Parts & Articulations
• The clavicle is a an ‘S’ shape bone, placed horizontally, the medial aspect is convex,
and the lateral aspect concave.
• Sternal (medial) End
• The sternal end contains a large facet – for articulation with the manubrium of the
sternum at the sternoclavicular joint.
• The inferior surface of the sternal end is marked by a rough oval depression for
the costo-clavicular ligament (a ligament of the SC joint).
• Shaft
• The shaft of the clavicle acts a point of origin and attachment for several muscles
– deltoid, trapezius, subclavius, pectoralis major, sternocleidomastoid and
sternohyoid.
• Acromial (lateral) End
• The acromial end houses a small facet for articulation with the acromion of the
scapula at the acromioclavicular joint. 
Clavicle
X-Ray of Clavicle & Joints
 CT of Clavicle & Acromioclavicular Joint

RT clavicle

Acromioclavicular joint
Distal end of RT clavicle

Acromion
MRI of Clavicle & Joint
 Humerus
• The humerus is the bone that forms the upper
arm, and joins it to the shoulder and forearm.
• The proximal end (head) articulates with the
scapula, forming the shoulder joint.
• Distally the humerus articulates with
forearm bones (radius & ulna) to form the
elbow joint.
• The humerus acts as an attachment site for
many muscles and ligaments, resulting in
various raised roughening on the bony surface.
 Proximal Region of Humerus
• The important anatomical features of the proximal humerus
are the head, anatomical neck, surgical neck, greater and lesser
tubercles.
1. The head of the humerus: is connected to the greater
and lesser tubercles by the anatomical neck.
2. The greater tubercle: is located laterally on the
humerus and the greater tubercle serves as attachment
site for three of the rotator cuff muscles – supraspinatus,
infraspinatus and teres minor.
3. The lesser tubercle: is much smaller, and more
medially located on the bone. It is a place of attachment
for the last rotator cuff muscle – subscapularis.
Proximal Region of Humerus
 Distal Region of Humerus
• Distally, the trochlea is located medially, and
extends onto the posterior of the bone.
• Lateral to the trochlea is the Capitulum, which
articulates with the radius.
• Also found on the distal portion of the humerus are
three depressions, known as the coronoid, radial
and olecranon fossae, which accommodate the
forearm bones during movement at the elbow.
• The distal part of the humerus articulates with the
ulna and radius at the elbow joint, at the
trochlea and capitulum respectively.
Distal Region of Humerus
 Ulna of The Forearm
• The ulna is a long bone in the
forearm.
• It lies medially and parallel to the
radius which is second forearm bone.
• Proximally, the ulna articulates with
the humerus at the elbow joint.
• Distally, the ulna articulates with the
radius forming the distal radio-ulnar
joint.
 Proximal End of The Ulna
• The proximal end of the ulna articulates with the trochlea of
the humerus and the most Important landmarks of the proximal
ulna are:
1. Olecranon –  A large projection of bone that extends
proximally, forming part of trochlear notch.
2. Coronoid process –  This ridge of bone projects
outwards anteriorly, forming part of the trochlear notch.
3. Trochlear notch – Formed by the olecranon and
coronoid process.
4. Radial notch – Located on the lateral surface of the
trochlear notch, this area articulates with the head of the
radius.
5. Tuberosity of ulna – A roughening immediately distal
of the coronoid process. It is where the brachialis
muscle attaches.
 Distal End of The Ulna
• The distal end of the ulna is much
smaller in diameter than the
proximal end.
• It is mostly unremarkable,
terminating in a rounded head, with
distal projection – the ulnar styloid
process.
• The head articulates with the ulnar
notch of the radius to form the distal
radio-ulnar joint.
 Radius of The Forearm
• The radius is a long bone in the forearm. It lies
laterally and parallel to ulna the second of the
forearm bones.
• The radius articulates in four places:
1. Elbow joint – Partly formed by an articulation between
the head of the radius, and the capitulum of the humerus.
2. Proximal radioulnar joint – An articulation between
the radial head, and the radial notch of the ulna.
3. Wrist joint – An articulation between the distal end of
the radius and the carpal bones.
4. Distal radioulnar joint – An articulation between the
ulnar notch and the head of the ulna.
 Proximal End of The Radius
• The proximal end of the radius articulates in both the
elbow and proximal radioulnar joints.
• Important bony landmarks include:
1. Head of radius –  A disk shaped structure, with
a concave articulating surface. It is thicker
medially, where it takes part in the proximal
radioulnar joint.
2. Neck – A narrow area of bone, which lies
between the radial head and radial tuberosity.
3. Radial tuberosity – A bony projection, which
serves as the place of attachment of the biceps
brachii muscle.
 Distal End of The Radius
• In the distal region, the radial shaft
expands to form a rectangular end.
• The lateral side projects distally as
the styloid process. In the medial surface,
there is a concavity, called the ulnar
notch, which articulates with the head of
ulna, forming the distal radioulnar joint.
• The distal surface of the radius has two
facets, for articulation with the scaphoid
and lunate carpal bones. This makes up
the wrist joint.
X-Ray of Forearm
(Ulna/Radius)
X-Ray of Forearm
(Ulna/Radius)
 Hands
• The bones of the hand provide support and
flexibility to the soft tissues. They can be divided
into three categories:
1. Carpal bones (Most proximal) – A set of
eight irregularly shaped bones. These are
located in the (wrist area).
2. Metacarpals – There are five metacarpals,
each one related to a digit
3. Phalanges (Most distal) – The bones of the
fingers. Each finger has three phalanges,
except for the thumb, which has two.
 Carpal Bones
• The carpal bones are a group of eight, irregularly shaped bones.
• They are organized into two rows – proximal and distal.
• In the proximal row, the bones are (lateral to medial):
1. Scaphoid
2. Lunate
3. Triquetrum
4. Pisiform

• In the distal row, the bones are (lateral to medial):

1. Trapezium
2. Trapezoid
3. Capitate
4. Hamate

• Proximally, the scaphoid and lunate articulate with the radius to form the wrist
joint. In the distal row, all of the carpal bones articulate with the metacarpals.
Carpal Bones
 Metacarpal Bones
• The metacarpal bones articulate proximally with the carpals, and distally
with the proximal phalanges. They are numbered, and each associated
with a digit:
1. Metacarpal I – Thumb.
2. Metacarpal II – Index finger.
3. Metacarpal III – Middle finger.
4. Metacarpal IV – Ring finger.
5. Metacarpal V – Little finger.

• Each metacarpal consists of a base, shaft and a head.

• The medial and lateral surfaces of the metacarpals are concave, allowing
attachment of the interoessei muscles.
 Phalanges of Hand
• The phalanges are the bones of the fingers.
• The thumb has a proximal and distal phalanx.
• The rest of the digits have proximal, middle and distal phalanges.
CT & X-Ray of Hand & Wrist
X-Ray of Carpal Bones (Wrist)
 Lecture Highlights

• Upper Extremity Bones:

1. Scapula
2. Clavicles
3. Humerus
4. Ulna/Radius
5. Bones of the hand

• Upper Extremity Muscles:

1. Pectoral region
2. Shoulder region
3. Upper arm
 Pectoral Region
• The pectoral region is located on the anterior chest
wall. It contains two important muscles that exert a
force on the upper limb; the pectoralis major,
pectoralis minor.
• Pectoralis major: is the most superficial muscle in the
pectoral region. It is large and fan shaped, and is
composed of a sternal head and a clavicular head:
1. Attachments: The distal attachment of both heads
is into the intertubercular sulcus of the humerus.
2. Function: Adducts and medially rotates the upper
limb, and draws the scapula anteroinferiorly.
3. Innervation: Lateral and medial pectoral nerves.
 Pectoral Region
• Pectoralis minor lies underneath its larger

counterpart muscle, pectoralis major. Both of

these muscles form part of the anterior wall of

the axilla region.

• Attachments: Originates from the 3rd-5th

ribs, and inserts into the coracoid process of

the scapula.

• Function: Stabilizes the scapula by drawing

it antero-inferiorly against the thoracic wall.

• Innervation: Medial pectoral nerve.

 Shoulder Region
• The muscles of the shoulder are associated with movements of
the upper limb. And those muscles are:
– Deltoid

– Teres Major
– Supraspinatus

– Infraspinatus
– Subscapularis
 Deltoid Muscles

• The deltoid muscle is shaped like the Greek letter

delta (Δ)

• It can be divided into an anterior, middle and

posterior part.

• Attachments: Originates from the scapula and

clavicle, and attaches to the deltoid tuberosity on the

lateral surface of the Humerus.

• Innervation: Axillary nerve.

 Teres Major
• The teres major forms the inferior border
of the quadrangular space.
• Attachments:
– Originates from the posterior surface of the
inferior angle of the scapula. It attaches to the
intertubercular groove of the humerus.

• Innervation: Lower subscapular nerve.

• Actions: Adducts at the shoulder and
medially rotates the arm.
Supraspinatus, Infraspinatus, & Subscapularis
• Supraspinatus
• Attachments: Originates from the supraspinous fossa of the scapula,

attaches to the greater tubercle of the humerus.

• Innervation: Suprascapular nerve.

• Actions: Abducts the arm 0-15o, and assists deltoid for 15-90o

• Infraspinatus
• Attachments: Originates from the infraspinous fossa of the scapula,

attaches to the greater tubercle of the humerus.

• Innervation: Suprascapular nerve.

• Actions: Rotates the arm.

• Subscapularis
• Attachments: Originates from the subscapular fossa, on the costal surface

of the scapula. It attaches to the lesser tubercle of the humerus.

• Innervation: Subscapular nerves.

• Actions: Rotates the arm.

Supraspinatus, Infraspinatus &
Subscapularis
 Upper Arm Muscles
• The upper arm is located between the shoulder joint and elbow
joint. It contains four muscles – three in the anterior compartment
(biceps brachii, brachialis, coracobrachialis), and one in the
posterior compartment (triceps brachii).
• The biceps brachii: is a two-headed muscle. Although the
majority of the muscle mass is located anteriorly to the humerus,
it has no attachment to the bone itself.
1. Attachments: Long head originates from the supraglenoid
tubercle of the scapula, and the short head originates from
the coracoid process of the scapula.
2. Function: Supination of the forearm. It also flexes the arm
at the elbow and at the shoulder.
3. Innervation: Musculocutaneous nerve.
 Upper Arm Muscles
• The brachialis muscle: lies deep to the biceps brachii, and is found
more distally than the other muscles of the arm.

1. Attachments: Originates from the humeral shaft and inserts into

the ulna tuberosity.

2. Function: Flexion at the elbow.

3. Innervation: Musculocutaneous nerve.

• The coracobrachialis muscle: lies deep to the biceps brachii in

the arm.
1. Attachments: Originates from the coracoid process of the scapula.

2. Function: Flexion of the arm at the shoulder, and weak adduction.

3. Innervation: Musculocutaneous nerve.
 Upper Arm Muscles

• Triceps Brachii: the triceps brachii lies in the

posterior compartment of upper arm,has three
heads (Medial, lateral and long head).
• Attachments: 
– Long head –  originates from the infra-glenoid tubercle. 
– Lateral head – originates from the humerus, superior to
the radial groove. 
– Medial head – originates from the humerus, inferior to
the radial groove.

• Function: Extension of the arm at the elbow.

• Innervation: Radial nerve.
Upper Arm Muscles
Cross-Sectional Images
Axial MRI\ Pectoral & Shoulder Muscles
Coronal MRI\ Shoulder Muscles
Axial MRI\ Shoulder Muscles
MRI of Shoulder
MRI of Shoulder
Axial MRI\ Upper Arm Muscles
Sagittal MRI\ Arm Muscles
Axial MRI\ Upper Arm Muscles
Thank You For Listening