SCAPULA AND UPPER EXTREMITIES The scapula (or shoulder blade) is a mostly flat, somewhat triangular bone located at the

back top of the rib cage (from the second to seventh ribs). An amazing thing about the scapula is that it floats over the ribs (held in place my muscles) and does not attach to any of the rib bones. This area, called the scapulothoracic motion interface, is supported by extrinsic shoulder muscles that suspend the scapula over the rib cage, stabilize it, and actively move it. These muscles are the trapezius, levator scapula, rhomboid major and minor, serratus anterior, and pectoralis minor. The scapula is the back part of the pectoral girdle (also called the shoulder girdle), which is where the arm attaches to the torso. The only bones that the scapula attaches to are the clavicle (collarbone) at the acromioclavicular and coracoclavicular joints and the humerus (upper arm bone) at the glenohumeral (shoulder) joint. At the top outside part of the scapula is the glenoid fossa, which is where the humerus attaches, forming the shoulder joint. It is a ball and socket joint held together by muscles and these four ligaments: * The coracoacromial ligament helps prevent the head of the humerus from moving too far up. * The coracohumeral ligament strengthens the top part of the joint capsule and provides some support when you move your shoulder and arm in towards your body. *The transverse humeral ligament holds the long head of the biceps muscle in a groove on the head of humerus * The glenohumeral ligaments strengthen the front part of the joint capsule. The intrinsic shoulder muscles that attach the scapula to the humerus and support the shoulder joint are the deltoid, teres major, and rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis). The glenoid fossa is a shallow socket and the ligaments are relatively lax, giving the shoulder joint its mobility and relative lack of stability, which lets you freely move your shoulder and arm in all directions. On the back surface of the scapula, a nearly horizontal ridge of bone called the scapular spine divides the scapula into the supraspinatous fossa and infraspinatous fossa. That's where the supraspinatus and infraspinatus muscles are located. On the outside end of the scapular spine is a projection called the acromion. You can feel it if you place your fingers on the outside point of the top of the shoulder. The acromion is an attachment point for the deltoid and trapezius muscles. The front surface of the scapula, just to the inside of the glenoid fossa, has a beaklike projection called the coracoid process. It is the attachment site for the short head of the biceps, coracobrachialis, and pectoralis minor muscles and for the coracoacromial and coracoclavicular ligaments. The scapula is an important bone in upper limb movement and stability. Fortunately, the bone is well protected by muscles and is rarely broken.

To transmit forces from the upper limb to the axial skeleton.Bones of the Upper Limb This contains the bones of the superior appendicular skeleton: • • • • • • The clavicle and scapula (pectoral girdle) Humerus (arm) Ulna and radius (forearm) Carpal bones (wrist) Metacarpals (hand) Phalanges (fingers) Bones of the Pectoral Girdle The Clavicle (p. . 501) • • This bone extends laterally and almost horizontally across the root of the neck. little key) connects the upper limb to the axial skeleton and the trunk. • • • The clavicle has three functions: • • • To act as a strut for holding the upper limb free from the trunk so it may have maximum freedom of action. Its curvature increases its resilience. The triangular-shaped medial (sternal) end of the clavicle articulates with the sternum at the sternoclavicular joint. To provide attachments for muscles. The clavicle (L. The broad lateral (acromial) end of the clavicle articulates with the acromion of the scapula at the acromioclavicular joint. whereas the lateral one-third is flattened and concave anteriorly. It extends from the manubrium of the sternum to the acromion of the scapula. The medial two-thirds of the body (shaft) of the clavicle are convex anteriorly.

Distal to the anatomical neck is the surgical neck. and the larger part. The body is thin and translucent. This is where the bone narrows to become the shaft. This part of the scapula. called the head. The scapula connects the clavicle to the humerus. is connected to its blade-like body by a short neck. neck. The coracoid process. The region is called the surgical neck because it is the most frequent fracture site of the proximal end of the humerus. ball-like head articulates with the glenoid fossa of the scapula. Close to the head are the greater and lesser tubercles for the insertion of the muscles that surround and move the shoulder joint. The spine continues laterally into a flattened process called the acromion. is called the infraspinous fossa. like a bird's beak. The smaller part. 539) • • • • The humerus is the largest bone in the upper limb. 501) • • This flattened. The anatomical neck separates the head and tubercles. is called the supraspinous fossa. triangular bone lies on the posterolateral aspect of the thorax. from which lies the tendon of the long head of biceps brachii muscle. The scapular notch is in the superior border. which is superior to the spine. • • • • • • • The Bone of the Arm The Humerus (p. • • . covering parts of the 2nd to 7th ribs. It projects anteriorly and articulates with the clavicle. It is highly mobile and has a head. The scapula has a concave costal or anterior surface ( subscapular fossa) and a convex posterior surface from which the spine of the scapula projects.The Scapula (p. Its smooth. the scapula has a shallow glenoid fossa for articulation with the head of the humerus. Superolaterally. and body. which is inferior to the spine. arises from the superior border of the head and projects superoanteriorly. The lesser tubercle is separated from the greater tubercle by the intertubercular groove (sulcus).

Anterolaterally. The medial epicondyle is more prominent. the medial epicondyle. Traumatic separation of the proximal epiphysis of the humerus can occur in young persons because this epiphysis does not fuse with the body of the humerus until about 18 years of age in females and 20 years of age in males. Fracture-separation of the proximal epiphysis occurs in children because the articular capsule of the shoulder joint is stronger than the epiphyseal cartilaginous plate. radial. a bony ridge runs proximally. It was given its name because it resembles the spoke of a wheel (in Latin). the axillary. teres major and latissimus dorsi muscles. From each epicondyle.• • • The body. There is a shallow. Just proximal to the trochlea are the coronoid fossa and the olecranon fossa. pulley) fits into the trochlear notch of the ulna. Because nerves are in contact with the humerus. . 555) • • This is the shorter of the two forearm bones. which accommodate corresponding parts of the ulna. which swings on this pulley when the elbow is flexed. little head). there is a roughness know as the deltoid tuberosity for the insertion of the deltoid muscle. • • • • • Fractures to the Humerus • • • • Fractures of the surgical neck are common in elderly persons and usually from falls on the elbows when the arm is abducted. Adjoining the lateral part of the trochlea is a rounded ball of bone called the capitulum (L. A prominent process. of the humerus is easy to palpate. • Bones of the Forearm The Radius (p. projects from the trochlea. respectively. and the lateral epicondyle projects from the capitulum. The fracture line occurs superior to the insertion of the pectoralis major. oblique radial groove for the radial nerve that extends inferolaterally on the posterior aspect of the body. these are know as the medial and lateral supracondylar ridges. as are its medial and lateral epicondyles. and ulnar nerves may be injured in fractures of the humerus. The distal end of the humerus is expanded from side to side. or shaft. The trochlea (L. The epicondyles being subcutaneous are easily felt. Its superior half is cylindrical.

and the trochlear notch the mouth. the distal fragment of the radius is displaced posterior. 555. a smooth cylindrical neck. and an oval prominence or tuberosity. The anterior oblique line of the radius runs obliquely across the body from the region of the radial tuberosity to the area of greatest bowing. forming the distal radioulnar joint. The Ulna (pp. the coronoid process the lower jaw. Laterally the distal end of the radius tapers abruptly into a prominent pyramidal styloid process. . Its lateral border is rounded. elbow) is the longer bone of the forearm. with the olecranon resembling the upper jaw. Posteriorly there is a prominent dorsal tubercle on the distal end of the radius.• The proximal end of the radius has a disc-shaped head. Sometimes there is also a fracture of the styloid process of the ulna. distal to the neck. it has a slight lateral convexity or bowing. The distal end of the radius has a medial ulnar notch into which the head of the ulna fits. The result is the radial and ulna styloid processes being at approximately the same horizontal level which is an abnormal condition (dinner fork deformity). The body (shaft) of the radius increases in size from its proximal to its distal end. The body is concave anteriorly in its proximal three-fourths and flattened in its distal one-fourth. The medial aspect of the body has a sharp interosseous border for attachment of the interosseous membrane. • • • • • • • • Fractures of the Radius • • • A fall on the outstretched hand may result in a fracture of the distal end of the radius. The inferior surface of the distal end of the radius is smooth and concave where it articulates with the wrist or carpal bones. In the common Colle's fracture. This prismatic bone looks somewhat like a pipe wrench. 558) • • The ulna (L.

slender distal end of the ulna has a rounded head and a conical styloid process. The body (shaft) of the ulna is thick proximally. capitate. trapezoid. The lateral side of the coronoid process has a small.• • • • The olecranon and coronoid processes clasp the trochlea of the humerus. The lunate is moon-shaped. Its prominent lateral edge. called carpal bones are referred to collectively as the carpus (L. about 1 cm proximal to the styloid process of the radius. which provides an attachment for the supinator muscle. each containing four bones. pisum. They are arranged in proximal and distal rows. lunate. even though it is a sesamoid bone in the tendon of flexor carpi ulnaris muscle. shallow radial notch for the disc-shaped head of the radius. 560-1) • • • The eight small bones of the wrist. the interosseous border. and pisiform. The irregular anterior surface of the coronoid process is rough and ends distally in a tuberosity onto which the brachialis. triquetrum. scaphe). The proximal "wrench-like" end of the ulna is larger that the small. The distal row of carpal bones (lateral to medial) consists of the trapezium. The pea-shaped pisiform (L. the chief flexor muscle of the forearm. • • • • Bones of the Wrist and Hand The Carpus (pp. The boat-shaped scaphoid is the largest bone of the proximal row and was given its name because of its resemblance to a rowboat (G. This fossa is bounded posteriorly by a distinct supinator crest. and hamate. The styloid process projects distally. The proximal row of carpal bones (lateral to medial) consists of the scaphoid (navicular). The small. Inferior to the radial notch is the triangular supinator fossa. • • • • . somewhat like a pipe wrench clasps a pipe. rounded distal end called the head. wrist). The pisiform bone is a clinically important landmark that is easily palpable. inserts. is where the interosseous membrane attaches. The distal end of the ulna has a convex articular surface on its lateral side for articulation with the ulnar notch of the radius. pea) is included in the proximal row.

565) • • • • • • • The five metacarpal bones are miniature long bones. where the dorsal interosseous muscles attach. They form knuckles of the hand that become visible when the fist is clenched. The first metacarpal is much shorter than the others.• • • The hamate can be identified by its prominent process. The carpal bones articulate with each other at synovial intercarpal joints and are bound together with ligaments to form a compact mass. 561. The capitate has a rounded head (L. Although covered with tendons. The heads of the metacarpals are at their distal ends. the hook of the hamate. The bases of the metacarpals are arranged in a fan-shaped manner from the distal row of carpal bones. The carpus has an anterior concavity known as the carpal groove (sulcus). 565) • Each phalanx (bone of a digit) is a miniature long bone. They extend from the carpus (wrist) to the digits (thumb and fingers) and are numbered from the lateral side. which consists of a body (shaft). Compression of the median nerve in the carpal tunnel produces the carpal tunnel syndrome. and a smaller distal end or head. the metacarpals can easily be palpated throughout their whole length on the dorsum of the hand. caput). where they articulate with the phalanges (bones of the digits). which projects anteriorly. The bodies (shafts) of the metacarpal are slightly concave on their medial and lateral sides. . The carpal tunnel is filled with tendons and the median nerve. • • • The Metacarpus (pp. On the dorsal surface of each head is a small tubercle on each side for attachment of collateral ligaments and joint capsules. a larger proximal end or base. The groove is converted into an osseofibrous carpal tunnel (canal) by the flexor retinaculum). • • The Phalanges (p. which is attached to the scaphoid and trapezium laterally and to the pisiform and the hook of the hamate bone medially.

com/watch?v=u63sxXYaLPE The Anatomy Coloring Book by Wynn Kapit and Lawrence Elson .htm YOUTUBE: http://www. • REFERENCES: http://download. The phalanges in the first digit are shorter and broader than those in the other digits. The proximal phalanges are the longest and the distal ones are the shortest. middle and distal).com/vitualis/med/uppbone.• The thumb (first digit) has two phalanges (proximal and distal) and each finger (second to fifth digits) has three phalanges (proximal.videohelp.helium.

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