BONES OF UPPER LIMB 21

Part One

Osteology

22 OSTEOLOGY

Chapter4

Bones of the Upper Limb

A study of the skeleton is called osteology. The skeleton bone has attained its full length the epiphyseal plate disap-
forms the structural frame work of the body. In the limbs and pears and the diaphysis and epiphysis fuse with each other.
body wall the bones of the skeleton provide a scaffolding or This is referred to as fusion of the epiphysis. Knowledge of
base over which other tissues (muscles, ligaments, blood ves- the ages at which various centres of ossification appear, and
sels, nerves etc.,) are placed. At places where two (or more) the ages at which epiphyses fuse to the diaphysis is of practical
bones meet each other, joints are formed, and these usually importance in determining the age of a person. Histological
enable movement. In the head, the thorax and parts of the details of the process of ossification are described in the au-
abdomen the bones of the skeleton provide protection to im- thor’s Textbook of Human Histology.
portant organs that lie within these regions. The first step in the study of any bone is to orientate it as it
From the above remarks it will be seen that fundamental lies in the body. To do this we have to distinguish the anterior
knowledge of the skeleton is essential for the understanding aspect from the posterior aspect; the upper end from the lower
of the anatomy of any part of the body. A brief introduction to end; and the medial side from the lateral side. Once we have
the skeleton has been given in Chapter 2. In this section we this information we can find out whether the bone belongs to
will undertake a systematic study of bones in different parts the right limb or the left one.
of the body.
The study of each bone has to be done in two distinct phases.
In the first phase (that requires no previous knowledge) the THE CLAVICLE
various named features on the bone have to be identified.
This phase should be completed before beginning dissection
The clavicle is a long bone having a shaft, and two ends
of the region to which the bone belongs. In the second phase
(Figs.4.1, 4.2). The medial end is much thicker than the shaft
all attachments on a bone are reviewed. This is logically pos-
and is easily distinguished from the lateral end which is
sible only after the muscles and joints of the region have been
flattened. The anterior and posterior aspects of the bone can
studied. For sake of completeness the entire information on
be distinguished by the fact that the shaft (which has a gentle
each bone is given at one place.
S-shaped curve) is convex forwards in the medial two thirds,
During embryonic development most bones of the body are
and concave forwards in its lateral one third. The inferior aspect
first seen in the form of cartilage. The replacement of these
of the bone is distinguished by the presence of a shallow
cartilages by bone is called ossification. In most bones ossi-
groove on the shaft, and by the presence of a rough area
fication begins during intrauterine life at an area called the
near its medial end. The side to which a clavicle belongs can
primary centre of ossification. However, the ends of long
be determined with the information given above.
bones are still cartilaginous at birth. These are ossified from
For purposes of description it is convenient to divide the
secondary centres that (as a rule) appear after birth. The
clavicle into the lateral one third which is flattened, and the
part of the bone formed by extension of bone formation from
medial two thirds which are cylindrical.
the primary centre is called the diaphysis. Each part ossified
from a secondary centre is called an epiphysis. For many The lateral one third has two surfaces, superior and inferior.
years after birth bone of the epiphysis and diaphysis is sepa- These surfaces are separated by two borders, anterior and
rated by a plate of cartilage called the epiphyseal plate. posterior. The anterior border is concave and shows a small
This plate is a site of active bone growth. Growth in length of thickened area called the deltoid tubercle. The lower surface
a bone is possible only as long as the plate exists. When a (of the lateral one third) shows a prominent thickening near
the posterior border; this is the conoid tubercle. Lateral to

5). facet which articulates with the acromion of the scapula to 5. The medial or sternal end of the clavicle articulates with the manubrium sterni. The articular capsules of the acromioclavicular joint. Right clavicle seen from above.6. The 1. that are not clearly 1. 4. The rough area above the articular surface for the manubrium sterni gives attachment to the interclavicular ligament and to the The clavicle can be easily felt in the living person as it lies articular disc of the sternoclavicular joint. The conoid part of the coracoclavicular ligament is attached to the conoid tubercle.1. part of the inferior surface.4. and is called the trapezoid line. and also with the first costal cartilage Other structures attached to the clavicle are as (Fig. 2. are attached to the margins of the articular areas for these joints. The trapezius is inserted into the posterior border of the lateral form the acromioclavicular joint. considerably from bone to bone. 4. The costoclavicular ligament is attached to the rough triangular the bone forms a prominent bulge which extends above the area near the medial end of the inferior surface. 4. the tubercle there is a rough ridge that runs obliquely up to Attachments on the Clavicle the lateral end of the bone. 4. The deltoid arises from the anterior border of the lateral one third of the shaft. 4. The sternohyoid (lateral part) arises from the lower part of the The lateral or acromial end of the clavicle bears a smooth posterior surface just near the sternal end. The articular area is smooth and extends on to follows. posterior. anterior.BONES OF UPPER LIMB 23 Fig. and of the sternoclavicular joint. superior and inferior. The muscles attached to the clavicle are as follows The medial two thirds of the shaft has four surfaces: (Figs. The edges of the groove for the subclavius give attachment to uppermost part of the sternal surface is rough for ligamentous the clavipectoral fascia. attachments. A. Fig. one third of the shaft. the inferior surface of the bone for a short distance.3. The sternocleidomastoid (clavicular head) arises from the medial aspect shows a longitudinal groove the depth of which varies part of the upper surface.4).2. The sternal end of 3. and its trapezoid part to the trapezoid line. upper border of the manubrium sterni. 5. The pectoralis major (clavicular head) arises from the anterior marked off from each other. The subclavius is inserted into the groove on the inferior surface of the shaft. Right clavicle seen from below. on the inferior aspect of the bone near the medial end forms 2. 4. . The large rough area present surface of the medial half of the shaft. The middle third of the inferior 3. just deep to the skin in its entire extent.

but the upper part of the posterior surface gives off a large projection called the spine.5. and three borders: Medial end of clavicle seen from the medial medial. In addition to the spine already mentioned there is an acromion process and a coracoid process. 4. An additional centre may The inferior end is pointed and represents the apex. smooth.3.24 OSTEOLOGY Fig.8). seen from below. 4.6 to 4. seen from above. has anterior (or costal) and posterior (or dorsal) surfaces which The greater part of the clavicle is formed by intramembranous can be distinguished by the fact that the anterior surface is ossification. 4. lateral and superior. Arising from the body there are aspect. In addition to its costal and dorsal surfaces the body has Fig. Fig. Right clavicle showing attachments. and part of the body is broad. inferior and lateral. representing the base of the triangle. The lateral border runs from the glenoid cavity to the inferior angle. The upper secondary centre that appears between 15 to 20 years of age. The sternal end ossifies from a plate of bone called the body (Figs. The sternal and acromial ends are preformed in cartilage. Ossification of the clavicle THE SCAPULA The clavicle is the first bone in the body to start ossifying. Two primary centres appear in the shaft during the 6th week of fetal life The greater part of the scapula consists of a flat triangular and soon fuse with each other. At its lateral angle the bone is enlarged and bears a large shallow oval depression called the glenoid cavity which articulates with the head of the humerus. Right clavicle showing attachments. The medial border extends from the superior . 4. The body appear in the acromion.4. fuses with the shaft by the age of 25 years. three angles: superior. three processes. The side to which a given scapula belongs can be determined from the information given above.

Fig. along with the upper surface of the spine. Immediately above the glenoid cavity there is a rough area called the supraglenoid tubercle. Its posterior border is free: it is greatly thickened and forms the crest of the spine. It is somewhat concave from above The lateral border meets the crest of the spine at a sharp downwards. (To appreciate this remember to form a longitudinal bar of bone. Immediately medial to it there is a constriction which constitutes the neck. seen from the front. Its anterior border is attached to the dorsal surface of the body. glenoid cavity (representing the lateral angle) by the root of The acromion is continuous with the lateral end of the the coracoid process. not anteriorly.8) is pear shaped and forms the shoulder joint along with the head of the humerus. The region of the glenoid cavity is often regarded as the head of the scapula. 4. It has a lateral border and a The costal surface lies against the posterolateral part of medial border that meet anteriorly at the tip of the acromion. The tip of the coracoid process The part of the body adjoining the lateral border is thickened is directed straight forwards. by the supraglenoid tubercle. the chest wall. The infraspinous fossae communicate with each other through root of the process is attached to the body of the scapula just the spinoglenoid notch that lies on the lateral side of the above the glenoid cavity. The medial end of the spine lies near the medial border of the scapula: this part is referred to as the root of the spine. A deep suprascapular notch is seen spine. the lower surface of the spine). Just below the cavity the lateral border shows a rough raised area called the infraglenoid tubercle . but is separated from the boundary of the spino-glenoid notch.BONES OF UPPER LIMB 25 The glenoid cavity (Fig. .4. angle to the inferior angle. The lower part of the root is marked spine. overhangs the glenoid cavity. The acromion below the spine forms the infraspinous fossa (along with has upper and lower surfaces. The dorsal aspect of the that the costal surface of the body of the scapula faces scapula adjoining the lateral border is rough for muscular anteromedially. The area articulation with the lateral end of the clavicle. It forms a projection that is directed forwards and partly at the lateral end of the superior border. The supraspinous and The coracoid process is shaped like a bent finger. The part above the spine forms the supraspinous acromion shows the presence of a small oval facet for fossa.6. The medial border of the spine. The spine of the scapula is triangular in form. The superior border passes The lateral border of the spine is free and forms the medial laterally from the superior angle. Right scapula. The glenoid cavity faces equally attachments. The dorsal surface gives attachment to the angle termed the acromial angle.

9 to 4. The muscles attached to the scapula are as follows (Figs.8. . 4. The deltoid takes origin from the lower border of the crest of the spine. forwards and laterally).7.26 OSTEOLOGY Fig. At the point where the coracoid process bends forwards. 1. 4. The trapezius is inserted into the upper border of the crest of the spine. 2. Right scapula seen from behind. tip and upper surface of the acromion. seen from the lateral side. and from the lateral margin. Fig. and into the medial border of the acromion. 4.11). Upper part of right scapula. Attachments on the Scapula A. its dorsal surface is marked by a ridge.

5. extending from the superior angle to the level of the root of the spine. from the root of the spine to the inferior angle. The coracoacromial ligament is attached as follows. but for a part near the lateral border and a part near the neck. 6. The subscapularis arises from the whole of the costal surface. 4. seen from 3. 10. The lower 4 or 5 digitations are inserted into a large triangular area over the inferior angle. Right scapula. 13. 7.BONES OF UPPER LIMB 27 11. The latissimus dorsi receives a small slip from the dorsal surface of the inferior angle. B. showing attachments. The coracobrachialis arises from (the medial part of) the tip of the coracoid process. showing attachments. The capsule of the acromioclavicular joint is attached to the margins of the facet for the clavicle. 17. 15. The pectoralis minor is inserted into the superior aspect of the coracoid process. The supraspinatus arises from the medial two thirds of the supraspinous fossa. . Right scapula.10. The ligaments attached to the scapula are as follows. There is a gap in the area of origin for passage of the circumflex scapular vessels. Fig. The rhomboideus minor is inserted into the dorsal aspect of the medial border. Fig.9. 2. 8. The rhomboideus major is inserted into the dorsal aspect of the medial border. 14. including the upper surface of the spine. In its upper part the attachment of the capsule extends above the supraglenoid tubercle so that the origin of the long head of the biceps is within the capsule. 4. The inferior belly of the omohyoid arises from the upper border near the suprascapular notch. but for a small part near the neck.seen from behind. The first digitation of the muscle is inserted from the superior angle to the root of the spine. opposite the root of the spine. 12. 9. The next two or three digitations are inserted into a narrow line along the medial border. 4. 16. end is attached to the lateral border of the coracoid process. The infraspinatus arises from the greater part of the infraspinous fossa. 1. near the lateral border. The short head of the biceps brachii arises from the (lateral part of the) tip of the coracoid process. and its lateral 3. The teres minor arises from the upper two thirds of the rough strip on the dorsal surface. The teres major arises from the lower one third of the rough strip along the dorsal aspect of the lateral border. The capsule of the shoulder joint and the glenoidal labrum are attached to the margins of the glenoid cavity. The area is wide and extends over the inferior angle. and the long head from the supraglenoid tubercle. The long head of the triceps arises from the infraglenoid tubercle. The levator scapulae is inserted into a narrow strip along the dorsal aspect of the medial border. Its anteromedial the front. The serratus anterior is inserted on the costal surface along the medial border.

13). 3. . The subcoracoid centre fuses with the body by the 15th year. 4. Fig. It forms the large rounded head. Right scapula. 2. It has a cylindrical central part called the The head is rounded and has a smooth convex shaft. Other centres fuse with the body by the 20th year. The anterior aspect of scapula. The suprascapular vessels lie above the ligament. 5. At about the age of puberty two centres appear in the acromion. This is called the subcoracoid centre. The greater part of the coracoid process is ossified from a centre that appears in the first year.28 OSTEOLOGY Fig. A centre appears in the body during the 8th week of fetal life. and the conoid part near the root. and also upper end is easily distinguished from the lower by the presence of a somewhat backwards and upwards. The articular surface. The coracoclavicular ligament is attached to the coracoid process: the trapezoid part on its superior aspect. The side to which a given bone belongs can cavity.12. the inferior angle and the medial border. The suprascapular ligament bridges across the suprascapular notch and converts it into a foramen which transmits the suprascapular nerve. be determined from the information given above. THE HUMERUS The humerus is a long bone. and enlarged upper and lower ends (Figs. and one each in the lower part of the glenoid cavity. Extension of ossification from this centre is responsible for forming the upper part of the glenoid cavity.4. 4. Ossification of the scapula The scapula usually has eight centres of ossification. Right humerus seen from the front. showing attachments. It may be noted that the articular area of the upper end shows a prominent vertical groove called the the head is much greater than that of the glenoid intertubercular sulcus.12. seen fromthe lateral side end to the medial aspect of the tip of the acromion just in front of the clavicular facet. 4.11. 1. It is directed medially. About the age of puberty a second centre appears in the root of the coracoid process. The spine is ossified by extension from this centre. The medial and lateral sides can be distinguished shoulder joint along with the glenoid cavity of the by the fact that the head is directed medially. 4. 4.

Note that because of the convergence of the anterior and medial borders in the upper part of the bone. The shaft of the humerus has three borders: anterior. be seen from both the anterior and posterior aspects. We may now note certain additional features of the shaft. but its upper part runs upwards on the posterior aspect of the bone. 4.14. the anteromedial surface becomes continuous with the intertubercular sulcus (Figs. It has a smooth upper part and a rough lower part.4. medial and lateral. and part of the posterior surface can be seen from the front. When the shaft is observed from behind we see that its In addition to the head. and to its sharp lateral margin (crest of the lesser tubercle.13) part of the anterolateral surface can be seen from behind. Upper end of right humerus the lateral border of the shaft. 4. the lowest on the posterior aspect.4. The tubercle shows three areas (or impressions) where muscles are attached (Fig. but it can be traced to the lower end of the lesser tubercle. because of the medial inclination of the lateral border in its upper part (Fig. There are two distinct regions of the upper end of the humerus that are referred to as the neck. Fig. The radial groove interrupts Fig. These are readily identified in the lower part of the bone (Fig. the upper end of the upper part is crossed by a humerus shows two prominences called the broad and shallow radial greater and lesser tubercles (or tuberosities). therefore.15B). or lateral lip of the intertubercular sulcus). The junction of the head with the rest of the upper end is called the anatomical neck.12. aspect of the upper end mentioned above. The lower part of the lateral border can be seen from the front. The medial border also bears a roughened strip near it middle. groove which runs These two tubercles are separated by the downwards and laterally intertubercular sulcus (also called the bicipital across the posterior and groove): this is the vertical groove on the anterior anterolateral surfaces. The anterolateral surface lies between the anterior and lateral borders.13. seen from above. and the posterior surface between the medial and lateral borders. When traced upwards the anterior border becomes continuous with the anterior margin of the greater tubercle (or crest of the greater tubercle. while the junction of the upper end with the shaft is called the surgical neck. or medial lip of the intertubercular sulcus). The three borders divide the shaft into three surfaces. . 4. The anterolateral surface has a V-shaped rough area called the deltoid tuberosity which is present near the middle of this surface.15A). between it and the head.14). The uppermost of these is placed on the superior aspect. The greater tubercle is placed on the lateral aspect of the upper end and parts of it can. 4. the anteromedial surface between the anterior and medial borders. The medial border is indistinct in its upper part.BONES OF UPPER LIMB 29 The lesser tubercle lies on the anterior aspect of the bone medial to the sulcus. Its anterior part forms the lateral boundary (or lip) of the intertubercular sulcus. 4. Right humerus seen from behind. Similarly. and the middle is in between them. The anterior limb of the tuberosity lies above the lower part of the radial groove (see below).

Parts of the head of the radius and of the coronoid process of the ulna lie in these depressions when the elbow is fully flexed. and that of the latissimus dorsi is the shortest. The brachialis arises from the lower halves of the anteromedial and ridges respectively. The lowest parts of the medial 9. at its middle. The medial epicondyle is the larger of the two. and of the epicondyles. is also called the condyle. The sections are viewed from below. The deltoid is inserted into the deltoid tuberosity. 4. 1. The teres minor is inserted into the lower impression on the greater C. This depression is called the olecranon fossa as it lodges the olecranon process of the ulna when the elbow is fully extended. The trochlea articulates with the upper end (trochlear notch) of the ulna. sulcus. Between the two epicondyles the lower end presents an irregular shaped arti cular surface which is divisible into medial and lateral parts. The teres major is inserted into the medial lip of the intertubercular roughened ridge that runs obliquely across the shaft: sulcus. pectoralis major is the most extensive.4. Transverse sections through the shaft of the tubercle. near lower end. . The anterior aspect of the lower end of the humerus shows two depressions: one just above the capitulum and another above the trochlea. the lower end of the ridge is continuous with the posterior Of the three insertions into the intertubercular sulcus that of the limb of the deltoid tuberosity. part above the groove is also not well marked.15. A. The subscapularis is inserted into the lesser tubercle. It articulates with the head of the radius. The infraspinatus is inserted into the middle impression on the greater Fig. tubercle.16 to 4. Attachments on the Humerus A. 4. Part of the area of origin extends onto prominences called the medial and lateral the posterior aspect. The muscles attached to the humerus are as follows (Figs. The pectoralis major is inserted into the lateral lip of the intertubercular The part of the border below the groove is indistinct. but can 6. The supraspinatus is inserted into the upper impression on the greater tubercle. Their lower ends terminate in two anterolateral surfaces of the shaft. near upper end. The upper margin of the radial groove is formed by a 7. that are called the medial and lateral supracondylar 10. The depression above the capitulum is called the radial fossa and that above the trochlea is called the coronoid fossa (Fig. The medial part of the articular surface is shaped like a pulley and is called the trochlea. Another depression is seen above the trochlea on the posterior aspect of the lower end (Fig. the sulcus. 4.13). It is separated from the capitulum by a faint groove.12). B. humerus. 4. 3. The lower end of the humerus is irregular in shape and 8. 5.30 OSTEOLOGY epicondyles. 2. The coracobrachialis is inserted into the rough area on the middle of and lateral borders of the humerus form sharp ridges the medial border. The medial margin of the trochlea projects downwards much below the level of the capitulum. The latissimus dorsi is inserted into the floor of the intertubercular be traced to the posterior part of the greater tuberosity. The lateral part is rounded and is called the capitulum.18).

showing attachments seen from behind. near the lower end of the medial supracondylar the upper part of the posterior surface. just above the radial groove. . The capsular ligament of the shoulder joint is attached on the muscles of the forearm is located on the anterior aspect of the anatomical neck except on the medial side where the line of attachment lateral condyle.17. The pronator teres (humeral head) arises from the 16. The superficial flexor muscles of the forearm arise from the anterior aspect of the medial epicondyle. Right humerus. Fig. 13. The brachioradialis arises from the upper two thirds of the the radial groove. seen from the front. epicondyle. The lateral head of the triceps arises from the oblique ridge on anteromedial surface.16. showing attachments. the anterior aspect of the shaft. ridge. Right humerus. The common extensor origin for the superficial extensor 1.BONES OF UPPER LIMB 31 Fig. 15. 4. The upper end of the area of origin extends on to lateral supracondylar ridge. 11. This origin is called the B. The medial head of the muscle arises from the posterior surface below 12. The extensor carpi radialis longus arises from the lower one 17. The anconeus arises from the posterior surface of the lateral third of the lateral supracondylar ridge. 14. 4. Other structures attached to the humerus are as common flexor origin. follows.

3. anteriorly. 4. Right radius seen THE RADIUS from the front. 4. and fuses with the shaft about the twentieth year. Ossification of the humerus 1.32 OSTEOLOGY dips down by about a centimetre to include a small area of the shaft within the joint cavity. seen from above. The intertubercular sulcus lodges the tendon of the long head of the biceps brachii.18. showing smooth anteriorly. and in the lateral epicondyle around the twelfth year. Fig. At the lower end a centre appears in the capitulum during the first year. The line of attachment of the capsule is interrupted at the intertubercular sulcus to provide an aperture through which the tendon of the long head of the biceps leaves the joint cavity. but the posterior aspect is marked by a number of attachments. for the greater tubercle in the second year. 3. The radial nerve and the profunda brachii vessels lie in the radial groove between the attachments of the lateral and medial heads of the triceps. A separate centre appears in the medial epicondyle around the fifth year. The surgical neck of the bone is related to the axillary nerve and to the anterior and posterior circumflex humeral vessels. The anterior and posterior aspects of the bone may be identified by looking at the lower end: it is Fig. The ascending branch of the anterior circumflex humeral artery also lies in this sulcus. 4. The greater part of the bone is formed from this centre. In contrast the lower end is much enlarged. The medial and lateral epicondyles give attachment to the ulnar and radial collateral ligaments respectively. and for the lesser tubercle in the fifth year. The line of attachment reaches the upper limits of the radial and coronoid fossae. ridges and grooves. The side to which a given radius belongs can be determined from the information given above. . and of the olecranon fossa posteriorly so that these fossae lie within the joint cavity. Medially the line of attachment passes between the medial epicondyle and the trochlea. Upper end of right humerus. The capsular ligament of the elbow joint is attached to the lower end of the bone.23). On the lateral side it passes between the lateral epicondyle and the capitulum. 2. 2. The ulnar nerve crosses behind the medial epicondyle. These three parts fuse with each other in the sixth year to form a single epiphysis for the upper end which fuses with the shaft around 18 to 20 years of age.19. The medial and lateral supracondylar ridges give attachment to the medial and lateral intermuscular septa. A secondary centre for the head appears early in the first year. The lateral and medial sides of the bone can be distinguished by examining the shaft which is convex laterally and has a sharp medial (or interosseous) border. Important relations 1. The upper end bears a disc shaped head. The radius is a long bone having a shaft and two ends: upper and lower (Figs. 4.19 to 4. 4. These fuse to form a single epiphysis which fuses with the shaft around 15 years of age. A primary centre appears in the shaft during the 8th fetal week. 3. 2. in the medial part of the trochlea in the ninth or tenth year.

23. The tuberosity is rough in its posterior part. The head is disc shaped. 4. In the upper part of the bone the lateral surface expands into concave and articulates with the capitulum a wide triangular area as it extends on to the anterior and posterior aspects of of the humerus. Lower end of the right radius seen: posterior borders. Scheme to show the relationship of anteriorly. Medially it The lower end of the radius has anterior. This joint between the as a projection called the styloid process. The region just below the head is constricted to form the neck.22). Just below the medial part of the neck there is an elevation called the radial tuberosity. The interosseous or medial border is easily identified as it forms a sharp ridge which extends from just below the tuberosity to the lower end of the shaft. also smooth and articular. between the interosseous and Fig. lateral and posterior surfaces articulates with a notch on the ulna: the continuous with the corresponding surfaces of the shaft.20. and is smooth Fig.21. The lateral surface is prolonged downwards ligament (Fig. posterior. head. This part of the anterior border is called the anterior oblique line. posterior. Its upper surface is slightly posterior borders. borders (anterior. the posterior surface Fig. 4. 4. The medial aspect of the lower end . It then runs downwards and forms the lateral boundary of the smooth A anterior aspect of the lower part of the shaft. From below. 4. Transverse section across the a small triangular area.22. a neck and a tuberosity. Near the lower end this border forms the posterior margin of Fig.21). In addition it has a remaining part is enclosed by the annular medial surface and an inferior surface. the head of the radius to the ulna and to the The shaft of the radius has three annular ligament. The upper end of the bone consists of a surface between the anterior and B. From the medial side. and the lateral A. The upper part of the posterior border runs downwards and laterally from the posterior part of the tuberosity. 4. and runs downwards and laterally across the anterior aspect of the shaft. The lateral surface shows a rough area near the middle (and most head (representing the edge of the disc) is convex) part of the shaft. 4. The anterior surface lies between B the interosseous and anterior borders. The lower part of the posterior border runs downwards along the middle of the posterior aspect of the shaft to the lower end. lateral) (Fig. The anterior middle of the shaft of the radius to show its border begins at the radial tuberosity borders and surfaces. Right radius seen from behind. The circumference of the the bone. and interosseous) and three surfaces (anterior.BONES OF UPPER LIMB 33 radius and ulna is the superior radioulnar joint.

Other structures attached to the radius are as follows.34 OSTEOLOGY has an articular area called the ulnar notch (Fig. It articulates with with the lunate bone. at the point of maximum convexity of the shaft. The most prominent ridge is called the dorsal tubercle which is placed roughly midway between the medial and lateral A. 3. The articular capsule of the wrist joint is attached to the anterior and posterior margins of the lower end and to the styloid process. posterior part of the radial tuberosity. The 1.24. The external pollicis brevis arises from a small area on the posterior surface below the area for the abductor pollicis longus. 4. Immediately medial to the tubercle there is a narrow into the radius (Figs. The pronator quadratus is inserted into the lower part of the anterior surface. 2. It takes part in forming the 2. It is subdivided into a medial quadrangular area that articulates of the lateral surface. The brachioradialis is inserted into the lowest part of the lateral surface just above the styloid process. 4. Note that the articular capsule of the elbow joint does not have a direct attachment to the upper end of the radius.25. The flexor pollicis longus arises from the upper two thirds of the anterior surface. The supinator is inserted into the upper part wrist joint.24 to 4. Right radius. The inferior surface of the lower end is articular. 2. The area of insertion extends on to the anterior and posterior aspects of the shaft. 4. 3. and still more medially there is a wide shallow groove. The pronator teres is inserted into the rough area on the middle of the lateral surface. 5. The following muscles take origin from the radius. 4. 1. 1. attachments seen from behind.23A). the notch there is a triangular area bounded posteriorly by the interosseous border. Just above area that articulates with the scaphoid bone. C. 5. B. The posterior aspect of the lower end is marked by a number of Attachments on the Radius vertical grooves separated by ridges. attachments seen from the front. showing here). oblique groove. and a lateral triangular the lower end of the ulna to form the inferior radioulnar joint. The extensor retinaculum is attached to the lower part of the anterior border (which is sharp Fig. 4. The articular disc of the inferior radioulnar joint is attached to the lower border of the ulnar notch. . and into the triangular area on the medial side of the lower end. The flexor digitorum superficialis (radial head) arises from the upper part of the anterior border (oblique line). The abductor pollicis longus arises from the upper part of the posterior surface. Right radius. The oblique cord is attached just below the radial tuberosity. The following muscles are inserted aspects of the lower end. 4. The biceps brachii is inserted into the rough area lateral to the dorsal tubercle shows two grooves separated by a ridge. 3.27). 4. The interosseous membrane is attached to the lower three fourths of the interosseous border. showing Fig.

seen from the medial side Fig. Tendons related to the lower end of the radius.showing attachments.31). 4. The lateral aspect of the lower end of the radius is crossed by the tendon of the abductor pollicis Fig. The medial and lateral sides of the bone can be distinguished by examining the shaft (Fig. The side to which an ulna belongs can be determined from these facts. 4. while its medial side is rounded.26. from the front. The groove lateral to the dorsal tubercle is occupied by the tendons of the extensor carpi radialis longus and brevis. while the lower end is small. 3.28 to 4. The oblique groove medial to the dorsal tubercle is occupied by the tendon of the extensor pollicis longus. Right ulna seen longus and of the extensor pollicis brevis. The upper end is large and irregular. The upper end has a large trochlear notch on its anterior aspect. A primary centre appears in the shaft during the 8th week of fetal life. 4. Lower end of right radius.BONES OF UPPER LIMB 35 THE ULNA The ulna has a shaft. 2. The shallow groove behind the medial part of the lower end lodges the tendons of the extensor digitorum and of the extensor indicis. A secondary centre appears in the lower end in the first year and joins the shaft around 18 years of age. 4. an upper end and a lower end (Figs. 1. 3.27. Lower end of right radius seen from below. 2. The related tendons are shown D. 4. A secondary centre appears in the head of the bone during the 4th or 5th year and fuses with the shaft around the 16th year.28. . Ossification of the radius 1. Fig. 4.31): its lateral margin is sharp and thin. Occasionally the radial tuberosity may ossify from a separate centre.

The styloid process is a small downward projection that lies on the posteromedial aspect of the head.30). 4. It is of importance to note that in the intact body the tip of the styloid process of the ulna lies at a higher level than the styloid process of the radius. Between the styloid process and the head the posterior aspect is marked by a vertical groove. The coronoid process has an upper surface which forms the lower part of the trochlear notch. The upper and lower parts of the olecranon process appears to be a direct notch may be partially separated from each other by a non-articular area. medial and lateral flanges of the trochlea. 4. 4. 4.29. ulna to show its surfaces and borders. The bone shows a depression just below the radial notch. 4. The upper part of the interosseous border is continuous with the supinator crest mentioned above. When seen from behind the and articulates with the trochlea of the humerus. Its lower part shows a rough projection called the tuberosity of the ulna. Upper part of right ulna Fig. 4.36 OSTEOLOGY The upper end of the ulna consists of from the anterior aspect of the ulna just below the olecranon process (Fig.30). The lower end of the ulna consists of a disc-like head and a styloid process. 4. across middle of shaft of seen from the lateral side. T. This surface is separated from the cavity of the wrist joint by an articular disc. 4. Right ulna seen from behind. Its central part forms a prominent ridge on the Fig.30). posterior.30). The medial margin of the anterior surface is sharp and shows a small tubercle at its upper end. and less prominent anterior and posterior borders (Fig. When viewed from the lateral side the uppermost part of the olecranon is seen projecting forwards beyond the rest of the process (Fig. The upper part of the lateral surface of the coronoid process shows a concave articular facet called the radial notch (Fig. The shaft of the ulna has a sharp lateral or interosseous border. Fig. The upward continuation of the shaft and trochlear notch is also divisible into medial and lateral areas corresponding to the forms the uppermost part of the ulna. two prominent projections called the The trochlear notch covers the anterior aspect of the olecranon process and the olecranon process and the coronoid superior aspect of the coronoid process. The radial notch articulates with the head of the radius forming the superior radio- ulnar joint. posterior and medial surfaces.4. It has anterior. It takes part in forming the elbow joint process. . The posterior border of this depression is formed by a ridge called the supinator crest (Fig. In addition it has anterior. The coronoid process projects forwards In addition to its anterior surface which forms the upper part of the trochlear notch the olecranon process has superior. medial and lateral surfaces (Fig.36).S. 4.31).30.31.28). The head has a circular inferior surface (Fig. medial and lateral surfaces. The head has another convex articular surface on its lateral side: this surface articulates with the ulnar notch of the radius to form the inferior radioulnar joint. The anterior surface is triangular.

B. Right ulna. 3. The upper of these lines runs obliquely downwards and medially across the upper part of the surface.37). and from the upper two thirds of the posterior border through an attachments. The brachialis is inserted into the anterior surface of the coronoid process including the tuberosity. (b) The next part gives origin to the extensor pollicis longus. The flexor carpi ulnaris (ulnar head) arises from the medial side of the olecranon Fig. . 2. as follows. side of the tuberosity (Fig. The part of the posterior surface above the line is triangular. The anterior surface of the ulna lies between the interosseous and anterior borders. 3. 4. Near its lower end it curves backwards to end in front of the styloid process.BONES OF UPPER LIMB 37 lateral aspect of the shaft.e. The flexor pollicis longus (occasional ulnar head) arises from the lateral border of the coronoid process. 4.28) and runs downwards.29) and ends at the styloid process. 3. The flexor digitorum profundus arises from the upper three fourths of the anterior and medial surfaces.32). The posterior surface is bounded by the interosseous and posterior borders. Other attachments on the ulna are aponeurosis common to it. (i. the flexor carpi ulnaris and the flexor digitorum profundus. 2. The pronator quadratus arises from the oblique ridge on the lower part of the anterior surface of the shaft. 7. 4.32. 8. to the coronoid and olecranon processes). showing process (Fig. aponeurosis common to it. The capsular ligament of the elbow joint is (c) The third part gives origin to the extensor indicis attached to the margins of the trochlear notch (d) The lowest part is devoid of attachments. the flexor carpi ulnaris and the extensor carpi ulnaris.37) 1. The muscles inserted into the ulna are as follows (Figs.32 to 4. The posterior border begins at the apex of the triangular area on the posterior aspect of the olecranon process (Fig. The oblique cord is attached to the lateral (a) The uppermost part gives origin to the abductor pollicis longus. The anterior border begins at the tuberosity of the ulna (Fig. The extensor carpi ulnaris (ulnar head) arises from the posterior border by an C. This part the interosseous border. The part below the oblique line is subdivided into medial and lateral parts by a vertical ridge. Its lower part shows an oblique ridge that runs downwards and medially from the interosseous border. The flexor digitorum superficialis (ulnar head) arises from the tubercle at the upper end of the medial margin of the coronoid process. The pronator teres (ulnar head) arises from the medial margin of the coronoid process. 2. 4. 4. It is marked by two lines that divide it into three areas. seen from the front.34). The supinator arises from the supinator crest and from the triangular area in front of it. 6. 4. 5. The lower part of this border is indistinct and ends on the lateral side of the head. of the posterior surface may be divided into four parts. 1. The muscle also takes origin from the posterior border through an aponeurosis common to it. The lateral part lies between the vertical ridge and the interosseous border. 9. 4. the extensor carpi ulnaris and the flexor digitorum profundus. The posterior surface of the ulna is divided into medial and lateral parts by a vertical 1. Attachments on the Ulna A. 4.35. 4.. The anconeus is inserted into the lateral aspect of the olecranon process and into the upper one fourth of the posterior surface of the shaft. The medial surface lies between the anterior and posterior borders. The muscles taking origin from the ulna are as follows. The triceps is inserted into the posterior part of the superior surface of the olecranon process (Figs. The interosseous membrane is attached to ridge. It starts at the posterior end of the radial notch and terminates by joining the posterior border. The origin extends upwards on to the medial surfaces of the coronoid and olecranon processes.

The distal row is made up (from lateral to 1. up of five metacarpal bones. seen from the lateral side. pisiform) take part in forming the wrist joint.32 and 4.47). 4. rows. The proximal row is made up Ossification of the ulna (from lateral to medial side) of the scaphoid. 4. 4. the anterior and posterior borders of the There are three phalanges (proximal. the palm. Each carpal the primary centre. THE SKELETON OF THE HAND The skeleton of the hand consists of the bones of the wrist. the 15th year. THE CARPAL BONES D.33). The skeleton of 4. bones.38 to aspect of the lower end of the ulna. Lower end of right ulna seen from below. (proximal and distal). Upper end of right ulna.36). A primary centre appears in the shaft in the 8th fetal week and medial side) of the trapezium. 4. roughly cuboidal carpal Fig. lunate. . The articular disc of the inferior radio- ulnar joint is attached by its apex to a small rough area just lateral to the styloid process (Fig. and of the digits. middle and distal) in each digit except 5.38 OSTEOLOGY Fig.34. Right ulna.33. Upper end of right ulna showing attachments. A centre for the lower end appears around the 5th or 6th year and joins the shaft by the 18th year. triquetral and pisiform bones. seen from the medial side. bones. The skeleton of the wrist consists of eight. trapezoid.35. Fig.37. The annular ligament is attached to the fingers is made up of the phalanges. The ulnar collateral ligament of the the thumb which has only two phalanges wrist is attached to the styloid process. small. capitate and hamate forms the greater part of the ulna. seen from behind. 4. Fig. showing The carpal bones are arranged in two ulnaris lies in a groove on the posterior attachments.36. The greater part of the olecranon is ossified by extension from carpal bones articulate with the metacarpal bones. proximal and distal (Figs. The skeleton of the palm is made showing attachments. 4. Olecranon seen from above. The distal row of 3. 6. The carpal bones of the proximal row (except the 2. 4. 4. The proximal part of the process is ossified from bone articulates with neighbouring carpal bones to form two centres that appear about the 10th year and join the shaft around intercarpal joints. These are miniature ‘long’ bones. 4. radial notch (thick dots in Figs. The tendon of the extensor carpi Fig.

BONES OF UPPER LIMB 39 Fig.40. Distal aspect. Some further details can be seen only on isolated bones. B.39.40). 4. Medial aspect. The dorsal surface is narrower than the palmar surface. A. seen from the palmar aspect. The palmar aspect can be distinguished from the dorsal as it bears the tubercle (on its distal and lateral part). 4. convex.38 and 4. This information is included for the use of postgraduate students. undergraduate student who may wish to use it. The tubercle is placed distally. In these figures note that the proximal part of the bone is covered by a large. Right carpus.38 to 4. and these are the ones that need to be known for understanding the attachments of various structures. Distally and laterally the palmar surface of the bone bears a projection called the tubercle. 1. Most teachers of anatomy no longer expect undergraduate students to be able to assign individual bones to the right or left side. 2.39. Skeleton of the The Scaphoid Bone hand. articular surface for the radius. Palmar aspect. 4. . 4. or for the occasional Fig. Many of the features to be described can be identified in the articulated hand (Fig. The orientation of the bone is shown in Figs. The scaphoid bone can be distinguished because of its distinctive boat-like shape (Figs. 4. The proximal side is distinguished from the distal as it bears a large convex facet for the radius. seen from the front. C. The distal surface of the scaphoid articulates with the trapezium (laterally) and with the trapezoid bone (medially).38). Fig. The medial surface of the scaphoid articulates with the lunate bone (proximally) and with the capitate (distally). We will now take up the consideration of individual bones of the hand. Right scaphoid bone. The side to which a given scaphoid bone belongs can be determined as follows.38. 4.

Lateral aspect From Figs. and distally with the capitate.38 and 4.43). It has palmar. Its dorsal aspect bears a single facet for articulation with the triquetral bone. 4.39. 4. Palmar aspect. Proximal aspect. It bears a slightly convex surface which takes part in forming the wrist joint: it comes into contact with the articular disc of the inferior radioulnar joint.39. The palmar aspect bears a discrete oval facet (for the pisiform bone).39. 4. A. The medial surface is directed as much proximally as medially. Note the following in Figs. Note the following in Figs.42. The bone articulates laterally with the scaphoid. This ridge is called the tubercle. 2. The proximal aspect bears a convex facet (for the radius) while the distal aspect bears a concave facet (for the capitate). 3. The distal part of its palmar surface articulates with the pisiform bone. 4. It is difficult to determine the side of this bone. 4. The medial surface bears a square facet (for the triquetral) while the lateral B. The Lunate Bone The lunate bone can be distinguished because it is shaped like a lunar crescent (Figs. 4. Fig. 4. 4. The side to which a given triquetral bone belongs can be determined with the help of the following information. Medial aspect surface bears a semilunar facet (for the scaphoid bone). 4. The palmar surface is larger than the dorsal surface.40 OSTEOLOGY 3. Between the areas for the capitate and for the triquetral the lunate may articulate with the hamate bone.41).44). B. The Triquetral Bone The triquetral bone can be distinguished from other carpal bones by the fact that it is a small roughly cuboidal bone (Figs. medially with the triquetral. The medial surface bears a convex facet (for the wrist joint) while the lateral surface bears a concavo-convex facet (for the hamate bone). 1. 4. 4. The Trapezium This bone can be distinguished because it bears a thick prominent ridge on Fig. its palmar aspect (Figs. Proximally. Lateral aspect.38. . 3. medial and lateral surfaces. C. The dorsal aspect is non-articular. 4. 1. proximal. 2.38 and 4.38. The side to which a given lunate bone belongs can be determined with the help of the following information. It articulates with the lunate bone. 4. dorsal. Its lateral surface is also directed distally. The Pisiform Bone This bone is easily distinguished as it is shaped like a pea (Figs.42). the bone has a convex articular facet that takes part in forming the wrist joint. and a concave facet for the capitate bone. 4.38.38 and 4. Right lunate bone.39 note that the trapezium articulates proximally and medially with the scaphoid. distally and laterally with the first metacarpal bone.39.39. Both these surfaces are non-articular and rough. A. The medial aspect bears a flat semilunar facet for the lunate bone.41. 4. It articulates with the hamate bone. distal.39.38. 4. The distal aspect can be distinguished from the proximal aspect because of the fact that the facet for the pisiform is located on the distal part of the palmar surface. 4. The medial and lateral aspects can also be distinguished by looking at the tubercle which lies laterally. Right triquetral bone. The proximal surface is also directed laterally.

38 and 4. 4. Both are rough.BONES OF UPPER LIMB 41 Fig. The Trapezoid Bone This bone can be distinguished from other carpal bones because of its small size and its irregular shape. 4. A. The medial and lateral sides can be distinguished by the fact that a rough. The Capitate Bone Fig. The side to which a given trapezoid belongs can be determined as follows. capitate bone articulates mainly with the third metacarpal bone. Right trapezoid bone. 4. A. The distal surface bears a concavo-convex facet (for 3. The medial and lateral aspects can also be following information. medially with the capitate. (The dorsal aspect corresponds to the sole of the shoe). Proximal and medial aspect.38.46). The distal surface is triangular. Palmar aspect. The side to which a given capitate bone belongs can be determined using the 2.45. Distally the with the base of the second metacarpal bone. Right trapezium.45). 4. . The dorsal surface is larger than the palmar surface. It is also useful to know that the small concave facet (for the scaphoid).39. 4. while the proximal surface bears a has a smaller facet for the trapezoid bone. The medial aspect bears a large facet for the hamate. 4.39. 4. and and lateral aspect. 4. but it also The side to which a given trapezium belongs can be found articulates with the second and fourth metacarpal bones. Its shape resembles that of a shoe (Figs. deep groove on the medial side of the tubercle.38.39 it will be seen that the capitate lies right in the middle of the carpus. B. 1. (The toe of the shoe is directed distally). 2. Lateral aspect.43. C. strip passes dorsally from the lateral (and distal) part of the palmar surface. The palmar surface is much smaller than the dorsal aspect. 2. The rounded head is proximal. The palmar surface is distinguished from the dorsal trapezoid (distally). the rounded medially with the trapezoid bone.38 and 4. and proximally with the scaphoid. From Figs. non-articular.39 note that the trapezoid articulates distally with the base of the 2nd metacarpal bone. it articulates with the hamate bone. Proximally. laterally with the trapezium. From Figs. B. it articulates with the lunate bone. dorsal aspect Fig.44. using the following information. 4. Medially. 4. as it bears the tubercle. bears a rounded head at one end (Figs. The distal aspect bears a concavo-convex facet for the base of the 2nd metacarpal bone. The lateral surface the first metacarpal). 3. Its lateral aspect articulates with the scaphoid (proximally) and with the 1. 3. distinguished by examining the palmar surface: there is a 1. articular surface on the head extends considerably on to the lateral aspect (this part being for articulation with the scaphoid bone). Medial aspect. Distal The capitate bone is easily recognized as it is the largest carpal bone. and distally and medially head fitting into a socket formed by the lunate and scaphoid bones. Right pisiform bone. 4.

Lateral aspect. The hook is attached near the distal end of the palmar aspect.38 and 4. 4. for articulation with the 4th and 5th metacarpal bones. 4. and lateral surfaces of the carpus form one convex surface. 4. The two facets for the hamate are often fused. medial by noting the following facts about the hook. flexor retinaculum (Fig. Fig. Right hamate bone. Lateral aspect. The apex may medial aspect. Palmar aspect. From Figs. Distal aspect. Right capitate bone.42 OSTEOLOGY Fig. 1. 4. converted into the carpal tunnel by a band of fascia called the The distal aspect bears a facet that is divided into two parts by a ridge. The hook is attached to the palmar surface. 4. D.38.46. On the other hand the palmar surface is deeply concave with 2. Anterior aspect. . Distally the hamate articulates with the 4th and 5th metacarpal bones. Medial aspect. A. The Carpal Tunnel The side to which a particular hamate bone belongs can be found The carpal bones are so arranged that the dorsal.48). B. C. The concavity of the hook is directed laterally.39. Proximal and the apex of the triangle being directed proximally. and laterally with the capitate.39 note that when viewed from the palmar aspect the hamate is triangular in shape. The Hamate Bone The hamate is easy to recognize as it has a prominent hook-like process attached to the distal and medial part of its palmar aspect (Figs. overhanging medial and lateral projections. 4. A.47. C. 4.47). B. This concavity is 3. articulate with the lunate bone. Medially and proximally the hamate articulates with the triquetral bone.

50. 4.49.A. 4. B. It bears a large convex articular surface for articulation with the proximal phalanx of the corresponding digit. Inferior aspect. Lateral aspect. Transverse section across the shaft of a metacarpal bone. 4. Anterior aspect. The shaft is triangular in cross section (Fig. Fig. carpal bones.BONES OF UPPER LIMB 43 The retinaculum is attached. and that related to the little finger is the fifth. and laterally to the tubercle of the scaphoid and to the tubercle of the trapezium. Lateral aspect. They are numbered from lateral to medial side so that the bone related to the thumb is the first metacarpal. Each metacarpal is a miniature long Fig. The distal end forms a rounded head. . Base of the right first metacarpal bone.55). A. C. THE METACARPAL BONES The hand has five metacarpal bones (Figs. 4. 4. C.52.49 to 4. Fig.51. Schematic section across the distal row of bone having a shaft. Carpal and metacarpal bones of the right hand as seen from the front. 4. medially to the pisiform bone and to the hook of the hamate.38. a distal end and a proximal end. B. 4. Fig.48. Medial aspect Fig. Base of the right second metacarpal bone. Anterior aspect. Medial aspect.D.

53. laterally. but the medial side is non-articular. C. 4.53) is distinguished by the us to distinguish them from each other as described below.55) articulates than any other metacarpal bone. The proximal aspect of the base articulates with the capitate bone. shape. The groove is bounded. and the dorsal surface faces laterally (and not As stated above the fifth metacarpal has a facet only on one (lateral) backwards).54) articulates The base of the first metacarpal bone (Fig. Medial aspect. third and fourth. and with the fourth metacarpal. 4. A. Medial aspect. 4. The base also articulates with the second Some Features Of Individual Metacarpal Bones metacarpal. Anterior Fig. Lateral aspect. The palmar Fig. 4. The medial side of the base articular surface on its proximal aspect for articulation with the articulates with the fifth metacarpal bone by a single facet. C. and it appears to have been rotated The fourth and fifth metacarpal bones can be distinguished from through ninety degrees so that its palmar surface faces medially each other by examining the medial and lateral sides of their bases. Base of right fourth metacarpal. Anterior aspect. Its lateral side articulates with the is unique in that it is widely separated from the other metacarpal fourth metacarpal. medially. medially. A. 4. B. by a prominent ridge which articulates with the capitate bone. laterally. The base of the fourth metacarpal bone (Fig. The bases The second metacarpal bone (Fig. This articular surface is saddle shaped being convex from the base articulates with the third metacarpal by two discrete facets.54. it is much more mobile. The medial and lateral sides of the base are non-articular. B. They articulate with the distal row of carpal bones. Lateral aspect. 4. The palmar surface of the shaft is subdivided by a ridge side. (and not forwards). Determination of the side to which a Metacarpal Bone Belongs The proximal and distal ends of any metacarpal bone can be easily differentiated as the head of the bone is placed distally. trapezium. 4.44 OSTEOLOGY 4. lateral and dorsal surfaces. The bone is shorter and thicker The base of the fifth metacarpal bone (Fig. bones. Base of right third metacarpal bone. presence of a styloid process which is attached to the lateral and dorsal part of the base. and fourth medially. . and fifth metacarpal bones also articulate with each other. while the fourth metacarpal has facets on both the lateral and into a larger lateral part and a smaller medial part. medial sides of its base. side to side and concave from front to back. The base of each of the metacarpal bones has certain characteristics that enable The third metacarpal bone (Fig.52) has a grooved base (or proximal ends) of the metacarpal bones are irregular in which articulates with the trapezoid bone. aspect.51) bears a large proximally with the hamate bone. In the intact hand the first metacarpal proximally with the hamate bone.50) and has medial. The base also articulates. The bases of the second and third. with the trapezium and. Laterally. with the base of the third metacarpal bone.

3. of the latter group. B. The flexor carpi radialis is inserted into the palmar surface of the bases of the 2nd and 3rd metacarpal bones. and those which 4. The flexor carpi ulnaris is inserted into the proximal part of the phalanx has a distal end or head. Chapter 5. 1. bones of the hand. A. 4. A. Each 2. Medial aspect. Fourth metacarpal: There are two facets on the lateral side of are located in the forearm. and only one on the medial side. The phalanges of a typical digit of the hand and dorsal aspects are also easily recognized as the shaft is concave pulley shaped. The flexor digitorum superficialis is inserted on both sides of the The base of each proximal phalanx is concave for articulation with middle phalanges of all digits except the thumb. proximal and distal.56. and an intervening shaft or body. 4. It will be obvious that in the case of the former 5. that of the middle phalanx.55. Lateral aspect. but have tendons that gain insertion into the base. This can be done as follows. Muscles of the front of the forearm that gain THE PHALANGES OF THE HAND insertion into bones of the hand. the rounded head of the corresponding metacarpal bone. The base of the middle phalanx bears two small concave on the palmar aspect and convex dorsally. Fig. The thumb has only two phalanges.BONES OF UPPER LIMB 45 Fig. while in the case but the lateral side has a facet for the fourth metacarpal.58).57. The proximal end of the distal phalanx is similar to sides of the bone. pisiform bone. the muscles that are intrinsic to the hand. 1 57). separately. C. group both the origins and insertions will be seen. 4. First metacarpal: The palmar surface of the shaft is divided into a larger lateral part and a smaller medial part. Its distal end is non-articular and irregular in shape. Its distal end is pulley shaped like that of the be determined if we can distinguish between the medial and lateral proximal phalanx. Fifth metacarpal: The medial side of the base is non-articular.38. facets (separated by a ridge) to fit the two convexities on the head of It follows that the side to which a metacarpal bone belongs can the proximal phalanx. except the thumb. 4. 4. has three phalanges: proximal. middle and distal (Figs. Third metacarpal: The styloid process is attached to the lateral (Figs. a proximal end or base. Understanding is facilitated by considering part of the base. 2. A large number of muscles are attached to the bones of the hand 3. 1. Anterior aspect. Its head is . only the insertions will be encountered in the For distinction between metacarpal and metatarsal bones see hand. Second metacarpal: The ridge on the base is medial to the Attachments on the Skeleton of the Hand groove. Base of right fifth metacarpal bone. Each digit of the hand.

Attachments of the hypothenar muscles. 2. It is 5. surface of the palmar aspect of the shaft of the 5th metacarpal bone. The transverse head arises from the distal two thirds of the ridge separating the medial and lateral surfaces of the third metacarpal bone. The muscle is inserted into the medial side of the base of the proximal phalanx of the thumb.57. Skeleton of the right hand showing attachments on the palmar aspect. 4. The extensor pollicis brevis is inserted on the dorsal aspect of 1. The extensor carpi radialis brevis is inserted into the dorsal and is inserted into the medial surface of the 5th metacarpal bone aspect of the bases of the 2nd and 3rd metacarpal bones. 3. 4. 4. The opponens pollicis arises from the middle of the tubercle of the trapezium. phalanges.46 OSTEOLOGY It is inserted on the lateral side of the base of the proximal phalanx of the thumb. of all digits except the thumb. C. The second palmar interosseous muscle takes origin from the phalanx of the thumb. The flexor pollicis brevis has two heads. 4. 3. bones. the proximal phalanx of the little finger (along with the flexor digiti 1. and from the capitate. and the deep head from the trapezoid and capitate bones. the little finger (along with the abductor digiti minimi). The extensor carpi ulnaris is inserted into the medial side of the minimi). 5. The abductor digiti minimi arises from the medial and distal part B. Fig. side of the base of the first metacarpal bone. Attachments of interossei (Figs. Muscles on the back of the forearm that gain of the pisiform bone. The flexor digiti minimi arises from the hook of the hamate. The extensor pollicis longus is inserted on the base of the distal 2. The extensor digitorum is inserted into the bases of middle bone. 6. base of the fifth metacarpal bone. and of distal phalanges. 2. It is inserted into the medial side of the base of insertion into bones of the hand (Fig. 1. and each 4. The third palmar interosseous muscle arises from the lateral surface of the palmar aspect of the shaft of the 4th metacarpal bone. The abductor pollicis brevis arises from the tubercle of the 4. 4. The flexor digitorum profundus is inserted on the bases of the D. There are four palmar and four dorsal interossei. The adductor pollicis has two heads. 4. 3. Attachments of the thenar muscles (Fig. interosseous muscle takes origin from one metacarpal bone.59. .60). The flexor pollicis longus is inserted into the palmar surface of inserted into the medial side of the base of the proximal phalanx of the base of the distal phalanx of the thumb. The oblique head arises from the bases of the 2nd and 3rd metacarpal bones. Each palmar aspect of the base of the 2nd metacarpal bone. The abductor pollicis longus is inserted into the lateral side of dorsal interosseous muscle from adjacent sides of two metacarpal the base of the first metacarpal bone. It is inserted into the lateral side of the base of the proximal phalanx of the thumb.57). 1. 3. The fourth palmar interosseous muscle arises from the lateral scaphoid and from the proximal part of the tubercle of the trapezium. 4. It is inserted into the lateral part of the palmar surface of the shaft of the first metacarpal bone. The superficial head arises from the distal part of the tubercle of the trapezium. medial surface of the palmar aspect of the shaft of the 2nd metacarpal 7. 2.58). The first palmar interosseous muscle takes origin from the medial the base of the proximal phalanx of the thumb. The opponens digiti minimi arises from the hook of the hamate. distal phalanges of all digits except the thumb. The extensor carpi radialis longus is inserted into the dorsal E.

The flexor retinaculum is attached medially to the pisiform bone and to the hook of the hamate. All the interossei are inserted mainly into dorsal digital expansions. The first dorsal interosseous muscle arises from the dorsal aspect of the contiguous sides of the shafts of the 1st and 2nd metacarpal bones. 4. lunate and attachments on the triquetral bones.58. Note insertions into dorsal digital expansions. metacarpophalangeal and inter-phalangeal joints are attached around the corresponding articular surfaces. 8. The fourth dorsal interosseous muscle arises similarly from the contiguous sides of the shafts of the 4th and 5th metacarpal bones. On the palmar aspect of each phalanx. The capsules of the various intercarpal. The pisometacarpal ligament is attached to the distal aspect of the pisiform bone. 4. 7. These two ligaments transmit the pull of the flexor carpi ulnaris to the fifth metacarpal and hamate bones. and to the anterior aspect of the base of the fifth meta- carpal bone. F. 3. Fig.BONES OF UPPER LIMB 47 5. Fig. dorsal aspect. the lateral margins give attachment to the fibres of the fibrous flexor sheaths. 4. Other attachments on bones of the hand. Attachments of palmar interossei. 1. 6. Each dorsal interosseous muscle also gains insertion into the base of one proximal phalanx. 7. 5. The second dorsal interosseous muscle arises similarly from the contiguous sides of the shafts of the 2nd and 3rd metacarpals. carpometacarpal. The pisohamate ligament connects the pisiform bone to the hook of the hamate. The dorsal aspect of the phalanges are covered by the dorsal digital expansions.59. The third dorsal interosseous muscle arises similarly from the contiguous sides of the shafts of the 3rd and 4th metacarpal bones. The medial end of the extensor retinaculum is attached to the triquetral and pisiform bones. The capsular ligament of the wrist joint is Skeleton of the right attached along the margins of the articular hand showing surface formed by the scaphoid. 2. Laterally it is attached to the tubercle of the scaphoid and to the tubercle of the trapezium. . 6.

Attachments of dorsal interossei of the hand. and last in the middle phalanges (about the Scaphoid: 4th to 5th year 12th fetal week). and unites with the shaft appears before birth as follows. The other metacarpal bones have secondary centres (not in the base but) in the heads.48 OSTEOLOGY Fig. They unite with the shafts between 16 to 18 years of age. at about 16 years. The first metacarpal has a secondary centre for 1. These appear at about 2 years of Capitate: 2nd month age and unite with the shaft between 16 and 18 years of age. 4. The primary centre appears first in the Triquetral: 3rd year distal phalanges (about the 8th week). . The secondary centres appear first in the proximal Trapezium: 4th to 5th year phalanges (2nd year) and later in the middle and distal phalanges Trapezoid: 4th to 5th year (3rd or 4th year). Each metacarpal has a primary centre for the shaft that appears in the 9th fetal week. next in the proximal phalanges Lunate: 4th year (about the 10th week). Hamate: 3rd month 3.60. Pisiform: About 10th year Ossification Of The Bones Of The Hand 2. Each phalanx has a primary centre for the shaft and a secondary centre for its proximal end. Note insertions into dorsal digital expansions. Each carpal bone is ossified from one centre that (as a rule) the base that appears in the 2nd or 3rd year.