OSTEOLOGY OF THE UPPER LIMB

LEARNING OBJECTIVES

To list and know the bones of the upper limb

Know the anatomy of the bones of the upper limb

To outline the functions and clinical Anatomy of the Bones of

the upper limb
 INTRODUCTION
The upper limb is characterized by
its mobility and ability to grasp,
strike, and conduct fine motor
skills (manipulation).
especially marked in the hand.

Efficiency of hand function results

in a large part from the ability to
place it in the proper position by
movements at the scapulothoracic,
glenohumeral, elbow, radio-ulnar,
and wrist joints.
The upper limb consists of four
segments, which are further subdivided
into regions :
 Shoulder, which includes: pectoral,
scapular, and lateral supraclavicular
regions.
• The pectoral (shoulder) girdle is a bony
ring, incomplete posteriorly, formed by
the scapulae and clavicles and
completed anteriorly by the manubrium
of the sternum.

Arm: ( brachium) is between the

shoulder and the elbow and is centered
around the humerus. It consists of the
anterior and posterior regions of the
arm.
Forearm : is between the elbow and the
wrist and contains the ulna and radius.
• It consists of the anterior and posterior
regions of the forearm.

Hand : is distal to the forearm and

contains the carpus, metacarpus, and
phalanges.
 It is composed of the wrist, palm, dorsum
of hand, and digits (fingers, including the
opposable thumb), and is richly supplied
with sensory endings for touch, pain, and
temperature
 CLAVICLE (COLLAR BONE)
The clavicle (modified long bone)
presents shaft and two ends
Medial end is quadrilateral
distinguished from the flattened lateral
end
The shaft shows a gentle S- shaped
curve (convex forward in medial two
third; concave forward in lateral one
third)
The inferior aspect of shaft present a
shallow groove
It is called the beauty bone
SIDE DETERMINATION:
Medial : quadrilateral sternal end
Anterior: Convexity of medial two
third
Inferior: groove for subclavius ,
conoid tubercle, trapezoid line

Anatomical position: placed

horizontally in the body
Peculiarities:
1st bone to start ossifying in the
body
Only bone that ossify in the
membrane
Only long bone that has two
primary centers of ossification,
placed horizontally,
 lacks medullary cavity,
subcutaneous throughout its
extent,
occasionally placed by
middle supraclavicular nerve
First bone to start ossifying in
the body
Only long bone that ossifies
in membrane
Functions of the clavicles:
Serves as a strut (rigid support) from
which the scapula and free limb are
suspended, keeping the limb away from
the thorax so that the arm has maximum
freedom of motion------- Fixing the strut
in position enables elevation of the ribs
for deep inspiration.
Forms one of the boundaries of the
cervicoaxillary canal (passageway
between neck and arm), affording
protection to the neurovascular bundle
supplying the upper limb.
Transmits shocks (traumatic impacts)
from the upper limb to the axial skeleton
Ossification
Clavicle is the first bone to start
ossifying---two primary center-----in the
shaft—6wks of fetal life
Sternal end ossifies from one
secondary center b/w 15yrsand 20yrs
of age----fuses with shaft by 25yrs.
Note additional center may appear in
the acromion
Greater part of clavicle develop in
membranous (intra membranous
ossification).sternal and acromial
ends are performed in cartilage
Medial end is the growing end of the
bone
General features:
Ends:
Sternal (medial) End
The medial end is quadrangular and articulates with the clavicular notch of
the manubrium of the sternum to form the sternoclavicular joint.
The articular surface extends to the inferior aspect for attachment with the
first costal cartilage.
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 costoclavicular ligament (a ligament of the SC joint)
Acromial (lateral) End Lateral End
The lateral end is also known as the acromial end. It is flat from above
downward.
It bears a facet that articulates with the shoulder to form the
acromioclavicular joint.
The area surrounding the joint gives an attachment to the joint capsule.
The anterior border is concave forward and the posterior border is convex
backward.

The acromial end houses a small facet for articulation with the acromion of
the scapula at the acromioclavicular joint. It also serves as an attachment
point for two ligaments
Conoid tubercle – attachment point of the conoid ligament, the medial
part of the coracoclavicular ligament.
Trapezoid line – attachment point of the trapezoid ligament, the lateral
part of the coracoclavicular ligament.
Shaft
of the collarbone can be divided into the lateral one third and the medial two thirds.
Lateral One-Third Of The Shaft
The lateral third of the shaft has two borders and two surfaces.
the anterior border is concave forward and gives origin to the deltoid muscle.

the posterior border is convex and gives attachment to the trapezius muscle.

 On the inferior surface of the lateral third is the conoid tubercle for the attachment
of the conoid ligament and lateral to this is the trapezoid line for attachment of the
trapezoid ligament, both constituting the coracoclavicular ligament

The medial two-thirds

On the inferior surface of the medial clavicle is the costal tuberosity and subclavian
groove, which form the attachment sites for costoclavicular ligament and subclavius
muscle, respectively.
 Attachments on Collarbone

Ligaments
Medial Ligaments:
The bulbous medial clavicular end contributes to forming the sternoclavicular joint.
Several ligaments support this joint.
Capsular Ligaments:
 are thickenings of the sternoclavicular joint capsule are capsular ligaments on
anterosuperior and posterior aspects of the capsule.

These are responsible for limiting superior displacement of the medial clavicular or,
through the clavicular moment arm, inferior displacement of the lateral end of an
intact clavicle.

The posterior part of the capsule resists both anterior and posterior translation at
the sternoclavicular joint
Interclavicular Ligament:
This ligaments has strong bands that span the medial clavicle to the
superior sternum to the contralateral clavicle.

The ligament loosens with shoulder elevation and prevents downward

displacement of the lateral end of the clavicle.

Costoclavicular Ligament:
These strong ligaments run from the upper aspect of the first rib and
adjacent aspects of the sternum to the inferior clavicle.

stabilizes the medial clavicle against both upward and downward

rotation, respectively.
Lateral Ligaments
Coracoclavicular Ligaments:
From the base of the coracoid process of the scapula to the inferior
aspect of the lateral clavicle are two ligaments, called trapezoid and
conoid ligaments.
Trapezoid ligament is lateral and attaches on a specific osseous ridge,
whereas the more medial conoid inserts at the conoid tubercle.
 These ligaments serve the important function of suspension of the
shoulder girdle from the clavicle.

Acromioclavicular Ligaments:
The capsule of the acromioclavicular joint forms the acromioclavicular
ligaments.
Posterosuperiorly, the ligament serves to resist anteroposterior
displacement of the distal clavicle.
Clavicular ligament
Muscles:
Medially, the collarbone serves as an origin of the pectoralis major
and sternohyoid muscles.
Superomedial part serves as an origin of the sternocleidomastoid.
• In a midshaft collarbone fracture, the sternocleidomastoid
becomes a medial clavicle elevator.

The undersurface of the middle collarbone serves as an insertion

point for the subclavius muscle.

Laterally, the anterior clavicle is the site of origin for the anterior
deltoid with the posterosuperior clavicle serving as an accessory
insertion for the trapezius.
 Attachment on collarbone Muscle/Ligament Other attachment
deltoid tubercle, anteriorly on the lateral
Superior surface and anterior border Deltoid muscle
third

Superior surface Trapezius muscle posteriorly on the lateral third

Inferior surface Subclavius muscle subclavian groove

Conoid ligament (the medial part of

Inferior surface conoid tubercle
the coracoclavicular ligament)

Trapezoid ligament (the lateral part of

Inferior surface trapezoid line
the coracoclavicular ligament)

Anterior border Pectoralis major muscle medial third (rounded border)

Sternocleidomastoid muscle (clavicular

Posterior border superiorly, on the medial third
head)

Posterior border Sternohyoid muscle inferiorly, on the medial third

Posterior border Trapezius muscle lateral third

Blood Supply Of Clavicle:
Periosteal arterial blood supply to the bony structure but no central nutrient artery
The suprascapular artery
Thoracoacromial artery
Internal thoracic artery (mammalian a.) have all been found to provide arterial
supply to the clavicle.

Nerves Of Clavicle:
Supraclavicular nerve,
Subclavian nerve, and
Long thoracic
Suprascapular nerve.

• Variations: The female clavicle is shorter, thinner, less curved and smoother than
the male clavicle.
Clinical anatomy of the clavicle:
1. Fractures of the clavicle:
 clavicle is the one of the most frequently fractured bones ,
 common in children.
Indirect forces due to outstretched hand cause most fractures----It may be
due to a direct blow to the shoulder
The weakest part of the clavicle is the junction of its middle and lateral thirds
The strong coracoclavicular ligament usually prevents dislocation of the AC
joint
2. Fractures of medial middle third are the most common fracture, the medial
fragment is displaced upward by the pull of sternocleidomastoid.
The slender clavicles of newborn infants may be fractured during delivery if
the neonates are broad shouldered; however, the bones usually heal quickly.
3. A fracture of the clavicle is often
incomplete in younger children that is,
it is a greenstick fracture---- one side of
a bone is broken and the other is bent.
so named because the parts of the
bone do not separate---- resembles a
tree branch (greenstick) that has been
sharply bent but not disconnected.
4. weight transmission from upper
limb----connection between the
appendicular and axial
skeleton(coracoclavicular ligament)-----
-upper limb-----clavicle-----sternum
SCAPULA

 The scapula (shoulder blade) is a triangular flat bone that

lies on the posterolateral aspect of the thorax, overlying the
second through seventh ribs .

It articulates with the humerus at the glenohumeral joint,

and with the clavicle at the acromioclavicular joint-----
It serves as a site for attachment for many (17!) muscles.
Costal Surface:
The costal (anterior) surface of the
scapula faces the ribcage.
It contains a large concave depression
over most of its surface, known as
the subscapular fossa.

The subscapularis (rotator cuff muscle)

originates from this fossa.

Originating from the superolateral

surface of the costal scapula is
the coracoid process----- It is a hook-like
projection, which lies just underneath
the clavicle.

Three muscles attach to the coracoid

process: the pectoralis minor,
coracobrachialis, and the short head of
the biceps brachii.
Lateral Surface:
The lateral surface of the scapula faces
the humerus----It is the site of the
glenohumeral joint, and of various muscle
attachments. Its important bony
landmarks include:
Glenoid fossa – a shallow cavity, located
superiorly on the lateral border.
• It articulates with the head of the humerus to
form the glenohumeral (shoulder) joint.
Supraglenoid tubercle – a roughening
immediately superior to the glenoid fossa.
• The place of attachment of the long head of
the biceps brachii.
Infraglenoid tubercle – a roughening
immediately inferior to the glenoid fossa.
• The place of attachment of the long head of
the triceps brachii.
Posterior Surface:
The posterior surface of the scapula faces outwards-----It is a site of
origin for the majority of the rotator cuff muscles of the shoulder.
• It is marked by:
Spine – the most prominent feature of the posterior scapula. It runs
transversely across the scapula, dividing the surface into two.
Acromion – projection of the spine that arches over the glenohumeral
joint and articulates with the clavicle at the acromioclavicular joint.
Infraspinous fossa – the area below the spine of the scapula, it displays
a convex shape.
• The infraspinatus muscle originates from this area.
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.
The scapula has medial (axillary),
lateral (vertebral), and superior
borders and superior and inferior
angles.
LATERAL BORDER
The lateral border is the thickest
border and extends from inferior
angle to the glenoid cavity.
The infraglenoid tubercle is present
at its upper end, just below the
glenoid cavity.
The long head of triceps muscle
starts from the infraglenoid tubercle.
Lateral border of scapula is thick
due to the fact that it serves as
fulcrum during rotation of the
scapula
MEDIAL BORDER (VERTEBRAL BORDER)
It goes on from superior angle to the
inferior angle.
It is thin and angled at the root of spine
of scapula.
The serratus anterior muscle is inserted
on the costal surface of the medial
border and the inferior angle.
The levator scapulae muscle is inserted
on the dorsal aspect of the medial
border from superior angle to the root of
spine.
The rhomboid minor muscle is inserted
on the dorsal aspect of the medial
border opposite the root of spine.
The rhomboid major muscle is inserted
on the dorsal aspect of the medial
border from the root of spine to the
inferior angle.
SUPERIOR BORDER
 shortest border and extends between superior and lateral angles.
The suprascapular notch exists on this border near the root of coracoid
process.
The suprascapular notch is transformed into suprascapular foramen by
superior transverse (suprascapular) ligament.
The suprascapular artery passes above the ligament and suprascapular
nerve passes below the ligament, via suprascapular foramen. (Mnemonic:
Air force flies above the Navy, i.e., A: artery is above and N: nerve is
below the ligament.)
The inferior belly of omohyoid arises from the superior border near the
suprascapular notch.
•
ANGLES:
Inferior angle:
It is located over the 7th rib or the
7th intercostal space.

Superior angle:
It is at the junction of superior and
medial borders, and is located over
the 2nd rib.

Lateral angle (head of scapula)

It is truncated and bears a pear-
shaped articular cavity referred to as
the glenoid cavity, which articulates
along with the head of humerus to
form glenohumeral (shoulder) joint.
There are three
processes. :
•Spinous
process.
•Acromion
process.
•Coracoid
process.
Side determination:
• Lateral : Glenoid cavity
• Inferior: inferior angle
• Dorsal: Spinous process

Anatomical position
• Glenoid cavity is directed anterolaterally
• Costal sueface is directed medially and forward
• OSSIFICATION
• The ossification of scapula is cartilaginous. The cartilaginous scapula is ossified by eight centres— one
primary and seven secondary. The primary centre appears in the body. The secondary centres appear as
follows:
• Two centres appear in the coracoid process.
• Two centres appear in the acromion process.
• One centre shows up each in the (a) medial border, (b) inferior angle, and (c) in the lower component of the
rim of glenoid cavity.
• The primary centre in the body and first secondary centre in the coracoid process shows up in eighth week
of intrauterine life (IUL) and first year of postnatal life, respectively and they merge at the age of 15 years.
• All other secondary centres show up at about puberty and merge by 20th year.
CLINICAL ANATOMY
Inferior angle of scapula as bony landmark: inferior angle of scapula
corresponds to spine of T-7 vertebra.

Triangle of auscultation: it is bounded by trapezius, latissimus dorsi and

medial border of scapula. Rhomboid major forms its floor. This triangle is
used for auscultating breath sounds as this area is least covered with
muscles

Winging of scapula: Serratus anterior keeps medial border of scapula closely

applied to chest wall. Injury to long thoracic nerve (Bell’s) causes paralysis of
serratus anterior. When the patient is asked to push against resistance medial
border of scapula on the affected side stands out called the winged scapula
Pulsating scapula: There exists rich arterial anastomosis around the
scapula. When the circulation in axillary/brachial artery is affected
(coarctation of aorta or blockade in main vessels) this necessitates
opening up the collaterals. It leads to dilation and tortuosity of the
collaterals makes the scapula pulsatile.
Scaphoid scapula: Developmental anomaly where the medial border of
the scapula is concave.
Painful arc syndrome (supraspinatus syndrome): It is characterized by
thickening of supraspinatus tendon with pain during 60°-120° abduction.
There is impingement of supraspinatus tendon against coracoacromial
arch. Important causes include tear of supraspinatus tendon and
calcified deposit in the supraspinatus tendon.
Frozen shoulder: It is due to tendinitis involving rotator cuff. All shoulder
movements are restricted due to adhesions.
Sprengel’s deformity: In this congenital deformity scapula remains
elevated. This failure of scapula descent is due to failure of migration
from cervical to thoracic region. Such individual may have other
skeletal anomalies (abnormal vertebrae or hypoplasia of pectoral
muscles).

Klippel-Feil syndrome: is bilateral failure of scapulae descent. The

associated anomalies include failure of fusion of occipital bone and
the defect in cervical spine. This results in webbing of neck and limited
neck movements.
 HUMERUS
 The humerus (arm bone), the largest bone in
the upper limb----articulates with the scapula at
the glenohumeral joint and the radius and ulna
at the elbow joint .
Proximally, the ball-shaped head of the
humerus articulates with the glenoid cavity of
the scapula.

Proximal Landmarks:
The proximal humerus is marked by a head,
anatomical neck, surgical neck, greater and
lesser tuberosity and intertubercular sulcus.
The upper end of the humerus consists of
the head. This faces medially, upwards and
backwards and is separated from the greater
and lesser tuberosities by the anatomical neck.
 greater tuberosity is located laterally on the humerus and has anterior
and posterior surfaces. It serves as an attachment site for three of
the rotator cuff muscles – supraspinatus, infraspinatus and teres minor
– they attach to superior, middle and inferior facets (respectively) on
the greater tuberosity

 lesser tuberosity is much smaller, and more medially located on the

bone----It only has an anterior surface-----It provides attachment for the
last rotator cuff muscle – the subscapularis.

Separating the two tuberosities is a deep groove, known as

the intertubercular sulcus-----The tendon of the long head of the biceps
brachii emerges from the shoulder joint and runs through this groove.
The edges of the intertubercular
sulcus are known as lips----
Pectoralis major, teres major
and latissimus dorsi insert on the
lips of the intertubercular sulcus.
This can be remembered with the
mnemonic “a lady between two
majors”, with latissimus dorsi
attaching between teres major on
the medial lip and pectoralis major
laterally.
surgical neck extends from just
distal to the tuberosities to the
shaft of the humerus-----The
axillary nerve and circumflex
humeral vessels lie against the
bone here.
• Clinical Relevance: Surgical Neck
Fracture
• The surgical neck of the humerus is a
frequent site of fracture – usually by a
direct blow to the area, or falling on an
outstretched hand.
• The key neurovascular structures at risk
here are the axillary nerve and posterior
circumflex artery.
• Axillary nerve damage will result in
paralysis to the deltoid and teres minor
muscles.
• The patient will have difficulty
performing abduction of the affected
limb. The nerve also innervates the skin
over the lower deltoid (regimental badge
area), and therefore sensation in this
region may be impaired
• Shaft
• The shaft of the humerus is the site of attachment for
various muscles. Cross section views reveal it to be
circular proximally and flattened distally.
• On the lateral side of the humeral shaft is a roughened
surface---- where the deltoid muscle attaches-----
known is as the deltoid tuberosity.
• The radial (or spiral) groove is a shallow depression
that runs diagonally down the posterior surface of the
humerus, parallel to the deltoid tuberosity-----radial
nerve and profunda brachii artery lie in this groove.
• The following muscles attach to the humerus along its
shaft:
• Anteriorly – coracobrachialis, deltoid, brachialis,
brachioradialis.
• Posteriorly – medial and lateral heads of the triceps
(the spiral groove demarcates their respective origins).
Clinical Relevance: Mid-Shaft
Fracture
A mid-shaft fracture of the
humerus risk damage to
the radial nerve and profunda
brachii artery (as they are tightly
bound in the radial groove).

The radial nerve innervates

the extensors of the wrist----In the
event of damage to this nerve
(either direct or as a
consequence of swelling), the
extensors will be paralysed----
This results in unopposed flexion
of the wrist, known as ‘wrist drop’.
Distal Region
The lateral and medial borders of the distal humerus form medial and
lateral supraepicondylar ridges----The lateral supraepicondylar ridge is
more roughened, providing the site of common origin of the forearm
extensor muscles.
Immediately distal to the supraepicondylar ridges are extracapsular
projections of bone, the lateral and medial epicondyles---- Both can be
palpated at the elbow.

The medial is the larger of the two and extends more distally-----The ulnar
nerve passes in a groove on the posterior aspect of the medial epicondyle
where it is palpable.

Distally, the trochlea is located medially, and extends onto the posterior
aspect of the bone-----Lateral to the trochlea is the capitulum, which
articulates with the radius.
Also located on the distal portion of
the humerus are three depressions,
known as the coronoid,
radial and olecranon fossae-----They
accommodate the forearm bones
during flexion or extension at the
elbow
Articulations
The proximal region of the humerus
articulates with the glenoid fossa of
the scapula to form the glenohumeral
joint (shoulder joint).

Distally, at the elbow joint, the

capitulum of the humerus articulates
with the head of the radius and the
trochlea of the humerus articulates
with the trochlear notch of the ulna
Clinical Relevance:
Supracondylar Fracture
 is a fracture of the distal
humerus just above the
elbow joint--- is transverse
or oblique, due to falling on
an outstretched hand-----
common in children than
adults---- brachial artery can
be damaged; either directly,
or via swelling following the
trauma
 resulting an ischaemia-----
can cause Volkmann’s
ischaemic contracture -----
uncontrolled flexion of the
hand – as flexor muscles
become fibrotic .
Ossification center: At birth, neonatal
humerus is only ossified in the shaft---
The epiphyses are cartilaginous at birth.
 The medial humeral head develops an
ossification center around 4 months of
age and the greater tuberosity around 10
months of age. These ossification
centers begin to fuse at 3 years of age.
The process of ossification is complete
by 13 years of age, though
the epiphyseal plate (growth plate)
persists until skeletal maturity, usually
around 17 years of age.
• Note: Fractures of the humerus are common--- can occur at any location on the
humerus. At the proximal end, most fractures are located at the surgical neck and
are most common in the elderly, especially those with osteoporosis
• The following parts of the humerus are in direct contact with the indicated nerves:
• Surgical neck: axillary nerve.
• Radial groove: radial nerve.
• Distal end of humerus: median nerve.
• Medial epicondyle: ulnar nerve.
• These nerves may be injured when the associated part of the humerus is fractured..
• Others clinical anatomy not mentioned above:
 Dislocation(subluxation) of the shoulder joint----damage axillary nerve
 Tennis elbow
 Golfers elbow
 Cubital tunnel syndrome
 Palpation of the ulnar nerve behind the medial epicondyle in semi flex elbow
 BONES OF THE FOREARM
The radius and ulna are the bones of the forearm---The
forearm is the region of the upper limb that extends from
the elbow to the wrist.
The radius bone supports the lateral (thumb) side of the
forearm and the ulna bone supports the medial (little finger)
side.
Ulna:
 the stabilizing bone of the forearm, is the medial and
longer of the two forearm bones .
 proximal end: has two prominent projections—olecranon
posteriorly and the coronoid process anteriorly; they form
the walls of the trochlear notch.
 The trochlear notch of the ulna articulates with the
trochlea of the humerus.
 Inferior to the coronoid process is the tuberosity of the
ulna
On the lateral side of the coronoid process is a smooth, rounded concavity,
the radial notch, which articulates with the head of radius .
Distal to the radial notch is a prominent ridge, the supinator crest, and
between it and the distal part of the coronoid process is a concavity, the
supinator fossa.
SHAFT:
Borders: anterior border, posterior border, interosseous border
Surfaces: anterior surface, posterior surface, medial surface
Proximally, the shaft of the ulna is thick, but it tapers, diminishing in
diameter distally.
Distal end:
At its narrow distal end is the rounded head of ulna with the small, conical
ulnar styloid process .
The ulna does not articulate directly with the carpal bones.
It is separated from the carpals by a fibrocartilaginous articular disc
 MUSCLES AROUND THE ULNA
BONE
•Triceps brachii - insertion - olecranon process

•Anconeus - insertion - olecranon process

•Brachialis - insertion - coronoid process

•Pronator teres - origin - coronoid process

•Flexor carpi ulnaris - origin - olecranon process and posterior surface

•Flexor digitorum superficialis - origin - anterior and medial surface

•Flexor digitorum profundus - origin - anterior and medial surface

•Pronator quadratus - origin - anterior surface (distal part)

•Extensor carpi ulnaris - origin - posterior border

•Supinator - origin - proximal end

•Abductor pollicis longus - origin - posterior surface

•Extensor pollicis longus - origin - posterior surface

•Extensor indicis - origin - posterior surface (distal part)

RADIUS:
The radius is the lateral and shorter of the two forearm bones.
proximal end:
consists of a cylindrical head, a short neck, and a projection from the
medial surface---the radial tuberosity .
Proximally, the smooth superior aspect of the head of the radius is
concave for articulation with the capitulum of humerus.

The head also articulates medially with the radial notch of ulna

The neck of the radius is the narrow part between the head and the radial
tuberosity-----The radial tuberosity demarcates the proximal end (head
and neck) from the shaft
SHAFT:
Borders: anterior border, interosseus border, posterior border
Surfaces: anterior surface, posterior surface , lateral surface
The shaft of the radius has a lateral convexity and gradually enlarges as it
passes distally.
DISTAL END :
Articular surfaces: carpal surface for the joint with scaphoid and lunate bones,
ulnar notch for the joint with the head of the ulna
Non-articular surfaces: anterior, posterior, lateral
The medial aspect of the distal end of the radius forms a concavity, the ulnar
notch, which accommodates the head of the ulna .
 Its lateral aspect terminates distally as the radial styloid process.
The radial styloid process is larger than the ulnar styloid process and extends
farther distally.
The dorsal tubercle of the radius lies between two of the shallow grooves for
passage of the tendons of forearm muscles
OSSIFICATION OF THE RADIUS:
The radius bone ossifies from three centers, one primary and two
secondary.
The primary center of the radius bone shows up in the mid-shaft
during 8th week of fetal life.
The secondary centers are for both upper end and lower end of the radius
bone.
The center for upper end of the radius bone shows up during fifth year.
The center for lower end of the radius bone shows up at the age
of first year.
The upper epiphysis merges at the age of 12 years. The lower epiphysis
merges at the age of 20th year.
Sometimes an additional center is found in the radial tuberosity, which
appears around 13th or 15th year.
MUSCLES ATTACHEMENTOF AROUND THE RADIUS

 Biceps brachii - insertion - radial tuberosity

 Supinator - origin and insertion - proximal
third of the shaft

 Flexor digitorum superficialis - origin - medial

surface

 Flexor pollicis longus - origin - medial surface

 Pronator teres - insertion - lateral surface

 Pronator quadratus - insertion - medial

surface

 Abductor pollicis longus - origin - posterior

surface
CLINICAL ANATOMY OF ULNA AND RADIUS
Fractures of the Radius and Ulna:
Fractures of both the ulna and the radius are the result of severe injury.
A direct injury usually produces transverse fractures at the same level,
often in the middle third of the bones.
 Because the shafts of these bones are firmly bound together by the
interosseous membrane, a fracture of one bone is likely to be
associated with dislocation of the nearest joint.
Fracture of the distal end or the radius is the most common fracture in
people older than 50 years.
A complete fracture of the distal 2 cm of the radius-----called a Colles
fracture-----most common fracture of the forearm .
distal fragment of the radius is displaced dorsally and often
comminuted (broken into pieces).
Due to forced dorsiflexion
of the hand---- fall by
outstretching the upper
limb----- ulnar styloid
process is avulsed (broken
off).
 radial styloid process
projects farther distally
than the ulnar ----- referred
to as a dinner fork (silver
fork) deformity because a
posterior angulation----
forearm proximal to the
wrist--- posterior
displacement and tilt of
the distal fragment of the
radius.
Fractures of radius and ulna
The most common pathological alterations that directly affect the
radius or the ulna bones are fractures-----Examples of these fractures
include:
Monteggia fracture: occurs when the upper portion of the ulna fractures
and is accompanied by the dislocation of the proximal radial head.
Galeazzi’s fracture: is a fracture that directly affects the radius----It
consists of a radial fracture along with the dislocation of the distal
radioulnar joint
Barton’s fracture: is an intra articular fracture of the distal radius that is
accompanied by the dislocation of the radiocarpal joint
Dislocation of the elbow
Student elbow
BONES OF HAND

The wrist, or carpus, is composed of eight carpal bones (carpals)

arranged in proximal and distal rows of four .
These small bones give flexibility to the wrist.
 The carpus is convex from side to side posteriorly and concave
anteriorly.

Augmenting movement at the wrist, the two rows of carpals glide on

each other; each carpal also glides on those adjacent to it.

The proximal surfaces of the proximal row of carpals articulate with the
inferior end of the radius and the articular disc of the wrist joint.
•
The distal surfaces of these bones
articulate with the distal row of
carpals---From lateral to medial.
• four bones in the proximal row of
carpals are:
Scaphoid : boat-shaped bone that
has a prominent scaphoid tubercle.
Lunate : moon-shaped bone that is
broader anteriorly than posteriorly.
Triquetrum : pyramidal bone on the
medial aspect of the carpus.

Pisiform : a small, pea-shaped bone

that lies on the palmar surface of the
triquetrum
The proximal surfaces of the distal
row of carpals articulate with the
proximal row of carpals,
their distal surfaces articulate with
the metacarpals.
From lateral to medial, the four
bones in the distal row of carpals are
the:
 Trapezium ( table): a four-sided
bone on the lateral side of the carpus.
Trapezoid: a wedge-shaped bone
that resembles a trapezium.
Capitate ( head): the head-shaped
bone that is the largest bone in the
carpus.
Hamate (, a little hook): a wedge-
shaped bone, which has a hooked
process---hook of hamate, that
extends anteriorly.
METACARPALS
The metacarpus forms the skeleton of the
palm of the hand between the carpus and the
phalanges .
 It is composed of five metacarpal bones.

Each metacarpal consists of a base, shaft,

and head.

The proximal bases of the metacarpals

articulate with the carpal bones, and the
distal heads of the metacarpals articulate
with the proximal phalanges and form the
knuckles.

The first metacarpal (of the thumb) is the

thickest and shortest of these bones.
Development and Ossification
metacarpals:
The metacarpals ossify from two
centers, the first being for the shaft,
and the second for the base in the
first metacarpal, and the head in the
other four .
The ossification centers of the
second and third metacarpals are the
first to appear, around the 8th-9th
week of fetal development, while the
first or thumb metacarpal is the last
to ossify.
 The ossification of all the
metacarpals completes around the
20th year of life .
PHALANGES
Each digit has three
phalanges (proximal,
middle, and distal) except
for the first (thumb), which
has only two (proximal and
distal).
 Each phalanx has a base
proximally, a shaft (body),
and a head distally.
The distal phalanges are
flattened and expanded at
their distal ends, which
underlie the nail beds
Fractures of Hand
Fracture of the scaphoid often results from a fall
on the palm with the hand abducted .
The fracture occurs across the narrow part (“waist”
) of the scaphoid.
 Pain occurs primarily on the lateral side of the
wrist, especially during dorsiflexion and abduction
of the hand.
 Initial radiographs of the wrist may not reveal a
fracture, but radiographs taken 10 to 14 days later
reveal a fracture because bone resorption has
occurred.
Owing to the poor blood supply to the proximal
part of the scaphoid, union of the fractured parts
may take several months.
 Avascular necrosis of the proximal fragment of
the scaphoid (pathological death of bone resulting
from poor blood supply) may occur and produce
degenerative joint disease of the wrist.
Fracture of the hamate may result
in nonunion of the fractured bony
parts because of the traction
produced by the attached muscles.
 Because the ulnar nerve is close
to the hook of the hamate, the
nerve may be injured by this
fracture, causing decreased grip
strength of the hand.
The ulnar artery may also be
damaged when the hamate is
fractured.
Severe crushing injuries of the
hand may produce multiple
metacarpal fractures, resulting in
instability of the hand.
 injuries of the distal
phalanges are common (e.g.,
when a finger is caught in a
car door).
 A fracture of a distal
phalanx is usually
comminuted, and a painful
hematoma (collection of
blood) develops.

 Fractures of the proximal

and middle phalanges are
usually the result of crushing
or hyperextension injuries