OSTEOLOGY OF THE UPPPER LIMB

AGBAJE. M. ADEDOYIN
BONES OF THE UPPER LIMB

• The bones of the upper limb

are divided into the following
regions of the upper limb:
▫ Shoulder Girdle: Clavicle and
Scapula
▫ Arm: Humerus
▫ Forearm: Ulna and Radius
▫ Hand: Carpal, Metacarpals
and Phalanges
Scapula (shoulder blade)
• it’s a flat triangular bone, that lies on the postero-lateral aspect of the
thorax from the 2nd to 7th ribs.

• It has 3 Borders which are:

▫ lateral/axillary border
▫ medial/vertebral border
▫ superior border.
• It has 2 surfaces:
▫ Anterior
▫ Posterior
• It has 3 angles :
▫ Superior
▫ Inferior
▫ Lateral
• The body is divided into:
▫ Posterior/Dorsal Surface: this part is divided by the spine of the scapula
into two :
 supraspinous fossa: surface of attachment for supraspinatus muscle
 Infraspinous fossa: Surface of attachment for infraspinatus muscle.

▫ The Anterior/costal surface is the Subscapula fossa, it’s the surface of

attachment for subscapularis muscle
It has 3 processes:

▫ Coracoid Process:

projecting from the glenoid

& is palpable anteriorly.

▫ Acromial Process

▫ Spine of the Scapula Neck

of scapula
Articulations
The scapula has two main
articulations:
• Glenohumeral joint –
between the glenoid fossa of
the scapula and the head of
the humerus.
• Acromioclavicular joint –
between the acromion of the
scapula and the clavicle
Winging of the Scapula
• The serratus anterior muscle originates from ribs 1-8, and
attaches the costal face of the scapula, pulling it against the
ribcage. The long thoracic nerve innervates the serratus
anterior.
• If this nerve becomes damaged, the scapula protrudes out of
the back when pushing with the arm. The long thoracic
nerve can become damaged by trauma to the shoulder,
repetitive movements involving the shoulder or by structures
becoming inflamed and pressing on the nerve
CLAVICLE
• It lies horizontally in the root of the neck.

It has important functions:

• It help to transmit forces from the upper limb to the
bones of the axial skeleton (sternum)
• It acts as strut holding the arm free from the
trunk.
• it protects the neurovascular bundle as it passes
through ‘cervical-axillary canal’.
• it is a long bone with two ends (medial and Lateral) and a shaft
▫ The medial end (Sternal) articulate with the manubrium of the sternum
to form the sterno- clavicular joint.
▫ The lateral end (Acromial) articulate with the acromial process of the
scapula forming the acromioclavicular joint.
• The shaft (body) has a medial 2/3 which is convex and a lateral 1/3 which
is concave
• Muscle attachment- P.major, Trapezius, sternocleidomastoid,
deltoid, subclavius(Subclavian groove)
• Coracoclavicular ligaments (conoid &trapezoid) joining it to
coracoid process & conoid &trapezoid tubercles of clavicle.
Clinical importance
• Fractures of clavicle are very common at the junction
between middle &lateral 1/3 often from indirect force.
• The medial fragment becomes elevated by
sternocleidomastoid. The lateral fragment sags down
from the weight of the arm , but also adducted especially
by P.Major.
HUMERUS

• It is a long bone of the upper limb, which extends from the shoulder to the elbow
• It is a tubular long bone composed two ends (upper and lower end) and the
middle shaft (body)
▫ The Upper End consists of:
 Head,
 Neck (Anatomical and Surgical )
 Tubercle (Greater and Lesser) and seprated by bicipital (Intertubercular)
groove
▫ The Lower end consists of:
 Two Epicondyle (Lateral and Medial)
 Two processes (Trochlea and Capitulum)
 Three Fossae
 ▫ The Shaft is cylindrical above and Prismatic below, it

contains:
 3 borders

 3 surfaces

 It gas contains a radial groove in the middle 1 /3 of

the posterior surface

• The proximal aspect of the humerus articulates with the

glenoid fossa of the scapula, forming the glenohumeral
joint.
• Distally, at the elbow joint, the humerus articulates with the
head of the radius and trochlear notch of the ulna.
• Proximal Landmarks
• The proximal humerus is marked by a head, anatomical neck,
surgical neck, greater and lesser tubercles 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
tubercles by the anatomical neck.
• Greater tubercle: 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 tubercle.
• The lesser tubercle 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 tubercles is a deep groove, known as the

intertubercular sulcus.
• It’s the area of passage for the tendon of the long head of the biceps brachii
which emerges from the shoulder joint
• 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.
• The surgical neck runs from just distal to the tubercles to the
shaft of the humerus. The axillary nerve and circumflex
humeral vessels lie against the bone here.
Shaft
• The shaft of the humerus is the site of attachment for various muscles. 

• On the lateral side of the humeral shaft is a roughened surface where the
deltoid muscle attaches. This is 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. The 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).
Distal Region
• It has two borders which form medial and
lateral supraepicondylar ridges.
• The lateral supraepicondylar ridge is more roughened, providing
the site of common origin of the forearm extensor muscles.
• Distal to the supraepicondylar ridges are extracapsular
projections of bone called the lateral and medial
epicondyles. Both can be palpated at the elbow.
• The medial is the most prominent one.
• 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:
▫ Coronoid, Radial and Olecranon fossae. They accommodate the
forearm bones during flexion or extension at the elbow.
ulnar
• The ulna is a long bone in the forearm, with two ends (upper and lower)
and a shaft
• It lies medially and parallel to the radius
• The ulna acts as the stabilising bone, with the radius pivoting to produce
movement.
• The Upper end consist:
▫ Two processes (Olecranon and Coronoid Processes)
▫ Trochlear notch
• The Shaft has:
▫ Three Surfaces (Anterior, Posterior and Lateral)
▫ Three borders (which seperates the surfaces)
• The Lateral border (Interosseous) is sharp

• The lower end consist:

▫ Head

▫ Styloid process

• Proximally, the ulna articulates with the humerus at

the elbow joint. Distally, the ulna articulates with the
radius, forming the distal radio-ulnar joint.
Proximal Osteology and Articulation
• The proximal(upper) end of the ulna articulates with the trochlea
of the humerus. To enable movement at the elbow joint, the ulna
has a specialised structure, with bony prominences for muscle
attachment.
• Important landmarks of the proximal ulna are the olecranon,
coronoid process, trochlear notch, radial notch and the tuberosity
of ulna:
• Olecranon –  a large projection of bone that extends proximally,
forming part of trochlear notch. It can be palpated as the ‘tip’ of the
elbow. The triceps brachii muscle attaches to its superior surface.
• Coronoid process – this ridge of bone projects outwards
anteriorly, forming part of the trochlear notch.
• Trochlear notch – formed by the olecranon and coronoid
process. It is wrench shaped, and articulates with the trochlea
of the humerus.
• Radial notch – located on the lateral surface of the trochlear
notch, this area articulates with the head of the radius.
• Tuberosity of ulna – a roughening immediately distal of
the coronoid process. It is where the brachialis muscle
attaches.
Shaft of the Ulna
• The ulnar shaft has three borders and three surfaces.
• The width reduces in size has it get to the distal part.

The three surfaces:

• Anterior – site of attachment for the pronator quadratus muscle
distally.
• Posterior – site of attachment for many muscles.
• Medial

The three borders:

• Posterior – palpable along the entire length of the forearm posteriorly
• Lateral (Interosseous) – site of attachment for the interosseous
membrane, which spans the distance between the two forearm bones.
• Anterior
Distal Osteology and Articulations
• The distal end of the ulna is much smaller in diameter than the
proximal end. It has a rounded head and distal projection called the
styloid process.
• The head articulates with the ulnar notch of the radius to form the
distal radio-ulnar joint.
Clinical correlate
• A fracture of the ulna without radius involvement is often caused by a
direct assault on the ulna.
• The shaft is the most common site of fracture.

• olecranon process fracture is a less common accident and its caused by

fall on a flexed elbow.

• The ulna and the radius are attached by the interosseous membrane.
The force of a trauma to one bone can be transmitted to the other via this
membrane. Thus, fractures of both the forearm bones are not uncommon.
There are two classical fractures:

• Monteggia’s Fracture – Usually caused by a force from behind the ulna.

The proximal shaft of ulna is fractured, and the head of the radius dislocates

anteriorly at the elbow.

• Galeazzi’s Fracture – A fracture to the distal radius, with the ulna head

dislocating at the distal radio-ulnar joint.

RADIUS
• it’s a Long bone which consist two ends of upper (thin narrow ) end , lower
(thick expanded )end and shaft.
• The upper end consist of :
▫ head : articulate with capitulum of humerus.
▫ lateral surface with the radial notch of the ulna .
▫ neck :constricted part below the head .
▫ radial tuberosity :below the medial part of the neck .
• The Shaft consist of:
▫ 3 surfaces (Anterior, Posterior and Lateral)
▫ 3 borders (Anterior, Posterior and Medial(interosseous border))
• The Distal end consist of :
▫ 5 Surfaces;
 Anterior (Smooth)
 Posterior (with Grooves)
 Lateral
 Medial
 Inferior

▫ A styloid Process
Shaft of the Radius
• The shaft of the radius expands in diameter as it moves
distally.
• It is triangular in shape and it contains:
▫ three borders
▫ three surfaces.

• In the middle of the lateral surface, there is a small

roughening for the attachment of the pronator teres
muscle.
Distal Region of the Radius
• In the distal region, the radial shaft expands to form a
rectangular end. The lateral side projects distally as
the styloid process.
• In the medial surface, there is a concavity, called the ulnar
notch, which articulates with the head of ulna, forming the
distal radioulnar joint.
• The distal surface of the radius has two facets, for articulation
with the scaphoid and lunate carpal bones. This makes up
the wrist joint.
Bones of Forearm
Clinical correlate
• The forearm is a common site for bone fractures. Here, we shall look at the
common fracture types involving the radius:
• Colles’ Fracture – The most common type of radial fracture. A fall onto an
outstretched hand causing a fracture of the distal radius. The structures distal
to the fracture (wrist and hand) are displaced posteriorly. It produces what is
known as the ‘dinner fork deformity’.
• Fractures of the radial head – This is characteristically due to falling on
an outstretched hand. The radial head is forced into the capitulum of
humerus, causing it to fracture.
• Smith’s Fracture –  A fracture caused by falling onto the back of the hand.
It is the opposite of a Colles’ fracture, as the distal fragment is now placed
anteriorly.
Colles’ fracture of the wrist; ‘dinner fork’ deformity, produced by the
posterior displacement of the radius.
Bones of the hand; Carpal,
Metacarpals and Phalanges
Carpal Bones
• The carpal bones are a group of eight, irregularly shaped
bones. They are organised into two rows; proximal and
distal.
▫ Proximal
 Scaphoid
 Lunate
 Triquetrum
 Pisiform (a sesamoid bone, formed within the tendon of the
flexor carpi ulnaris)
▫ Distal
 Trapezium
 Trapezoid
 Capitate
 Hamate (has a projection on its palmar surface, known as the
‘hook of hamate’
•Collectively, the carpal bones
form an arch in the coronal
plane. A membranous band,
the flexor retinaculum, spans
between the medial and
lateral edges of the arch,
forming the carpal tunnel.

•Proximally, the scaphoid and

lunate articulate with the
radius to form the wrist
joint (also known as the
‘radio-carpal joint’). In the
distal row, all of the carpal
bones articulate with the
metacarpals.
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