BONES OF THE
UPPER LIMBS
Khaleel Alyahya, PhD, MEd
King Saud University
College of Medicine
@khaleelya
OBJECTIVES
At the end of the lecture, students should be able to:
o List the different bones of the Upper Limb.
o List the characteristic features of each bone.
o Differentiate between bones of right and left sides.
o List the articulations between the different bones.
BONES OF UPPER LIMB
It consists of the following:
o Pectoral Girdle
o Arm
• Humerus
o Forearm
• Radius & Ulna
o Wrist
• Carpal bones
o Hand
• Metacarpals &
Phalanges
PECTORAL GIRDLE
It composed of Two bones:
o Clavicle
o Scapula
It is very light and it allows the
upper limb to have
exceptionally free movement.
CLAVICLE
It is a long bone lying horizontally
across the root of the neck
It is subcutaneous throughout its
length.
Functions:
• It serves as a rigid support from
which the scapula and free upper
limb are suspended keeping them
away from the trunk, so that the
arm has maximum freedom of
movement.
• Transmits forces from the upper
limb to the axial skeleton.
• Provides attachment for muscles.
• It forms a boundary of the
cervicoaxillary canal for
protection of the neurovascular
bundle of the UL.
If the clavicle is broken, the whole
shoulder region caves in medially.
CLAVICLE
It is considered as a long bone but
it has no medullary (bone
marrow) cavity.
Its medial (Sternal) end is
enlarged & triangular.
Its lateral (Acromial) end is
flattened.
The medial 2/3 of the body (shaft)
is convex forward.
The lateral 1/3 is concave
forward.
These curves give the clavicle its
appearance of an elongated
capital (S)
It has two surfaces:
Superior: smooth as it lies
just deep to the skin.
Inferior: rough because strong
ligaments bind it to the 1st
rib.
ARTICULATIONS
Medially, sternoclavicular joint
• with the Manubrium
Laterally, Acromioclavicular joint
• with the Acromial end of the
scapula
Inferiorly, costoclavicular Joint
• with the 1st rib
FRACTURES OF THE CLAVICLE
The clavicle is commonly fractured
especially in children as forces are
impacted to the outstretched hand
during falling.
The weakest part of the clavicle is
the junction of the middle and
lateral thirds.
After fracture, the medial fragment
is elevated (by the sternomastoid
muscle), the lateral fragment drops
because of the weight of the UL.
It may be pulled medially by the
adductors of the arm.
CLINICAL SIGNIFICANCE
Fracture of the Clavicle
A function of the clavicle is to transmit
forces from the upper limb to the axial
skeleton. Thus, the clavicle is the most
commonly fractured bone in the body.
Fractures commonly result from a fall
onto the shoulder, or onto an
outstretched hand.
The most common point of fracture is
the junction of the medial 2/3 and lateral
1/3.
After fracture, the lateral end of the
clavicle is displaced inferiorly by the
weight of the arm, and medially, by
the pectoralis major. The medial end is
pulled superiorly, by
the sternocleidomastoid muscle.
SCAPULA
It is a triangular flat bone.
Extends between the 2nd _ 7th
ribs.
It has:
o Three Processes:
Spine: a thick projecting ridge of bone
that continues laterally as the flat
expanded
Acromion: forms the subcutaneous
point of the shoulder.
Coracoid: a beaklike process. It
resembles in size, shape and direction
a bent finger pointing to the shoulder.
o Three Borders:
Superior, Medial (Vertebral) & Lateral
(axillary).
The lateral border terminates at the
lateral angle (the thickest) part of the
bone.
SCAPULA
o Three Angles :
Superior
Inferior
Lateral
– forms the Glenoid cavity: a
shallow concave oval fossa
that receives the head of the
humerus.
o Two Surfaces
Convex: posterior surface is divided
by the spine of the scapula into the
smaller Supraspinous Fossa - above
the spine and the larger Infraspinous
Fossa - below the spine.
Concave: Anterio (Costal) Surface , it
forms the large Subscapular Fossa.
Suprascapular notch: It is a nerve
passageway, medial to coracoid
process.
– Suprascapular nerve
FUNCTIONS OF SCAPULA
Gives attachment to muscles.
Has a considerable degree of
movement on the thoracic wall to
enable the arm to move freely.
The glenoid cavity forms the
socket of the shoulder joint.
Because most of the scapula is
well protected by muscles and by
its association with the thoracic
wall , most of its fractures involve
the protruding subcutaneous
acromion.
CLINICAL SIGNIFICANCE
Winging of the Scapula
The serratus anterior muscle
originates from ribs 2-8, and attaches
the costal face of the scapula, pulling it
against the ribcage. The long thoracic
nerveinnervates 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.
ARM (HUMERUS)
A typical long bone.
It is the largest bone in the UL
o Proximal End:
Head, Neck, Greater & Lesser Tubercles.
• Head: Smooth & forms 1/3 of a sphere, it
articulates with the glenoid cavity of the
scapula.
• Anatomical neck: formed by a groove
separating the head from the tubercles.
• Greater tubercle: at the lateral margin of the
humerus.
• Lesser tubercle: projects anteriorly.
• The two tubercles are separated by
• Intertubercular Groove.
• Surgical Neck: a narrow part distal to the
tubercles. It is a common fracture site of the
humerus.
ARM (HUMERUS)
Shaft (Body): it has two prominent
features:
• Deltoid tuberosity:
A rough elevation laterally
for the attachment of
deltoid muscle.
• Spiral (Radial) groove:
Runs obliquely down the
posterior aspect of the
shaft.
It lodges the important
radial nerve & vessels.
ARM (HUMERUS)
o Distal End:
Widens as the sharp medial and
lateral Supracondylar Ridges form
and end in the medial and lateral
Epicondyles providing muscular
attachment.
• Trochlea: (medial) for articulation
with the ulna
• Capitulum: (lateral) for articulation
with the radius.
• Coronoid fossa: above the
trochlea (anteriorly)
• Radial fossa: above the capitulum
• Olecranon fossa: above the
trochlea (posteriorly).
FRACTURES OF HUMERUS
Most common fractures of the
surgical neck especially in elder
people with osteoporosis.
The fracture results from falling
on the hand (transmittion of
force through the bones of
forearm of the extended limb).
In younger people, fractures of
the greater tubercle results from
falling on the hand when the arm
is abducted .
The body of the humerus can be
fractured by a direct blow to the
arm or by indirect injury as
falling on the oustretched hand.
NERVES AFFECTED IN FRACTURES OF
HUMERUS
Surgical neck: Axillary nerve
Radial groove: Radial nerve
Distal end of humerus: Median nerve
Medial epicondyle: Ulnar nerve
ARTICULATIONS
Head of the humerus with the
glenoid cavity of the scapula form
the Shoulder joint.
Lower end (Trochlea & Capitulum)
with the upper ends of the radius &
ulna form the Elbow joint.
CLINICAL SIGNIFICANCE
Distal Humeral Fracture
Medial epicondyle fractures are
common fracture types of the distal
humerus. A supraepicondylar fracture
occurs by falling on a flexed elbow. It is a
transverse fracture, spanning between the
two epicondyles
Direct damage, or swelling can cause
interference to the blood supply of the
forearm from the brachial artery. The
resulting ischaemia can cause Volkmann’s
ischaemic contracture – uncontrolled
flexion of the hand, as flexor muscles
become fibrotic and short. There also can
be damage to the median, ulnar or radial
nerves.
FOREARM
Formed of two bones:
o The Radius is the lateral bone.
o The Ulna is the medial bone.
ULNA
It is the stabilizing bone of the
forearm.
It is the medial & longer of the two
bones of the forearm.
o Proximal End:
It has two prominent projections:
• Olecranon process: projects
proximally from the posterior
aspect (Forms the prominence of
the elbow).
• Coronoid process: projects
anteriorly.
Trochlear notch: articulates with
trochlea of humerus.
Radial notch: a smooth rounded
concavity lateral to coronoid
process.
Tuberosity of ulna: inferior to
coronoid process.
ULNA
o Shaft :
Thick & cylindrical superiorly
but diminishes in diameter
inferiorly.
Three surfaces (Anterior,
Medial & Posterior).
Sharp lateral interosseous
border.
o Distal end:
Small rounded Head: Styloid
process
The head lies distally at the
wrist.
The articulations between
the ulna & humerus at the
elbow joint allows primarily
only flexion & extension
(small amount of abduction
& adduction occurs).
RADIUS
It is the shorter and lateral of the two
forearm bones.
o Proximal (Upper) End:
Consists of:
• Head: small, circular and its upper
surface is concave for articulation
with the capitulum.
• Neck
• Radial (Biciptal) Tuberosity: medially
directed and separates the proximal
end from the body.
RADIUS
o Shaft:
Has a lateral convexity.
It gradually enlarges as it passes distally.
o Distal (Lower) End:
It is rectangular.
Its medial aspect forms a concavity :
Ulnar notch to accommodate the head of
the ulna.
Radial Styloid process: extends from the
lateral aspect.
Dorsal tubercle: projects dorsally.
ARTICULATIONS OF RADIUS & ULNA
Distal end of Humerus with the
proximal ends of Radius & Ulna Proximal
Radioulnar
Elbow joint joint.
Proximal Radioulnar joint
Distal Radioulnar joint
The two bones are connected by the
flexible interosseous membrane
FRACTURES OF RADIUS & ULNA
Because the radius & ulna are firmly
bound by the interosseous membrane, a
fracture of one bone is commonly
associated with dislocation of the nearest
joint.
Colle’ s fracture (fracture of the distal end
of radius) is the most common fracture of
the forearm.
It is more common in women after middle
age because of osteoporosis.
It results from forced dorsiflexion of the
hand as a result to ease a fall by
outstretching the upper limb.
HANDS
The skeleton of the hand consists
of the:
Carpals for the carpus
(wrist)
Metacarpals for the palm
Phalanges for the fingers
WRIST (CARPUS)
Compose of eight carpal bones arranged
in two irregular rows, each of four.
These small bones give flexibility to the
wrist.
The Carpus presents Concavity on their
Anterior surface & convex from side to
side posteriorly.
o Proximal row (from lateral to medial):
• Scaphoid
• Lunate
• Triquetral
• Pisiform
o Distal row (from lateral to medial):
• Trapezium
• Trapezoid
• Capitate
• Hamate
FRACTURE OF SCAPHOID
It is the most commonly fractured
carpal bone and it is the most common
injury of the wrist.
It is the result of a fall onto the palm
when the hand is abducted.
Pain occurs along the lateral side of the
wrist especially during dorsiflexion and
abduction of the hand.
Union of the bone may take several
months because of poor blood supply to
the proximal part of the scaphoid.
METACARPALS
It is the skeleton of the hand between
the carpus and phalanges.
It is composed of Five Metacarpal
bones, each has a Base, Shaft, and a
Head.
They are numbered 1-5 from the
thumb.
The distal ends (Heads) articulate with
the proximal phalanges to form the
knuckles of the fist.
The Bases of the metacarpals
articulate with the carpal bones. The
1st metacarpal is the shortest and
most mobile. 3rd metacarpal has a
styloid process on the lateral side of
the base.
DIGITS (PHALANGES)
Each digit has Three Phalanges
Except the Thumb which has only two
Each phalanx has a base proximally, a
head distally and a body between the
base and the head.
The proximal phalanx is the largest.
The middle ones are intermediate in
size.
The distal ones are the smallest, its
distal ends are flattened and expanded
distally to form the nail beds.
ARTICULATIONS
Bases of the Metacarpal bones
articulate with the distal row of the
carpal bones
• Carpometacarpal joints
Heads (knuckles) articulate with the
Proximal Phalanges
• Metacarpophalangeal joints
The phalanges articulate with each
other
• Interphalangeal joints
Distal end of Radius with the Proximal
Raw of Carpal bones
• Wrist joint
QUESTIONS?
