The Upper Limb:

Osteology

Prof. Oluwadiya Kehinde

www.oluwadiya.com
 Introduction
• The bones of the upper limb can be divided into
four main groups:
i. the shoulder girdle
ii. arm
iii. forearm and
iv. hand
• In contrast to the lower limb (which is involved in
weight-bearing and locomotion), the main role of
the upper limb is to control the position of the
hand in space – enabling manipulation of objects
in the environment.
 Bones of the Upper Limb
32 bones in all
Shoulder Girdle -
• Clavicle (Collar Bone)
• Scapula (Shoulder Blade)

Arm
• Humerus

Forearm
• Radius (Lateral bone of forearm)
• Ulna (Medial bone of forearm)

Hand
• Carpal Bones (8)
• Metacarpals (5)
• Phalanges (14)

3
BONES OF THE
SHOULDER GIRDLE
 CLAVICLE

• Longest horizontal bone in the body.

• Anterior to the root of neck.
• “S” shaped bone
• subcutaneous throughout its length.
• 1st bone to ossify (5-6th week of fetal life)

• FUNCTIONS :-
• Attaches the upper limb to the trunk as part of the shoulder
girdle
• Transmit weight of upper limb to the trunk
• Protects the underline neurovascular structures

5
 CLAVICLE

• PARTS :-
1. SHAFT
a) Lateral 1/3 (Flattened)
b) Medial 2/3 (cylindrical shape)

2. ACROMIAL END
Flattened with small oval facet
Articulates with acromion process of scapula
(Acromioclavicular joint)

3. STERNAL END
Quadrangular and expanded, upper part rough
Articulates with manubrium sterni (Sternoclavicular joint)
6
 Clavicle: Clinical Relevance
• Fractures are the most
common clinical presentation
of the clavicle
• This is because:
– The clavicle acts to transmit
forces from the upper limb to
the axial skeleton.
– It is relatively small size
• 15% of fractures occur in the
lateral third
• 80% occur in the middle third
• 5% occur in the medial third.
Clavicle
Sternoclavicular Joint (SC)

1= Costoclavicular ligament
2= Anterior sternoclavicular
ligament
3= Interclavicular ligament
Acromioclavicular Joint (AC)
 Scapula
• Also known as the shoulder
blade.
• It articulates with:
I. the humerus at the
glenohumeral joint
II. the clavicle at the
acromioclavicular joint.
• In doing so, the scapula
connects the upper limb to
the trunk
• It serves as a site for
attachment for seventeen
muscles
 SCAPULA

Surfaces : Three surfaces

1. COSTAL SURFACE:

 Costal because it faces the ribs

 Faces forward and medially
 Largely made of a concave and hollow part
 This concave and hollow part is called the subscapular
fossa
 The subscapularis (rotator cuff muscle) originates from this
fossa.
 Coracoid process:
 originates from the superolateral surface of the costal
scapula
 Hook-like projection, which lies just underneath the clavicle.
 The pectoralis minor attaches here
 The coracobrachialis and biceps brachii (short head) muscles 12
originates here
 SCAPULA: Dorsal Surface
 It is divided in to 2 halves by the spine of
scapula.
 Upper small part is called the
supraspinous fossa. The supraspinous
muscle originates here
 Lower large part is called the
infraspinous fossa. The infraspinatus
muscle originates from this area
 Both fossae communicate with each
other through the spinoglenoid notch
 Acromion – projection of the spine that
arches over the glenohumeral joint and
articulates with the clavicle at the
acromioclavicular joint

13
 Scapula: Lateral Surface
• Faces the humerus.
• Site of the glenohumeral joint
• 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.
 SCAPULA: BORDERS
BORDERS : Three borders

1. LATERAL BORDER :
o Thickest border
o Extends from glenoid cavity to inf.
angle

2. MEDIAL BORDER :
o Longest border
o Extends from superior angle to
inferior angle.

3. UPPER BORDER :
o Thinnest & shortest border
o Extends from superior angle to
supra scapular notch.
15
Scapula
Scapula
Scapula
 Scapula: Clinical Relevance
• Fractures
– Relatively uncommon
– Indication of severe chest
trauma.
• Winged Scapula:
– Due to injury to long
thoracic nerve which
innervates the serratus
anterior muscle
– Causes the scapula to
protrude out of the back
when pushing with the
arm.
 HUMERUS
• Longest and strongest
bone of upper limb

PARTS :

1. Proximal end
2. Shaft
3. Distal end

20
HUMERUS: Proximal End
 Head: Fits into the glenoid cavity of the
scapula. Faces medially, upwards and
backwards
 Neck
• Anatomical neck: Separates the head
from the tuberosities
• Surgical neck: Most prone to fractures,
hence the name
 Greater tuberosity: Most lateral part of the
proximal end. serves as an attachment site
for three of the rotator cuff muscles –
supraspinatus, infraspinatus and teres
minor
 Lesser tuberosity: Provides attachment for
the subscapularis
 intertubercular (Bicipital) groove(Sulcus):
The tendon of the long head of the biceps
brachii emerges from the shoulder joint and
runs through this groove 21
 HUMERUS: Proximal End
• The edges of the
intertubercular sulcus are
known as lips.
• Pectoralis major attaches
to lateral lip
• Teres major to medial lip
• Latissimus dorsi in
between them
• (mnemonic = “a lady
between two majors”)
 Humerus: Shaft
• Deltoid tuberosity: On the lateral side of the humeral shaft,
roughed for the attachment of the deltoid muscle
• 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:
o Anteriorly – coracobrachialis, deltoid, brachialis,
brachioradialis.
o Posteriorly – medial and lateral heads of the triceps (the spiral
groove lies between their origins).
 HUMERUS: DISTAL END
A) Articular part
 Capitulum: for the radius
 Trochlea; for the ulna
B) Non-articular Part
 Medial Epicondylar Ridge
 Lateral epicondylar ridge: rougher, serves as
attachment for the forearm extensors
 Lateral Epicondyle
 Medial Epicondyle: 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
 Olecranon Fossa: posterior, accommodates
olecranon at full extension
 Coronoid Fossa: Anterior: accommodates the
coronoid process of the ulna at full flexion
 Radial Fossa: Anterior
24
Humerus: Distal end
 Humerus: Clinical Relevance
• Mid-shaft fracture of the humerus can injure the radial
nerve and profunda brachii artery (both in the radial
groove).
• Symptoms of radial nerve damage
• The nerve innervates the extensors of the wrist. When
the nerve is damaged, either direct or as a
consequence of swelling, the extensors will be
paralysed. This results in unopposed flexion of the
wrist, causing a ‘wrist drop’.
• There can also be some sensory loss over the dorsal
surface of the hand, and the proximal ends of the
lateral three and a half fingers dorsally.
 Humerus: Clinical Relevance
• The fracture is typically transverse or Supracondylar fracture:
oblique, and the most common fracture of the distal
mechanism of injury is falling on
an outstretched hand. It is more humerus just above the
common in children than adults elbow joint.
• Following structures can be damaged:
• Brachial artery can be damaged
directly or via swelling following the
trauma. The resulting ischaemia can
cause Volkmann’s ischaemic
contracture – uncontrolled flexion of
the hand – as flexor muscles become
fibrotic and short.
• Nerves:
i. Anterior interosseous nerve (branch
of the median nerve),
ii. Ulnar nerve or
iii. Radial nerve
 Humerus: 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
Glenohumeral Joint (Shoulder)
Labrum
Shoulder (anterior)
Shoulder (anterior)
Shoulder Girdle (Internal Rotation)
Shoulder Girdle (External Rotation)
Shoulder Girdle (Axillary)
THE FOREARM BONES
 RADIUS
• It lies laterally and parallel to ulna
• The second of the forearm bones.
The radius pivots around the ulna to
produce movement at the proximal
and distal radio-ulnar joints.

37
 Proximal Region of the Radius
• The proximal end of the radius articulates
in both the elbow and proximal
radioulnar joints.
• Important bony landmarks include:
• Head of radius – A disk shaped structure,
with a concave articulating surface. It is
thicker medially, where it takes part in the
proximal radioulnar joint.
• Neck – A narrow area of bone, which lies
between the radial head and radial
tuberosity.
• Radial tuberosity – A bony projection,
which serves as the place of attachment
of the biceps brachii muscle.
 Shaft of the Radius
• The radial shaft expands in diameter as it
moves distally.
• Like the ulna, it is triangular in shape, with
three borders and three surfaces.
• In the middle of the lateral surface, there is
a small roughening for the attachment of
the pronator teres muscle.
 Distal End 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.
• Ulnar notch: concavity in the
medial surface, articulates with
the head of ulna to form the
distal radioulnar joint.
• Wrist joint: The distal surface of
the radius has two facets, for
articulation with
the scaphoid and lunate carpal
bones. This makes up the
 Articulations of the Radius
• The radius articulates in four places:
i. Elbow joint – Partly formed by an articulation
between the head of the radius, and the capitulum
of the humerus.
ii. Proximal radioulnar joint – An articulation between
the radial head, and the radial notch of the ulna.
iii. Wrist joint – An articulation between the distal end
of the radius and the carpal bones.
iv. Distal radioulnar joint – An articulation between the
ulnar notch and the head of the ulna.
 RADIUS: Clinical Relevance
• 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 Colles’s Fracture
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.

Smith’s Fracture 42
 Ulna

• The medial of the forearm bones

• Acts as the stabilising bone, with the radius
pivoting to produce forearm movement.
 Ulna: Proximal End
• 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
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. Anterior
• Tuberosity of ulna – a roughening
immediately distal to the coronoid
process. It is where the brachialis
muscle attaches.
 Ulna: Shaft
• Triangular in shape
• As it moves distally, it decreases in width.
• Three surfaces:
i. Anterior – site of attachment for the pronator quadratus
muscle distally.
ii. Posterior – site of attachment for many muscles.
iii. Medial – unremarkable.
• Three borders:
i. Posterior – palpable along the entire length of the forearm
posteriorly
ii. Interosseous – site of attachment for the interosseous
membrane, which spans the distance between the two forearm
bones. It is the sharpest border, and most lateral
iii. Anterior – unremarkable.
 Ulna: Proximal End and Articulations

• The proximal end of the ulna articulates with

the trochlea of the humerus.
• It also articulates with the head of the radius
to form the superior radio-ulna joint
 Ulna: Distal End and Articulations

• The distal end of the ulna is much smaller in

diameter than the proximal end. It terminates
in a rounded head, with distal projection – the
ulnar styloid process.
• The head articulates with the ulnar notch of
the radius to form the distal radio-ulna joint.
 Ulna: Clinical Relevance
• Lone Ulna Fracture
– A fracture of the ulna alone (not involving the radius) usually occurs as a result
of the ulna being hit by an object. The shaft is the most likely site of fracture.
Commonly called nightstick fracture
– Less commonly, the olecranon process can be fractured. This is caused by the
patient falling on a flexed elbow. The triceps brachii can displace part of the
fragments proximally.
• Both Bones.
• Fractures of both bones
• Fracture of one bone with dislocation of any of the radio-ulna joints
• 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.
 X-ray of the Forearm
(AnterioPosterior) view
X-ray of the Forearm
(lateral) View
 Radius and Ulna Fracture

Radius and Ulna Galleazzi’s Monteggia’s

Fractures Fracture Fracture
Elbow (Anterio-Posterior)
Elbow (post)
Elbow (ant)
Elbow (lateral)
Elbow (medial)
Elbow (lateral)
Olecranon Bursa
BONES OF THE HAND
 CARPAL BONES
• 8 IN 2 ROWS
• PROXIMAL ROW – 4
1. SCAPHOID – Boat Shaped
2. LUNATE - Semilunar
3. TRIQUETRAL - Pyramidal
4. PISIFORM - Sesamoid bone Pea
Shaped

• DISTAL ROW – 4
1. TRAPEZIUM -
2. TRAPEZOID -
3. CAPITATE -
4. HAMATE - Has a hook

Mnemonic: She Likes To Play, Try To Catch Her61

 Carpal Bones
• 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. To form the
Carpometacarpal joints
 Carpal Bones: Clinical Relevance
• The scaphoid bone of the hand is the most
commonly fractured carpal bone
• In a fracture of the scaphoid, the
characteristic clinical feature is pain and
tenderness in the anatomical snuff box
• The scaphoid is at particular risk
of avascular necrosis after fracture
because of its ‘retrograde blood supply’
which enters at its distal end.
• This means that a fracture to the middle
(or ‘waist’) of the scaphoid may interrupt
the blood supply to the proximal part of
the scaphoid bone rendering it avascular.
• Patients with a missed scaphoid fracture
are likely to develop osteoarthritis of the
wrist in later life.
 METACARPALS
• Short long bones – 5
• PARTS :
1. HEAD – lies distally
2. BASE – lies proximally
3. SHAFT – lies in the middle

ARTICULATIONS :
1st – Trapezium
2nd – Trapezium + Trapezoid + Capitate+ 3rd Metacarpal
3rd – Capitate + 2nd Metacarpal + 4th Metacarpal
4th – Hamate + 3rd Metacarpal + 4th Metacarpal
5th – Hamate + 4th Metacarpal
 Metacarpals: Clinical Relevance
• Boxer’s fracture – A fracture of
the 5th metacarpal neck. It is
usually caused by a clenched fist
striking a hard object. The distal
part of the fracture is displaced
anteriorly, producing shortening
of the affected finger.
• Bennett’s fracture – A fracture of
the 1st metacarpal base, caused
by axial loading on a partially
flexed metacarpal. This fracture
extends into the first
carpometacarpal joint leading to
instability and subluxation of the
joint. As a result, it often needs
surgical repair.

Boxer’s Fracture Bennet's Fracture

Bones of the Wrist
Plain X-ray: Lateral View
 PHALANGES OF THE HAND
• 14: 2+3+3+3+3
• PARTS :
1. BASE – lies proximally
2. SHAFT – lies in the middle
3. HEAD – lies distally
Bones of the Hand
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