BONES OF THE UPPERLIMB

A LECTURE PRESENTED
BY

MR SAMUEL OKAFOR O

COURSE : GROSS ANATOMY

COURSE CODE : ANA 201

DATE : FEB , 2024 .

 Introduction

• The bones of the pectoral girdle and upper limb

form the superior appendicular skeleton.

• It articulates with the axial skeleton only at a small

sternoclavicular joint, thus permitting greater range

of mobility.
 Bones of the Pectoral Girdle
• Bones of the pectoral girdle are clavicle and scapula.
• Clavicle (Collar Bone)

• The clavicle (collar bone) connects the upper limb to

the trunk

• The shaft of the clavicle has a double curve in a

horizontal plane.

• Its medial two-thirds is convex anteriorly

• It has an enlarged triangular sternal end that
articulates with the manubrium at the
sternoclavicular joint.

• Its lateral flat acromial end articulates with the

acromion of the scapula at the
acromioclavicular joint.

• It serves as a strut (rigid support), suspending

the free upper limb away from the trunk with
freedom of motion.
 SURFACES
• Inferior Surface
• The inferior surface is rough at the sternal end for the attachment
of the costoclavicular ligament

• . In the middle third, it presents the subclavian groove that gives

attachment to the subclavius muscle

• The lips of the groove give attachment to the clavipectoral fascia.

• At the acromial end, it presents the conoid tubercle, extending

obliquely forwards from it is the trapezoid line
Superior Surface : The superior surface is smooth and featureless and
lies just deep to the skin and platysma.
 SCAPULA
• The scapula is a flat triangular bone, lying along the
posterolateral aspect of the thorax

• It rests on the second to the seventh rib

• Its posterior surface is convex and presents the spine of the

scapula that divides it into supraspinous fossa above and
infraspinous fossa below.

• The concave costal surface of most of the scapula forms a

large subscapular fossa

•
• The flat triangular body presents three angles and three
borders.

• The three angles are superior, inferior and lateral.

• The lateral angle is truncated forming the shallow glenoid

cavity that articulates with the head of the humerus forming
the shoulder joint

• The three borders of the scapula are medial (vertebral), lateral

(axillary) and superior borders

• The superior border presents the suprascapular notch

• Coracoid process: It is a beak-like process projecting forward

and provides attachment to an important coracoclavicular
• The deltoid tubercle of the scapular spine is the prominence
indicating the medial point of attachment of the deltoid
• The lateral border terminates in the truncated lateral angle of
the scapula

• the thickest part of the bone that bears the broadened head of
the scapula.

• The glenoid cavity is the primary feature of the head.

• The shallow constriction between the head and the body

defines the neck of the scapula

• The scapula is capable of considerable movement on the

thoracic wall at the physiological scapulothoracic joint,
 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

• The proximal end of the humerus has a head, surgical and

anatomical necks, and greater and lesser tubercles.

• The spherical head of the humerus articulates with the glenoid

cavity of the scapula

• The anatomical neck of the humerus is formed by the groove

circumscribing the head and separating it from the greater and
lesser tubercles.
• It indicates the line of attachment of the glenohumeral joint
capsule.

• The surgical neck of the humerus, a common site of fracture,

is the narrow part distal to the head and tubercles.

• The greater tubercle is at the lateral margin of the humerus,

whereas the lesser tubercle projects anteriorly from the bone.

• The intertubercular (bicipital) groove separates the tubercles

and provides protected passage for the slender tendon of the
long head of the biceps muscle

• The surgical neck is related to the axillary nerve and posterior

• SHAFT

• The shaft (body) of the humerus has two

prominent features:

• The deltoid tuberosity laterally, for attachment of

the deltoid muscle,

• The oblique radial groove (groove for radial

nerve, spiral groove) posteriorly, in which the
radial nerve and deep artery of the arm lie
• INFERIOR END
• The inferior end of the humeral shaft widens as
the sharp medial and lateral supraepicondylar
(supracondylar) ridges form
•
• End distally in the especially prominent medial
epicondyle and the lateral epicondyle, providing
for muscle attachment.

• The distal end of the humerus, including the

trochlea; the capitulum; and the olecranon,
coronoid, and radial fossae, makes up the
Humerus (right): (a) Anterior view, (b) lateral view and (c) posterior view
• The condyle has two articular surfaces: a lateral capitulum for
articulation with the head of the radius

• A medial spool-shaped or pulley-like trochlea for articulation

with the proximal end (trochlear notch) of the ulna.

• Two hollows or fossae occur back to back superior to the

trochlear

• Anteriorly, the coronoid fossa receives the coronoid process of

the ulna during full flexion of the elbow.

• Posteriorly, the olecranon fossa accommodates the olecranon

of the ulna during full extension of the elbow.

• Superior to the capitulum anteriorly, a shallower radial fossa

 Bones of the Forearm
• Bones of the forearm are the radius and ulna.
• They are parallel to each other in the supinated
forearm.
• The radius lies laterally and the ulna medially.
ULNA
• The ulna is the stabilizing bone of the forearm and is
the medial and longer of the two forearm bones.
• Upper end:
• The proximal end of the ulna is much larger than the
proximal end of the radius and consists of the
olecranon, the coronoid process, the trochlear notch,
the radial notch, and the tuberosity of ulna
• The ulna has an expanded upper end with beak-like
olecranon process (Posterior), shelf-like coronoid process
projecting forward (Anterior).

• Together they form the trochlear notch that articulates

with the trochlea of the humerus at the elbow joint

• Lateral aspect of the coronoid presents the radial notch

forming the superior radioulnar joint with the head of the
radius

• Inferior to the coronoid process is the tuberosity of the

ulna for attachment of the tendon of the brachialis muscle
• Supinator crest is a prominent ridge below the
radial notch on the lateral surface of the shaft
of the ulna, meant for attachment of the
supinator muscle.
• Between it and the distal part of the coronoid
process is a concavity, the supinator fossa.

Lower end
The lower end of the ulna has a small disc-
like head with a small conical projection called
the styloid process of the ulna.
 Radius
• The radius is the lateral and shorter of the two forearm bones.
• Its proximal end includes a short head, neck, and medially
directed tuberosity

Upper end

• It has a discoid head at the upper end.

• Its upper concave surface articulates with the capitulum of the

humerus at the elbow joint.

• The rim of the discoid head articulates with the radial notch of
the ulna at the superior radioulnar joint, a pivot type.

•
• The shaft (body) of the radius, in contrast to that of the ulna,
gradually enlarges as it passes distally.

• The distal end of the radius is essentially four sided when

sectioned transversely

• Its medial aspect forms a concavity, the ulnar notch which

accommodates the head of the ulna

• Its lateral aspect is ridge-like, terminating distally in the radial

styloid process.

• The radial styloid process is larger than the ulnar styloid process
and extends farther distally
 BONES OF THE 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 markedly convex from side to side

posteriorly and concave anteriorly.

• Augmenting movement at the wrist joint, the two rows

of carpals glide on each other.
• From lateral to medial and when viewed from
anteriorly, the proximal row of bones consists of:

• The boat-shaped scaphoid;

• The lunate, which has a 'crescent shape
• The three-sided triquetrum bone;
• The pea-shaped pisiform

• The pisiform is a sesamoid bone in the tendon of flexor

carpi ulnaris and articulates with the anterior surface of
the triquetrum.

• The scaphoid has a prominent tubercle on its lateral

• Distal row
• From lateral to medial and when viewed from
anteriorly,
• The distal row of carpal bones consists of:

• The irregular four-sided trapezium bone

• The four-sided trapezoid

• The capitate, which has a head

• The hamate, which has a hook

• Scaphoid (Boat Shaped)
• The scaphoid has a prominent tubercle and a
narrow waist making it vulnerable to fractures.

• It articulates with the radius proximally

• Lunate (Moon Shaped)
The lunate lies between the scaphoid and triquetrum.

It articulates proximally with the radius.

It has a broader anterior surface than the posterior,

making it vulnerable to dislocation.
• Triquetrum (Three-Cornered Bone)
The triquetrum is pyramidal in shape. Proximally, it
articulates with the triangular articular disc.

Pisiform
The pisiform is a pea-like, small bone on the palmar
surface of the triquetrum.

It is regarded as the sesamoid bone in the tendon

of the flexor carpi ulnaris muscle by some
researchers.
 Scaphoid

 Boat-shaped
 Articulates proximally with the radius and has a
prominent scaphoid tubercle on its lateral palmer surface
that is directed anteriorly

 It is the largest carpal bone in the proximal row

 Provides an attachment for the flexor retinaculum and

APB

 Pierced by small nutrient foramina

 Has a rough dorsal surface that is slightly grooved, and

narrower than the palmar and a rough lateral surface to
which the radial collateral ligament attaches

 Also feature articular surfaces for the capitate, trapezium

and trapezoid (Standring, 2008)
 Lunate

 Has a 'crescent shape

 Articulates proximally with the radius and

between the scaphoid and triquetrium

 Broader anteriorly than posteriorly

 Has a smooth convex proximal surface

that articulates with the radius and the
articular disc of the distal radio-ulnar joint.

 The Iateral surface bears a flat semilunar

facet for the scaphoid while the medial
surface, almost square, articulates with the
triquetrum

 The distal surface is deeply concave to fit

the medial part of the head of the capitate.
 Triquetrium

• A pyramidal bone (with three sides)

on the medial side of the carpus

 Articulates proximally with the

articular disc of the distal radioulnar
joint in full adduction.

 Bears an oval isolated facet for

articulation with the pisiform on its
distal palmar surface

 Has a hamate surface, which is

concavoconvex, broad proximally,
narrow distally and a lunate surface,
which is almost square is proximal
and lateral.
 Pisiform

 Shaped like a pea

• It is a sesamoid bone in the tendon of

flexor carpi ulnaris

• Articulates with the anterior surface

of the triquetrium via a dorsal flat
articular facet

From lateral to medial and when viewed

from anteriorly, the distal row of carpal
bones consists of:
 Trapezium
 Trapezoid
 Capitate
 Hammate
 Trapezium

 Irregular four-sided bone on the

lateral side of the carpus

• It articulates with the 1st and 2nd

metacarpals, scaphoid, and trapezoid
bones

• Has a distinct tubercle and a groove

on its palmar surface that projects
anteriorly

• The tubercle is obscured by the thenar

muscles which are attached to.

• A large sellar surface faces

distolaterally and articulates with the
base of the first metacarpal.
 Trapezoid

 A small and irregular wedge-shaped

bone (with four sides)

 Resembles the trapezoid.

 It has a rough palmar surface which is

narrower and smaller than its rough
dorsal surface

 The distal surface, which articulates

with the grooved base of the second
metacarpal is triangular

 The medial surface articulates by a

concave facet with the distal part of the
capitate, the lateral surface articulates
with the trapezium, and the proximal
surface articulates with the scaphoid.
 Capitate
 Has a head; (L. caput,

 Central and largest carpal bone

 Head-shaped bone with a rounded

extremity

 Articulates primarily with the base of 3rd

metacarpal distally via its triangular
distal concavoconvex surface , and with
the trapezoid, scaphoid, lunate, and
hamate.

 Its lateral border is a concave strip for

articulation with the medial side of the
base of the second metacarpal.

 Its dorsomedial angle usually bears a

facet for articulation with the base of the
 Hammate

• A wedge shaped bone with a

hook

• Lies on the medial side of the

hand; positioned just lateral
and distal to the pisiform

• it articulates with the 4th and

5th metacarpal, capitate, and
triquetral bones

• Its distinctive hooked

process, the hook of the
hamate, extends anteriorly on
its palmer surface.
 CARPAL ARCH
• The carpal bones form an arch, whose
base is directed anteriorly.

• The lateral side of this base is formed

by the tubercles of the scaphoid and
trapezium.

• The medial side is formed by the

pisiform and the hook of hamate

• The flexor retinaculum attaches to, and

spans the distance between, the medial
and lateral sides of the base to form the
anterior wall of the carpal tunnel.

• The sides and roof of the carpal tunnel

are formed by the arch of the carpal
bones.
• Distal row
• Trapezium (Trapeze Table)
• The trapezium has a crest and a groove on the
palmar aspect.
• It articulates with the first and second metacarpals
and the two carpals, the scaphoid and trapezoid.
• Trapezoid
• The trapezoid is a wedge-shaped bone.
• It articulates with the base of the second
metacarpal and the three carpals, that is, the
trapezium, capitate and scaphoid.
• Capitate (Caput Head)
• The capitate is the largest among the carpal
bones.
• Distally, it articulates with the bases of the
second, third and fourth metacarpals; proximally
with the scaphoid and lunate; laterally with the
trapezoid and medially with the hamate.
• Hamate
• The hamate is a wedge-shaped bone with a hook.
Distally, it articulates with the fourth and fifth
metacarpals.
• 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 (metacarpals).

• Each metacarpal has a base, shaft and head

• The proximal bases of the metacarpals articulate with the carpal bones.

• The distal heads of the metacarpals articulate with the proximal

phalanges and form the knuckles

• The 1st metacarpal (of the thumb) is the thickest and shortest of these
bones.
 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

(metacarpals).

• Each metacarpal has a base, shaft and head

• The proximal bases of the metacarpals articulate

with the carpal bones.

• The distal heads of the metacarpals articulate with

the proximal phalanges and form the knuckles

• The 1st metacarpal (of the thumb) is the thickest

and shortest of these bones.

• The 3rd metacarpal is distinguished by a styloid

process on the lateral side of its base
 First metacarpal

 The first metacarpal is short and

thick shaft is flattened, dorsally
broad and transversely convex.

 The palmar surface is longitudinally

concave and divided by a ridge into
a larger lateral (anterior) and
smaller (posterior) part.

 The base is concavoconvex and

articulates with the trapezium.

 APL is attached on its lateral

(palmar) side, opponens pollicis to
its radial border and adjoining
palmar surface and first DI to its
ulnar border
 Second metacarpal

 Has the longest shaft and largest base

 The base is grooved in a dorsopalmar direction
for articulation with the trapezoid.

 It features
 A deep ridge for articulation with the capitate
 A quadrilateral facet for articulation with the
trapezium
 A rough impression (attachment of ECRL).
 A small tubercle or ridge on palmar surface
(receives FCR).

 The medial side of the base articulates with that

of the third metacarpal by a long facet

 The shaft is prismatic in section and

longitudinally curved, convex dorsally, concave
towards the palm.

 Its dorsal surface is distally broad but

proximally narrows to a ridge which is covered
by extensor tendons of the index finger.
 Third metacarpal

 Has a short styloid process, projecting

proximally from the radial side
 Its base articulates with the capitate by a facet
anteriorly convex but dorsally concave.

 A strip-like facet, constricted centrally,

articulates with the bases of the second
metacarpal (laterally) and the fourth
metacarpal (medially) the latter by two oval
facets.

 The palmar surface of the base receives a slip

from the tendon of FCR

 The shaft resembles that of the second

metacarpal

 ECRB is attached to its dorsal surface, ulnar

head of the second dorsal interosseous to its
lateral surface and the radial head of the third
dorsal interosseous to its medial surface
 Fourth metacarpal

 The fourth metacarpal is shorter

and thinner than the second and
third

 Displays two lateral oval facets on

its base (for articulation with the
base of the third metacarpal

 A single medial elongated

facet is for articulation with the
base of the fifth metacarpal.

 The quad-rangular proximal surface

articulates with the hamate, and is
anteriorlyconvex, dorsally concave.

 The shaft is like the second

 Fifth metacarpal

 Differs in its medial basal surface, which is

non-articular and bears a tubercle for ECU

 The lateral basal surface is a facet,

transversely concave, convex from palm to
dorsum, for articulation with the hamate.

 A lateral strip articulates with the base of the

fourth metacarpal.

 The shaft bears a triangular dorsal area which

almost reaches the base; the lateral surface
inclines dorsally only at its proximal end and
is divided by a ridge, which is sometimes
sharp, into a palmar and dorsal strip.

 Opponens digiti minimi is attached to the

 PHALANGES
• There are 14 phalanges, three in
each finger (proximal, middle and
distal) and two in the thumb
(proximal and distal).

• Each phalanx has a base proximally,

a shaft (body), and a head distally

• The phalanges of the first digit are

stouter than those in the other
fingers.

• They vary in size with the proximal

phalanx being the largest and the
• The shafts of the phalanges taper
distally.

• The terminal phalanges are

flattened and expanded at their
distal ends, which underlie the nail
beds.

• The base of each proximal phalanx

articulates with the head of the
related metacarpal bone.

• The head of each distal phalanx is

non-articular and flattened into a
crescent-shaped palmar tuberosity,
which lies under the palmar pad at
 APPLIED ANATOMY
• A fracture of the clavicle is often incomplete in younger
children that is, it is a greenstick fracture, in which one side
of a bone is broken and the other is bent.

• The slender clavicles of newborn infants may be fractured

during delivery if the neonates are broad shouldered;
however, the bones usually heal quickly

• Fracture of the scapula is usually the result of severe

trauma, as occurs in pedestrian vehicle accidents.
• Most fractures involve the protruding subcutaneous
acromion
• Most injuries of the proximal end of the humerus are
fractures of the surgical neck.

• An avulsion fracture of the greater tubercle of the

humerus (pulling the tubercle away from the humeral
head) is seen most commonly in middle-aged and
elderly people .

• An intercondylar fracture of the humerus results from

a severe fall on the flexed elbow

• A transverse fracture of the shaft of the humerus

frequently results from a direct blow to the arm.
• An intercondylar fracture of the humerus results from a severe
fall on the flexed elbow.

• 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

• Fractures of the Radius and Ulna
• Fractures of both the radius and the ulna are usually the
result of severe injury.
• A direct injury usually produces transverse fractures at the
same level, usually in the middle third of the bones.
• Isolated fractures of the radius or ulna also occur.

• Fracture of the distal end of the radius is a common

fracture in adults > 50 years of age and occurs more
frequently in women because their bones are more
commonly weakened by osteoporosis

• A complete transverse fracture of the distal 2 cm of the

radius, called a Colles fracture, is the most common
fracture of the forearm
• Often the ulnar styloid process is avulsed (broken off).

• Normally the radial styloid process projects farther distally

than the ulnar styloid ; consequently, when a Colles fracture
occurs, this relationship is reversed because of shortening of
the radius.

• This clinical condition is often referred to as a dinner fork

(silver fork) deformity

• When the distal end of the radius fractures in children, the

fracture line may extend through the distal epiphysial plate.

• Epiphysial plate injuries are common in older children because

of their frequent falls in which the forces are transmitted from
the hand to the radius and ulna
• Fracture of the Scaphoid
• The scaphoid is the most frequently fractured carpal bone.

• It often results from a fall on the palm when the hand is

abducted, the fracture occurring across the narrow part of the
scaphoid

• Owing to the poor blood supply to the proximal part of the

scaphoid, union of the fractured parts may take at least 3
months

• Avascular necrosis of the proximal fragment of the scaphoid

(pathological death of bone resulting from inadequate blood
supply) may occur and produce degenerative joint disease of