1. Dr. Fadel Naim Orthopedic Surgeon Faculty of Medicine IUG-Gaza
Bones of the Upper Limb
Dr. Fadel Naim
Orthopedic Surgeon
Faculty of Medicine
IUG-Gaza

2. لَا أُقْسِمُ بِيَوْمِ الْقِيَامَةِ{1} وَلَا أُقْسِمُ بِالنَّفْسِ اللَّوَّامَةِ{2} أَيَحْسَبُ الْإِنسَانُ أَلَّن نَجْمَعَ عِظَامَهُ{3} بَلَى قَادِرِينَ عَلَى أَن نُّسَوِّيَ بَنَانَهُ{4}

3. Skeleton of the Upper Limb
Each upper limb has 32 bones
Two separate regions
1. The pectoral (shoulder) girdle (2 bones)
2. The free part (30 bones)

4. Upper Limb The pectoral girdle consists of two bones:
the scapula
the clavicle
The free part has 30 bones
1 humerus (arm)
1 ulna (forearm)
1 radius (forearm)
8 carpals (wrist)
19 metacarpal and phalanges (hand)
While progressing through a lecture, point out that many of the bones and their surface features (e.g., olecranon) may be easily palpated.

5. Composition of the upper limb

6. Pectoral Girdle
clavicle
scapula
humerus

7. Clavicle
The clavicle is an s-shaped bone that attaches the trunk to the upper extremity
Medial 2/3 convex forward and lateral 1/3 concave forward

8. Clinical Connection – Fractured Clavicle
A fall on an outstretched arm (F.O.O.S.H.) injury can lead to a fractured clavicle
The clavicle is weakest at the junction of the two curves
Forces are generated through the upper limb to the trunk during a fall
Therefore, most breaks occur approximately in the middle of the clavicle

9. Acromial end Sternal end Conoid tubercle Trapezoid line
is flat and has a small facet for articulation with the acromion
Sternal end
has a large facet for articulation with the manubrium, and first costal cartilage
Conoid tubercle
Attachment of conoid ligament of the coracoclavicular ligament
Trapezoid line
Attachment of trapezoid portion of the coracoclavicular ligament

10. Clavicle: Ligament Attachments
Sternal end of clavicle to first costal cartilage:
Costoclavicular ligament
Conoid tubercle:
Conoid portion of coracoclavicular ligament
Trapezoid line:
Trapezoid portion of coracoclavicular ligament

11. Clavicle: Muscle Attachments
Deltoid
Pectoralis major
Trapezius
Sternocleidomastoid
Subclavius

12. Muscular, ligamentous, and fascial attachments to the clavicle

13. Scapula Flat triangular bone On the posterior thoracic wall
Between 2nd and 7th rib

15. Anterior Scapula Borders: Angles: coracoid process acromion
Superior
Medial
lateral
Angles:
inferior
coracoid process
acromion
neck of scapula

16. Anterior Scapula acromion process coracoid process glenoid cavity
superior angle
subscapular fossa
inferior angle

17. Posterior Scapula Spine of scapula Acromion: Greater scapular notch
Divides the supraspinous and infraspinous fossae
Serves as attachment for the deltoid and trapezius
Acromion:
Lateral extension of spine of scapula;
Articulate with clavicle
Greater scapular notch
Point at which the spine of the scapula ends, but the acromion continues;
Coracoid process
Partially seen as it projects anteriorly;

18. Supraspinous fossa Infraspinous fossa Lateral border
Origin of the supraspinatus muscle
Infraspinous fossa
Origin of the infraspinatous muscle
Lateral border
Attachment of:
Teres major
The long head of the triceps brachii
Teres minor

19. Posterior Scapula acromion process supraspinous fossa
infraspinous fossa
spine
lateral border
medial border

20. Lateral Scapula Supraglenoid tubercle Infraglenoid tubercle
Attachement of the long head of the biceps brachii
Infraglenoid tubercle
Attachement of the long head of the triceps brachii

21. Lateral Scapula Acromion: Superior and inferior angles
Articulates with the clavicle
Attachment for the trapezius and deltoid muscles;
Superior and inferior angles
Coracoid process:
Attachment point for:
The short head of the biceps brachii
Corachobrachialis
Pectoralis minor

22. The Humerus
Longest and largest bone of the free part of the upper limb
The proximal ball-shaped end articulates with the glenoid cavity of the scapula
The distal end articulates at the elbow with the radius and ulna

23. The Humerus The proximal end consists of: The head Anatomical neck
Greater and lesser tubercles separated from each other by an intertubercular groove (bicipital groove)

24. The head The head, nearly hemispherical in form
Articulates with the glenoid cavity of the scapula.
The circumference of its articular surface is slightly constricted and is termed the anatomical neck

25. The anatomical neck
The anatomical neck of the humerus is an indentation distal to the head of the humerus on which the articular capsule attaches.
Fracture of the anatomical neck rarely occurs.

26. The Greater Tubercle
The greater tubercle is situated lateral to the head and lesser tubercle, and just lateral to the anatomical neck
Its upper surface is rounded and marked by three flat impressions:
the highest for insertion of the suprasinatus muscle
the middle for the infraspinatus muscle
the lowest one, and the body of the bone for teres muscle

27. The Lesser Tubercle
The lesser tubercle is more prominent than the greater tubercle
Above and in front it presents an impression for the insertion of the tendon of the subscapularis muscle

29. The Intertubercular (Bicipital) Groove
The tubercles are separated from each other by a deep groove, the intertubercular groove (bicipital groove), which lodges the long tendon of the biceps brachii muscle

30. The surgical neck
The surgical neck is the point distal to the tubercles at which the superior portion of the bone meets the shaft
The surgical neck is a common site of fracture.

31. The body of the humerus has two prominent features:
The deltoid tuberosity, laterally, for attachment of the deltoid muscle

35. Distal Humerus Medial epicondyle: Lateral epicondyle:
The pronator and flexor muscles of the forearm originate here
Lateral epicondyle:
The extensor and supinator muscles of the forearm originate here
Medial supracondylar ridge
Lateral supracondylar ridge
Trochlea (medial condyle):
Articulates with the trochlear notch of the ulna
Capitulum (lateral condyle):
Articulates with the radial head

36. Distal Humerus Coronoid fossa: Radial fossa: Olecranon fossa:
Accommodates the coronoid process of the ulna during flexion.
A fat pad is situated here
Radial fossa:
Accommodates the head of the radius during flexion.
Olecranon fossa:
Accommodates the olecranon.
Groove for ulnar nerve

37. intertubercular groove
Anterior Humerus
lesser tubercle
medial epicondyle
deltoid tuberosity
trochlea
coronoid fossa
intertubercular groove
greater tubercle
capitulum
lateral epicondyle

38. Humerus: Anterior Clavicle Acromion process Greater tubercle
Coracoid process
Lesser tubercle
Scapula
Glenoid fossa
Humerus
Coronoid fossa
Deltoid tuberosity
Medial epicondyle
Lateral epicondyle
Capitulum
Trochlea
Radius
Ulna
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39. Humerus: Anterior2 Clavicle Acromion process Greater tubercle
Coracoid process
Lesser tubercle
Scapula
Glenoid fossa
Humerus
Coronoid fossa
Deltoid tuberosity
Medial epicondyle
Lateral epicondyle
Capitulum
Trochlea
Radius
Ulna

40. Humerus: Posterior Acromion of scapula Head of humerus
Spine of scapula
Greater tubercle
of humerus
Scapula
Glenoid fossa of scapula
Deltoid tuberosity
of humerus
Humerus
Medial epicondyle
of humerus
Lateral epicondyle
of humerus
Olecranon process of ulna
Radius
Ulna
Right Arm, Posterior

41. Radius The radius is the lateral and shorter of the two forearm bones.
Its proximal end consists of:
A short cylindrical (or thick disc like) head
The smooth superior aspect of the head of the radius is concave for articnlation with the capitulum of the hnmerus during flexion and extension of the elbow joint.
The head also articulates peripherally with the radial notch of the ulna
The head is covered with articular cartilage.
A neck
Relatively constricted between the head and the tuberosity.
A medially directed tuberosity
The oval radial tuberosity separates the proximal end of the radius from the body.

42. Radius

43. The distal end of the radius
Its medial aspect forms a concavity, the ulnar notch, which accommodates the head of the ulna.
Extending from its lateral aspect is the radial styloid process.
The dorsal tubercle, (Lister’s) projecting dorsally lies between grooves for the passage of the tendons of forearm muscles

44. The radial styloid process is much larger than the ulnar styloid process and extends approximately a finger's breadth further distally
This relationship is of clinical importance when the ulna and/or the radius are fractured

45. Radius
radial tuberosity
head
styloid process

46. Ulna
The stabilizing bone of the forearm is the medial and longer of the two forearm bones
Its proximal end has two prominent projections:
The olecranon:
projects proximally from its posterior aspect
The coronoid process
Projects anteriorly.

47. The olecranon
The olecranon is the most proximal posterior eminence of the ulna
It is on the dorsal subcutaneous border and contains broad attachments for the triceps posteriorly
Anteriorly, the olecranon forms the trochlear notch of the ulna, which articulates with the trochlea
The radial notch
On the lateral side of the coronoid process is a smooth, rounded concavity, which articulates with the head of the radius.

48. Ulna
Inferior to the coronoid process is the tuberosity of the ulna for attachment of the tendon of the Brachialis muscle.
Inferior to the radial notch on the lateral surface of the ulna is a prominent ridge (the supinator crest)
Between it and the distal part of the coronoid process is a concavity (the supinator fossa)
The deep part of the supinator muscle attaches to the supinator crest and fossa.

50. At the narrow distal end of the ulna is a abrupt enlargement forming a disclike head and a small, conical styloid process.
styloid process

51. Ulna trochlear notch coronoid process head radial notch
styloid process
olecranon process

52. Ulna Distal end Proximal end olecranon Trochlear notch
Coronoid process
Ulnar tuberosity
Head of ulna
styloid process
Distal end
Proximal end

55. Bones of the Hand
The skeleton of the carpus is composed of eight carpal bones (carpals) arranged in two rows of four each
The pisiform is set on a plane anterior to the others and behaves as a sesamoid in the tendon of flexor carpi ulnaris, rather than participating in movements at the wrist

56. The carpus is markedly convex posteriorly and concave anteriorly

57. From lateral to medial, the bones in the proximal row of carpals are:
Scaphoid
Lunate
Triquetrum
Pisiform

58. From lateral to medial, the four bones in the distal row of carpals are the:
Trapezium:
Trapezoid:
Capitate:
Hamate: `

59. Mnemonic for Learning Carpals
She Likes To Play
Lunate
In the moonlight
Scaphoid
A boat
Triquetrum
The third T Bone
Mnemonic for Learning Carpals
Pisiform
Pea-shaped
Hamate
A hambone
With a hook
Trapezium:
“It’s by the thumb”
Capitate
Trapezoid
“Is by its side”
Try To Catch Her

60. Metacarpals The first element of each ray is its metacarpal.
The proximal end of a metacarpal is expanded to form a base that articulates with the carpus.
The distal end of a metacarpal is expanded to form a rounded head that articulates with the proximal phalanx of the digit to form the knuckles of the fist

61. Phalanges Each of the four fingers contains a: The thumb has only :
Proximal phalanx
Middle phalanx
Distal phalanx.
The thumb has only :
A proximal phalanx
A distal phalanx.

63. Naming of Digits 1 2 3 4 5
Thumb
Index
Middle
Ring
Little

64. Manus (Hand) 3 Metacarpals (5) Digits (5) 54321 1 pollex Carpals (8)
Proximal
Phalanx
Middle
Phalanx
Carpals (8)
Distal
Phalanx
54321 3 1
pollex
Proximal
Phalanx
Metacarpals (5)
Distal
Phalanx
Digits (5)