Osteology

Bone Structure Description Notes

scapula
(N420, N421,
TG2-03A,
TG2-03B,
Practical1,
Practical2)
the bone of the shoulder the scapula floats in a sea of muscles, so it is difficult to fracture; it articulates with the axial skeleton through only one bone - the clavicle at the
coracoclavicular and acromioclavicular joints
scapular notch a notch on the superior border
of the scapula located medial to
the attachment of the coracoid
process
it is bridged by the superior transverse scapular ligament; the suprascapular a. passes superior to the superior transverse scapular ligament and the
suprascapular n. passes inferior to it (Army goes over the bridge, Navy goes under the bridge)
acromion(Practical) a broad, flat process located at
the lateral end of the scapular
spine
it articulates with the clavicle through a synovial joint (acromioclavicular joint) (Latin, akron = tip + omos = shoulder, therefore the tip of the shoulder)
supraspinous fossa a broad depression located
superior to the spine of the
scapula
it is the site of origin of the supraspinatus m.
infraspinous fossa a broad depression located
inferior to the spine of the
scapula
it is the site of origin of the infraspinatus m.
humerus
(N420,N421,
TG2-03A,
TG2-03B,
Practical)
the bone of the arm (brachium) the humerus articulates proximally with the scapula at the glenoid fossa; it articulates distally with the radius and ulna at the elbow joint
head(Practical) the smooth, rounded proximal
end of the humerus
it articulates with the glenoid cavity of the scapula to form the shoulder joint
anatomical neck the constricted region located
inferolateral to the head
it is located at the circumference of the smooth articular surface of the head
surgical neck the proximal part of the shaft of
the humerus
it is located inferior to the greater and lesser tubercles; it is a site of frequent fracture; fractures of the surgical neck of the humerus endanger the
axillary n. and the posterior circumflex humeral a.
greater tubercle the large projection located
lateral to the head of the
humerus
it is the attachment site of the supraspinatus, infraspinatus & teres minor mm.
lesser tubercle the projection located lateral to
the head of the humerus on the
anterior surface
it is the insertion site of the subscapularis m.
intertubercular groove the groove on the anterior
surface of the humerus that is
located between the crest of
the greater tubercle and the
crest of the lesser tubercle
it is occupied by the tendon of the long head of the biceps brachii m.; the transverse humeral ligament spans the intertubercular groove and holds the
biceps tendon in place; it is the attachment site for the tendon of the pectoralis major (lateral lip), teres major (medial lip), and latissimus dorsi (floor)
crest of the greater
tubercle
the ridge of bone on the
anterior surface of the humerus
extending inferiorly from the
greater tubercle
it forms the lateral lip of the intertubercular groove; it is the attachment site for the transverse humeral ligament and the pectoralis major m.
crest of the lesser
tubercle
the ridge of bone on the
anterior surface of the humerus
extending inferiorly from the
lesser tubercle
it forms the medial lip of the intertubercular groove; it is the attachment site for the transverse humeral ligament and the teres major m.
deltoid tuberosity the roughened process on the
lateral surface of the mid-shaft
of the humerus
it is the insertion site of the deltoid m.
lateral epicondyle a knob-like projection on the
lateral side of the humerus
proximal to the capitulum
it is the site of attachment of the common extensor tendon which is the origin of several forearm extensor muscles (extensor carpi radialis brevis m.,
extensor digitorum m., extensor digiti minimi m., extensor carpi ulnaris m. and supinator m.); inflammation of the attachment of the common extensor
tendon is called lateral epicondylitis which is also known as "tennis elbow" (Greek, kondylos = the knob formed by the knuckle of any joint)
medial epicondyle a knob-like projection on the
medial side of the humerus
proximal to the trochlea
it is the attachment site of the common flexor tendon which is the origin for the superficial group of forearm flexor muscles (pronator teres m., flexor
carpi radialis m., palmaris longus m., flexor carpi ulnaris m. and flexor digitorum superficialis m.); inflammation of the attachment of the common flexor
tendon is called medial epicondylitis which is also known as "tennis elbow"; the ulnar nerve is in contact with bone as it courses posterior to the medial
epicondyle where it is susceptible to injury from blunt trauma or fracture Greek, kondylos = the knob formed by the knuckle of any joint)
radial groove (Practical) the groove that spirals around
the posterior surface of the
shaft of the humerus
it is a depression for the radial n. and the deep brachial vessels; fracture of the humerus at mid-shaft can injure the radial nerve and deep brachial
vessels because they are in contact with bone at this location
ulna
(N436,N439,
TG2-04AB,
Practical)
the bone on the medial side of
the forearm (antebrachium)
the ulna articulates proximally with the trochlea of the humerus and the head of the radius; it articulates distally with the ulnar notch of the radius (Latin,
ulna = elbow or arm)
olecranon the proximal end of the ulna it is the insertion site of the tendon of the triceps brachii m.; when the elbow is extended, the olecranon of the ulna engages the olecranon fossa of the
humerus (Greek, olecranon = the head or point of the elbow)
coronoid process the anterior projection of bone
located distal to the trochlear
notch
(Greek, coronoid = resembles a crow)
styloid process a small projection from the
distal surface of the head of the
ulna
it is the site of attachment of the articular disk of the distal radioulnar joint
radius
(N436,N439,
TG2-04AB,
Practical)
the bone on the lateral side of
the forearm (antebrachium)
the radius pivots on its long axis and crosses the ulna during pronation
head the rounded proximal end of
the radius
it has a smooth, rounded surface for articulation with the ulna; the head of the radius is encircled by the annular ligament (4/5 of a circle) and the radial
notch of the ulna (1/5 of a circle)
neck the constricted area of the
radius located distal to the
head
the annular ligament of the radius surrounds the head of the radius, not the neck of the radius
radial tuberosity a roughened area on the
anteromedial surface of the
radius located just distal to the
neck
it is the insertion site of the tendon of the biceps brachii m.
styloid process the distal-most projection from
the lateral side of the radius
the radial styloid process projects lateral to the proximal row of carpal bones


Muscles
Muscle Origin Insertion Action Innervation Notes Image
deltoid
(N424, TG2-07,
Practical)
lateral one-third of clavicle, acromion, lower lip of
the crest of the spine of the scapula
deltoid tuberosity of the
humerus
abducts arm; anterior
fibers flex & medially rotate
arm; posterior fibers
extend & laterally rotate
arm
axillary nerve (C5,6)
from posterior cord of
brachial plexus
deltoid is the principle abductor of the arm but due to
poor mechanical advantage it cannot initiate this action;
assisted by supraspinatus

teres major
(N424, TG2-07, TG2-
08)
dorsum of the inferior angle of scapula crest of lesser tubercle
of humerus
adducts arm, medially
rotates arm, assists in arm
extension
lower subscapular
nerve (C5,6) from the
posterior cord of the
brachial plexus
teres major inserts beside the tendon of latissimus dorsi,
and assists latissimus in its actions (Latin, teres =
round)

rotator cuff
supraspinatus
(N425, N426, TG2-08,
TG2-16A, TG2-16B,
TG2-16C, Practical)
supraspinatus fossa greater tubercle of
humerus (highest facet)
abduct arm (initiate
abduction)
suprascapular nerve
(C5,6) from superior
trunk of brachial plexus
supraspinatus initiates abduction of the arm, then the
deltoid muscle completes the action

infraspinatus
(N425, N426, TG2-08,
TG2-16A, TG2-16B,
TG2-16C, Practical1,
Practical2, Practical3)
infraspinatus fossa greater tubercle of
humerus (middle facet)
laterally rotate arm suprascapular nerve infraspinatus, supraspinatus, teres minor and
subscapularis are the rotator cuff muscles

teres minor
(N425, N426, TG2-08,
TG2-16A, TG2-16B,
TG2-16C, Practical)
upper 2/3 of the lateral border of the scapula greater tubercle of
humerus (lowest facet)
laterally rotates arm axillary fixes head of humerus in glenoid fossa during abduction
& flexion of arm

subscapularis
(N425, N426, TG2-08,
TG2-16A, TG2-16B,
TG2-16C)
medial two-thirds of costal surface of scapula
(subscapular fossa)
lesser tubercle of
humerus
medially rotates arm;
assists extension of arm
upper and lower
subscapular nerves
(C5,6)
subscapularis, supraspinatus, infraspinatus, and teres
minor are the rotator cuff muscles

biceps brachii
(N431, TG2-17)
short head: tip of coracoid process; long head:
supraglenoid tubercle of scapula
tuberosity of radius flexes forearm, flexes arm
(long head), supinates
musculocutaneous
nerve (C5,6)
a powerful supinator only if the elbow is flexed
brachialis
(N431, TG2-17)
anterior surface of lower one-half of humerus and
intermuscular septa
ulnar tuberosity of ulna flexes forearm musculocutaneous
nerve (C5,6)
powerful flexor
coracobrachialis
(N431, TG2-17,
Practical)
coracoid process of scapula medial humerus at mid-
shaft
flexes and adducts arm musculocutaneous
nerve (C5,6)
musculocutaneous nerve passes through the
coracobrachialis muscle to reach the other arm flexors
(biceps brachii and brachialis)

serratus anterior
(N191, TG4-07,
Practical1, Practical2)
ribs 1-8 or 9 medial border of the
scapula on its costal
(deep) surface
it draws the scapula
forward; the inferior fibers
rotate the scapula
superiorly
long thoracic nerve
(from ventral rami C5-
C7)
a lesion of long thoracic nerve will cause winging of the
scapula (i.e., the medial border of the scapula falls away
from the posterior chest wall and looks like an angel's
wing) (Latin, serratus = to saw)

triceps brachii
(N432, TG2-18A, TG2-
18B, Practical)
long head: infraglenoid tubercle of scapula; lateral
head: posterolateral humerus & lateral
intermuscular septum; medial head:
posteromedial surface of inferior 1/2 of humerus
olecranon process of
the ulna
extends forearm; long
head extends and adducts
arm
radial nerve long head of triceps separates the triangular and
quadrangular spaces (teres major, teres minor and the
humerus are the other boundaries)

anconeus
(N432,N444, TG2-18)
lateral epicondyle lateral side of olecranon
and upper one-fourth of
ulna
extends forearm nerve to anconeus from
radial nerve
(Greek, ankon = elbow or a bend)

Nerves
Nerve Source Branches Motor Sensory Notes
brachial plexus
(N429,N430, TG2-14,
TG2-13, Practical1,
Practical2, Practical3,
Practical4)
ventral
primary
rami of C5-
8 & T1
dorsal scapular, long thoracic, n. to
subclavius, suprascapular, lateral & medial
pectoral, medial brachial & antebrachial
cutaneous, upper, middle & lower
subscapular, musculocutaneous, ulnar,
median, axillary, radial
muscles of upper limb, excluding trapezius skin of upper
limb
axons from spinal cord levels C5-T1 are mixed (braided) in the
brachial plexus and repackaged into terminal branches so that each
branch contains axons from several spinal cord levels (Latin, plexus
= a braid. A network of nerves, blood vessels, or lymphatic vessels)
dorsal scapular
(N429, TG2-14,
Practical1, Practical2)
brachial
plexus (C5)
rhomboid major & minor; levator scapulae passes through scalenus medius
long thoracic
(N429,N190, TG2-13,
TG2-14)
brachial
plexus (C5-
C7)
serratus anterior located on superficial surface of serratus anterior; lesion causes
scapular winging, hence the saying "C5, 6, & 7 keep the wings from
heaven"
lateral cord
(N429, N474, TG2-13,
TG2-14)
union of
anterior
divisions of
upper &
middle
trunks
lateral pectoral, lateral root of median n.,
musculocutaneous
anterior arm; contributes to anterior forearm &
thenar compartment
lateral forearm;
contributes to
palmar hand

medial cord
(N430, TG2-14)
anterior
division of
lower trunk
medial pectoral, medial brachial cutaneous,
medial antebrachial cutaneous, medial root
of median n., ulnar
fl. carpi ulnaris & medial half of fl. dig. profundus,
contributes to other anterior forearm muscles; hand
muscles
medial forearm &
hand

posterior cord
(N430, TG2-13, TG2-
14)
posterior
divisions of
upper,
middle, &
lower
trunks
upper, middle, & lower subscapular, axillary,
radial
deltoid, teres major & minor, subscapularis,
posterior arm & forearm
posterior arm &
forearm,
posterolateral
hand

suprascapular
(N429, N426, TG2-08,
TG2-14, Practical)
superior
trunk of the
brachial
plexus (C5-
C6)
no named branches supraspinatus, infraspinatus no cutaneous
branches
passes through the suprascapular notch inferior to the superior
transverse scapular ligament
lateral pectoral
(N429, TG2-13, TG2-
14, Practical)
lateral cord
of brachial
plexus
pectoralis major communicates with medial pectoral n. anterior to axillary a.; pierces
clavipectoral fascia
musculocutaneous
(N474, TG2-13, TG2-
14, Practical)
lateral cord
of brachial
plexus
(C5,6)
lateral antebrachial cutaneous coracobrachialis, biceps brachii, brachialis skin of lateral
side of forearm
pierces coracobrachialis
medial pectoral
(N429, TG2-13,
Practical1, Practical2)
medial cord
of the
brachial
plexus
pectoralis minor & major communicates with lateral pectoral n. anterior to axillary a.; pierces
pectoralis minor
medial brachial
cutaneous
(N433,N479, TG2-13,
medial cord
of brachial
plexus
skin of the
medial side of
the arm
communicates with intercostobrachial n. (Latin, cutis = skin)
TG2-14)
medial antebrachial
cutaneous
(N433,N479, TG2-13,
TG2-14)
medial cord
of brachial
plexus
skin of medial
side of forearm
travels with basilic vein for part of course (Latin, cutis = skin)
ulnar
(N433,N476, TG2-13,
TG2-14, Practical1,
Practical2, Practical3)
medial cord
of the
brachial
plexus
palmar cutaneous br., dorsal br., superficial
& deep br.
flexor carpi ulnaris, flexor digitorum profundus
(ulnar half), abductor digiti minimi, flexor digiti
minimi brevis, opponens digiti minimi, ulnar 2
lumbricals, palmar & dorsal interossei, adductor
pollicis
skin of medial
side of wrist &
hand & ulnar 1
1/2 digits on
palmar side and
2 1/2 digits
dorsally
motor to most of the muscles of the hand (Latin, ulna = elbow or
arm)
upper subscapular
(N429, TG2-13, TG2-
14)
posterior
cord of
brachial
plexus
subscapularis (superomedial part)
thoracodorsal (middle
subscapular)N426,
TG2-13, TG2-14)
posterior
cord of
brachial
plexus
latissimus dorsi
lower subscapular
(N426, TG2-13, TG2-
14)
posterior
cord of
brachial
plexus
subscapularis (lateral part), teres major
radial
(N477,N478, TG2-13,
TG2-14, Practical1,
Practical2)
posterior
cord of
brachial
plexus
posterior brachial cutaneous, inferior lateral
brachial cutaneous, posterior antebrachial
cutaneous, superficial & deep br.
triceps brachii, anconeus, brachioradialis, extensor
carpi ulnaris, extensor carpi radialis longus &
brevis, extensor digitorum, extensor digiti minimi,
supinator, abductor pollicis longus, extensor pollicis
longus & brevis, extensor indicis
skin of posterior
arm, forearm &
hand
motor to the extensor muscles of the arm and forearm
axillary
(N426, TG2-13, TG2-
14. Practical1,
Practical2)
posterior
cord of
brachial
plexus
superior lateral brachial cutaneous nerve deltoid, teres minor skin of upper
lateral arm
endangered by surgical neck fractures
median
(N473,N475, TG2-13,
TG2-14, Practical1,
Practical2)
lateral &
medial
cords of
brachial
plexus
anterior interosseous, palmar br., recurrent
(motor) br., common palmar digital ns. (1st-
3rd)
pronator teres, flexor carpi radialis, palmaris
longus, flexor digitorum superficialis, flexor
digitorum profundus (radial half), flexor pollicis
longus, pronator quadratus, abductor pollicis brevis,
flexor pollicis brevis, opponens pollicis, radial 2
lumbricals
skin of radial half
of palm & palmar
side of radial 3
1/2 digits (and
nail bed for these
digits)
motor to the flexor muscles of the forearm (except flexor carpi
ulnaris and the medial 1/2 of the flexor digitorum profundus),the
muscles of the thenar compartment and the lateral 2 lumbricals
intercostobrachial
(N429,N473,N479)
lateral cut.
branch of
2nd
intercostal
floor of axilla,
medial and
posterior
surfaces of arm
communicates with the medial brachial cutaneous n.

Arteries
Artery Source Branches Supply Notes
suprascapular
(N426, TG2-08,
thyrocervical trunk muscular supraspinatus & infraspinatus,
shoulder joint
anastomoses with the circumflex scapular a. and the dorsal scapular a. to
form the scapular anastomosis
N427TG2-15,
Practical)
axillary
(N184,N189, TG2-
15A, TG2-15B,
Practical)
subclavian (continuation of
the subclavian lateral to the
1st rib)
1st part: superior thoracic; 2nd part: thoracoacromial, lateral
thoracic; 3rd part: ant. & post. humeral circumflex,
subscapular
shoulder & upper limb pectoralis minor crosses the axillary artery anteriorly and is used to
delineate the 3 parts mentioned at left (Latin, axillary = armpit)
superior thoracic axillary, 1st part muscular intercostal spaces 1 & 2 laterally
thoracoacromial
(N427, TG2-15,
Practical1,
Practical2)
axillary, 2nd part pectoral br., clavicular br., acromial br., deltoid br. pectoralis major & minor,
subclavius, deltoid, shoulder joint

lateral thoracic
(N191,N427, TG2-
15A, TG2-15B)
axillary, 2nd part muscular serratus anterior & adjacent
muscles, skin & fascia
a rare artery in that it enters the serratus anterior from its superficial
surface
subscapular
(N427, TG2-15A,
TG2-15B)
axillary, 3rd part circumflex scapular, thoracodorsal subscapularis, teres major, teres
minor, infraspinatus, latissimus
dorsi
anastomoses with suprascapular, dorsal scapular & deep br. of transverse
cervical
circumflex scapular
(N427, TG2-09A,
TG2-15)
subscapular muscular teres major & minor,
infraspinatus
anastomoses with suprascapular & dorsal scapular branches (Latin,
circum- = around + -flex = to bend)
thoracodorsal
(N427, TG2-15A,
TG2-15B)
subscapular muscular latissimus dorsi
anterior circumflex
humeral
(N427, TG2-09A,
TG2-15, Practical)
axillary, 3rd part muscular arm muscles near surgical neck
of humerus
(Latin, circum- = around + -flex = to bend)
posterior circumflex
humeral
(N427, TG2-09A,
TG2-15)
axillary, 3rd part muscular arm muscles near surgical neck
of humerus
passes through quadrangular space with axillary nerve
brachial
(N434,N429, TG2-
17, TG2-19,
Practical)
axillary (continuation distal to
teres major m.)
deep brachial, sup. ulnar collateral, nutrient, inf. ulnar
collateral; terminal branches are the radial & ulnar
arm, forearm & hand normally terminates at the level of the elbow, but high branching may
occur
deep brachial
(N434, TG2-18,
TG2-19)
brachial ascending br., terminal branches are the middle collateral &
radial collateral
post. arm

Lymphatics of the Axillary Region
Structure Location Afferents from
Efferents
to
Regions drained Notes
axillary
nodes
(N184,
TG2-11)
axilla efferents
form
subclavian
trunk
upper limb, most of
breast, some
anterolateral chest wall
axillary nodes are grouped as: 1) pectoral/anterior nodes, along lower border of pectoralis major; 2) lateral nodes, distal along
axillary v.; 3) central nodes, centrally located along axillary v.; 4) subscapular/posterior nodes, along subscapular v. & tributaries; 5)
apical nodes, at apex of axilla, receiving lymph from all other groups
pectoral lateral border of most of breast, central anterolateral thoracic wall also known as anterior axillary or level I nodes; an important group of nodes to examine during breast exam
nodes
(N184,
TG2-11)
pectoralis major anterolateral
chest wall &
muscles
axillary
nodes
and muscles, including
most of the mammary
gland
lateral
axillary
(N184,
TG2-11)
along distal axillary
v.
small nodes in
cubital fossa
central
axillary
nodes
upper limb
posterior
axillary
(N184,
TG2-11)
anterior to
subscapularis m.
central
axillary
nodes
posterior shoulder a.k.a. subscapular nodes
central
axillary
(N184,
TG2-11)
along axillary v.
posterior to
pectoralis minor m.
lateral, anterior
& posterior
axillary nodes
apical
axillary
nodes
upper limb, breast,
posterior shoulder, lateral
chest wall
a.k.a. level II nodes
apical
axillary
(N184,
TG2-11)
along axillary v.
medial to pectoralis
minor m. at apex of
axilla
central axillary
nodes
subclavian
lumph trunk
upper limb, breast,
posterior shoulder, lateral
chest wall
a.k.a. level III nodes