BONES OF THE UPPER

LIMB AND
OSSIFICATION
DR SAM CHIME
Bones of upper limb
• Superior appendicular skeleton is formed by
• -pectoral girdle
• -bones of the free part of the upper limb
• Pectoral girdle is formed by the clavicle and scapula
• Bones of the free part are humerus, ulna, radius, hand bones
• The superior appendicular skeleton articulates with the axial skeleton
at the sternoclavicular joint allowing great mobility
Clavicle
• Collar bone connects the upper limb to the trunk
• Has a shaft with a convex medial two thirds and a concave lat third
• Medial end is enlarged triangular articulates with the manubrium
• Lateral end is flat articulates with the acromion of the scapula
• FUNCTIONS
• Serves as a moveable, crane-like strut from which the scapula and free
limb are suspended
• Forms part of the bony boundaries of the cervico-axillary canal
• Transmits shocks from upper limb to the trunk
Clavicle contd
• FEATURES
• Subcutaneous
• Long bone but no medullary cavity but compact exterior
• Sup surface is smooth
• Inf surface is rough gives attachment to ligaments connecting it to the
1st rib, coniod ligament[coracoclavicular ligament], trapezoid ligament
• Subclavian groove attachment for the subclavius muscle
SCAPULA
• Triangular flat bone on the postlateral aspect of the thorax overlying
2nd to 7th ribs
• Convex post surface is unevenly divided by the spine into a small
supraspinous and a larger infraspinous fossa
• Concave costal surface forms the subscapular fossa
• The spine continues laterally as the flat expanded acronium
• The glenohumeral joint is almost directly inferior to the AC joint
Scapula contd
• Superolaterally the glenoid cavity articulates the head of the humerus, glenoid
cavity is shallow concave oval fossa
• Coracoid process a beak like resemblance of a pointed bent finger to the
shoulder
• Has a medial[vertebral], lateral[axillary] and superior borders.
• Has a superior lateral and inferior angles.
• The lateral angle is the end of the lateral border which is broadened to form the
head which primary feature is the glenoid cavity and a neck separating it from
the body
• The suprascapular notch located on the superior border where it joins the base
of the coracoid process
HUMERUS
• Largest bone of the upper limb, articulates with scapula at the GH
joint and the ulna at the elbow joint.
• The proximal end has a head, anatomical neck and surgical neck
• Anatomical neck formed by the groove separating the head from the
tubercles indicates the line of attachment of glenohumeral joint
capsule
• Surgical neck is the narrow distal part
• The greater tubercle is at the lateral margin while the lesser tubercle
projects anteriorly
Humerus contd
• The shaft of the humerus has two prominent features: deltoid
tuberosity laterally for attachment of the deltoid muscle;
• Oblique radial groove where the radial nerve and the profunda brachii
artery lie
• The inferior end of the humerus widens as the sharp medial and
lateral supra-epicondylar ridges which distally tapers into the medial
and lateral epicondyle, providing attachment for muscle attachment
• The distal end of the humerus including the trochlea, capitulum,
olecranon, coronoid and radial fossa make up the condyle of the
humerus
Bones of the forearm
• Ulna and radius
• Involved in pronation and supination with the radius pivoting about the ulna
on flexion of the elbow joint
• ULNA
• This is the stabilizing bone of the forearm
• Medial and longer than the radius
• The proximal end is massive for articulation with the humerus and laterally
with the radius
• The olecranon and the coronoid process enable articulation with the
humerus
Bones of the forearm contd
• The articulation at the elbow joint allows for flexion and extension
primarily
• A small amount of adduction and abduction occurs during pronation
and supination
• The tuberosity of the ulna is the attachment of the tendon of
Brachialis muscle
• Radial notch receives the head of the radius
• Supinator crest and fossa gives attachment to the deep part of the
Supinator muscle
Bones of the forearm contd
• The shaft of the ulna is thick and cylindrical proximally but tapers
diminishing in diameter distally
• The ulna narrows distally to end abruptly with a small conical styloid
process
• RADIUS
• Shorter and lateral of the forearm bones
• Proximally the head articulates with the capitulum of the humerus
and the radial notch of the ulna
• The head is covered by articular cartilage
Forearm bones contd
• The neck is a constriction distal to the head
• Radial tuberosity separates the head/neck from the shaft
• The shaft enlarges distally ending in a four sided structure articulating
with the ulna medially but ending with a styloid process
• The styloid process of the radius is larger than the ulna, also more
distal
• The interosseous membrane run obliquely passing inferiorly from
radius to ulna, thus positioned to transmit forces from radius to ulna
on to humerus
Bones of the hand
• The carpus is composed of eight carpal bones arranged in proximal
and distal rows of four
• The small carpal bones give flexibility to the hand
• The carpus is markedly convex from side to side posteriorly and
concave anteriorly
• The carpal bones glide on each other, and on those adjacent to it
Bones of the hand
• From lateral to medial the four carpal bones in the proximal row
• Scaphoid
• Lunate
• Triquetrum
• Pisiform
• From lateral to medial the four carpal bones in the distal row
• Trapezium
• Trapezoid
• Capitate
• Hamate
Bones of the hand contd
• Scaphoid articulates with the radius and the largest bone of the
proximal row
• Lunate articulates with the radius
• Triquetrium articulates with the radioulnar joint
• Pisiform lies on the triquetrium
Bones of the hand contd
• The metacarpus forms the skeleton of the palm between the carpus
and phalanges
• Composed of five metacarpal bones
• Each metacarpal bone consist of a base, shaft and head
• The proximal base articulates with carpal bones
• The distal head articulate with the proximal phalanges[knuckles]
• 1st metacarpal is the thickest and shortest
• The 3rd metacarpal has a lateral styloid on its base
Bones of the hand contd
• Each digit has 3 phalanges except the first
• The thumb has only two, it is stouter than others
• Each phalanx has a base proximally, a shaft, and a head distally
• The proximal phalanges are the largest, while the most distal are the
smallest
• The shafts taper distally
• The terminal phalanges are flattened at their distal end to accomdate
the nail bed
Ossification of bones of upper limb
Ossification
• Bone growth takes many years to maturity, from embryonic life to
adulthood
• Bones derive from embryonic mesenchyme and from cartilage
• Intramembranous ossification and endochondral ossification
• Intramembranous ossification – mesenchymal models of bones form
during embryonic life with direct ossification
• Endochondral ossification – cartilage models form from mesenchyme
from which bone subsequently replace the cartilage
Ossification of bones of upper limb
• Bone ossification, or osteogenesis, is the process of bone
formation. ... Endochondral ossification begins with mesenchymal
tissue transforming into a cartilage intermediate, which is later
replaced by bone
• Bone formation, Soon after the osteoid is laid down, inorganic salts
are deposited in it to form the hardened material recognized as
mineralized bone. The cartilage cells die out and are replaced by
osteoblasts clustered in ossification centres.
• A primary ossification center is the first area of a bone to start
ossifying. It usually appears during prenatal development in the
central part of each developing bone. In long bones the primary
centers occur in the diaphysis/shaft and in irregular bones the
primary centers occur usually in the body of the bone.
• Secondary centers appear after birth in other parts of the developing
bone, these parts are the epiphyses.
• Metaphysis is the flared part of the diaphysis nearest to the epiphyses
Ossification of bones of upper limb
CLINICALS
Fracture of the clavicle
Fracture of the scapula
Fracture of the humerus:
surgical neck – axillary nerve
Radial groove – radial nerve
Distal end of humerus – median nerve
Medial epicondyle – ulnar nerve
Fracture of the radius/ulna – colles fracture/dinner fork deformity
Clinicals contd
• Fracture of the scaphoid
• Fracture of the hamate
• Fracture of the metacarpals
• Fracture of the phalanges