Dr.

Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

APPENDICULAR SKELETON

Bones of the limbs and their girdles are collectively called

appendicular skeleton because they are appended (attached) to
the axial skeleton.

The pectoral girdle

This connects upper limb to the axial skeleton and consists of the
clavicle and scapula.
Clavicle
Also called collar bone. The clavicle is known as the "beauty
bone" because of its location in the body. Clavicles are slender, S-
shaped bones which lie horizontally across the anterior part of the
thorax superior to the first rib. It is the most superficial bone of
the body. Each clavicle consists of two ends; medial end and
lateral end. The medial end, called the sternal end, is rounded
and articulates with the manubrium of the sternum to form the
sternoclavicular joint. The lateral end, called acromial end is
broad, flattened and articulates with the acromion process of the
scapula to form the acromio-clavicular joint.

The clavicle is subdivided into 3 portions; medial two thirds

(medial third and middle third) and lateral third. The medial two
thirds are convex shaped anteriorly, the lateral third is concave
shaped anteriorly.

Medial third; the longest region of clavicle. Convex anteriorly;

Its sternal end is rounded and consists of the sternal facet, which
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

articulates with the clavicular notch of sternum to form the

sternoclavicular joint. On inferior surface of medial third, is a
broad, rough, oval shaped area known as costal tuberosity or
tuberosity of clavicle. It provides the attachment site for the
costoclavicular ligament.

The middle third, or midshaft. Convex shaped anteriorly; it

is the thinnest area of the clavicle, and thus the most easily
fractured; on the inferior surface of middle third is a groove for
the subclavius muscle. There also nutrient foramen on middle
third.

Lateral third; concave shaped anteriorly; the widest region of

the clavicle. Its lateral end is flattened and consists of acromial
facet, which articulates with the acromion of scapula to form the
acromio-clavicular joint. On the inferior surface of lateral third, is
the trapezoid line (trapezoid ridge), a narrow oblique ridge for
attachment of the trapezoid ligament. Between the trapezoid line
and the groove for subclavius muscle, is the conoid tubercle, a
bony prominence on inferior surface of lateral third; for
attachment of conoid ligament. The superior surface appears
smooth and the acromial facet can be seen at the acromial end.
The clavicle provides points of attachment for thoracic and
shoulder muscles and also act as anterior braces; They hold the
scapular and upper limb laterally away from the narrower superior
part of the thorax. The clavicle also transmits compression forces
from the upper limb to the axial skeleton.
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

Diagram of clavicle
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

Scapula
The scapula, also called shoulder blade, is a large, triangular, flat
bone situated in the superior part of the posterior thorax between
the levels of the second and seventh ribs. Each scapula has three
borders; superior border, medial (vertebral) border and lateral
(axillary) border.
Superior border; superior edge of scapula, shortest and sharpest
border. Projecting anteriorly from the superior border is the
coracoid process, which anchors muscles and ligaments of the
arm. The coracoid process is bounded by the suprascapular notch
medially and by the glenoid fossa laterally
Medial border; thin medial edge of scapula, runs parallel to the
vertebral column.
Lateral border; thick edge of scapula which lies closer to the arm
pit. Has a small shallow fossa below the acromion called glenoid
cavity which articulates with the head of humerus forming the
gleno-humeral (shoulder) joint.
Since the scapula is triangular in shape, it has 3 angles; the
superior scapular border meets the medial border at the superior
angle. The superior border meets the lateral border at the lateral
angle. The medial and lateral borders meet at the inferior angle.
The inferior angle is important for understanding scapular
movements since it moves extensively as the arm is raised or
lowered.
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

The scapula also consists of two surfaces; anterior surface and

posterior surface. The anterior surface is concave shaped and
contains a depression known as the subscapular fossa. This fossa
is occupied by the subscapularis muscle. The posterior surface is
convex shaped and bears a sharp prominent ridge called scapular
spine, which can be felt through the skin. The spine runs
diagonally across the posterior surface and ends laterally into an
expanded process called acromion process, which forms the point
of the shoulder. The acromion articulates with the acromial end of
the clavicle forming acromio-calvicular joint.

Above the spine on the posterior surface is a depression known as

the supraspinous fossa, and below the spine is the infraspinous
fossa. The infraspinous fossa serves for attachment of
infraspinatus muscle and the supraspinous fossa serves as site for
attachment of supraspinatus muscle.

Diagram of scapula
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

The Humerus

Also known as arm bone because it is the only bone of the arm.
The humerus is a long bone situated between the shoulder joint
and elbow joint. It is the longest and largest bone of the upper
limb. It articulates with the scapula at the shoulder joint and with
the forearm bones to form the elbow joint.

The humerus consists of 3 main regions; proximal end, shaft and

distal end.
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

Proximal end: consists of a smooth, hemispherical head which

articulates with the glenoid cavity of the scapula to form the
shoulder joint. Immediately below the head is a slight oblique
constriction called anatomical neck, former site of epiphyseal
plate. Inferior to the anatomical neck is the lateral greater
tubercle and medial lesser tubercle. The greater tubercle is the
most laterally palpable bony landmark of the shoulder region and
is inferiorly related to the acromion of the scapula. These
tubercles are separated by the intertubercular sulcus or bicipital
groove. The groove guides the tendon of biceps muscle. The
tubercles are sites of muscle attachment. Just inferior to the
tubercles is the surgical neck, the most frequently fractured part
of the humerus.

Shaft: the elongated, cylindrical part of the bone. On the lateral

side about midway down the shaft is the deltoid tuberosity, a V-
shaped roughened area for attachment of deltoid muscle. On the
posterior surface of the shaft, is the radial groove, which runs
infero-laterally down and it anchors the radial nerve.

Distal end: there two condyles; trochlea and capitulum. The

trochlea is a medial pulley-shaped condyle which articulates with
the trochlear notch of the ulna. The capitulum is a lateral ball-like
condyle which articulate with the head of radius. Above these
condyles are the medial and lateral epicondyles. Behind the
medial epicondyle, is the ulnar groove through which the ulnar
nerve runs. The ulnar nerve which is responsible for your painful
funny facial expression you experience when you hit the funny
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

bone. Superior to the trochlea on the anterior surface is the

coronoid fossa; on the posterior surface is the olecranon fossa.
These two depressions allow the corresponding processes of the
ulna to fit when the elbow is flexed or extended. An anterior
depression, radial fossa is located lateral to the coronoid fossa,
above the capitulum and receives the head of radius when the
elbow is flexed.

Diagram of humerus
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

FORE ARM BONES

There two bones, radius and ulna.

These shafts of these two bones are connected by a fibrous

connective tissue membrane called interosseous membrane

The Ulna

It is a long bone situated on the medial aspect of the fore arm

region. The ulna is slightly longer than the radius. It has 3 main
regions; proximal end, shaft and distal end. The ulna has the main
responsibility of forming the elbow joint together with the
humerus.

Proximal end: it bears two prominent processes; olecranon

process and coronoid process, separated by a deep cavity known
as the trochlear notch. Together, these two processes grip the
trochlea of the humerus forming a stable elbow joint. When the
arm is fully extended, the olecranon process locks into the
olecranon fossa of humerus, keeping the fore arm from
hyperextending. The posterior olecranon process forms the angle
of the elbow when the fore arm is flexed and is the bony part that
rests on the table when you lean on your elbows. Laterally to the
coronoid process is a small depression, radial notch which
articulates with the head of radius forming the proximal radio-
ulnar joint.
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

Shaft: The ulnar shaft is the elongated part of the bone. It

narrows as it runs distally towards the head. Laterally, the ulnar
shaft consists of a sharp lateral edge known as interosseous crest
which serves as the attachment site for interosseous membrane
which connect ulnar shaft to the shaft of radius.

Distal end: Consists of the ulnar head, a knob-like structure.

Medial to the head is a styloid process, from which a ligament
extends to the wrist. Laterally, the ulnar head articulates with the
ulnar notch of radius at the distal radio-ulnar joint. The ulnar head
is separated from the wrist bones by a disc of fibrocartilage which
allows minimal hand movements. Distal to the head is the neck of
ulna.

The Radius

The radius is a long bone situated on the lateral aspect of the

forearm. The radius is the smaller bone of the forearm. In
contrast to the ulna, the radius is narrow at its proximal end and
widens at its distal end. The radius consists of 3 main regions;
proximal end, shaft and distal end.
Proximal end: consists of the head, shaped like head of a nail.
The superior surface of the head is concave and articulates with
the capitulum of the humerus at the elbow joint. Medially, the
head articulates with the radial notch of the ulna at the proximal
radio-ulnar joint. The ulna and radius articulate with the humerus
at the elbow joint. Just below the head of the radius, is the neck of
the radius and just below the neck is a rough medial projection,
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

radial tuberosity which anchors the tendon of biceps muscle of

the arm.

The shaft; elongated part of the radius. The shaft widens

towards the distal end. Medially, the shaft consists of a sharp
medial edge known as interosseous crest which serves as the
attachment site for interosseous membrane. The interosseous
membrane is a fibrous connective tissue membrane that connects
the shaft of radius to the ulnar shaft.

Distal end: Distally, the radius is expanded. It has a medial ulnar

notch which articulates with the head of ulnar at the distal radio-
ulnar joint. Laterally projecting from the head, is a styloid process,
a site for attachment of muscles and ligaments that run to the
hand. The inferior surface of distal end is concave where it
articulates with carpel bones of the wrist. The anterior surface of
distal end is smooth and slightly concave, whereas the posterior
surface is angled at the radial tubercle, a prominence on posterior
surface.

The radius is the major forearm bone contributing to the wrist

joint.

Articulations of radius and ulna

The radius and ulnar connect with one another at 3 sites;

 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

 At the shafts: the interosseous borders of shafts of the radius

and ulna are connected by the interosseous membrane, a
fibrous connective tissue membrane. This membrane also
provides site of attachment for deep skeletal muscles of the
fore arm.
 Proximal articulation; medially, the head of radius articulates
with the radial notch of ulnar at the proximal radio-ulnar
joint.
 Distal articulation; medially, the head of ulna articulates with
the ulnar notch of radius at the distal radio-ulnar joint.
 Finally, the distal end of radius articulates with two carpel
bones; scaphoid, and lunate to form the radio-carpel (wrist)
joint.
 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

Bones of the hand

The hand or carpus consists of bones called carpal bones. There 8

carpal bones grouped into proximal row and distal row.

Proximal (upper) row

4 bones;

Scaphoid, Lunate, Triquetrum, Pisiform

Distal (lower) row

4 bones;

Trapezium, Trapezoid, Capitate, Hamate

 Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161

For remembrance, consider this mnemonic

Stop Letting Those People Touch The Cadavers Hand

Or

Sally Left The Party To Take Cathy Home

Important points to note about carpal bones

 These bones are short bones named according to their shape

 Capitate is the largest of all carpal bones
 The capitate is the largest carpal bone; its rounded
projection, the head, articulates with the lunate.
 The distal end of radius articulates with two carpal bones;
scaphoid, and lunate to form the radio-carpal
 Pisiform is the smallest carpal bone.
 Scaphoid is the most frequently fractured carpal bone
 An opening known as a carpal tunnel exist between carpal
bones. This opening contains the median nerve.
Dr. Herbert (MD), MBChB-MUK, DCN, CFAEC 0775600161