THE UPPER LIMB

ARM - HUMERUS:
1. Proximal end (the proximal humeral epiphysis): consists of the head, anatomical neck and
the greater and lesser tubercles. The limit between the proximal end and the shaft is named
“surgical neck” which is closely related on its medial side to the axillary nerve and posterior
humeral circumflex artery.
- Head: forms rather less than half a spheroid; its smooth articular surface is covered with
hyaline cartilage and is directed medially, backwards and upwards to articulate with the
glenoid cavity of the scapula.
- Anatomical neck: the anatomical neck of the humerus immediately adjoins the margin of
the head and forms a slight constriction. It indicates the line of capsular attachment of the
shoulder joint.
- Lesser tubercle: is anterior to the anatomical neck. Subscapularis is attached to the lesser
tubercle.
- Greater tubercle: is situated laterally, it gives attachment for supraspinatus, infraspinatus
and teres minor.
- The intertubercular sulcus (bicipital groove) lies between the tubercles. It contains the
long tendon of biceps. The tendon of latissimus dorsi is attached on this groove.
The rough lateral lip of the groove is marked by the tendon of pectoralis major, its floor
by the tendon of long head biceps brahii and its medial lip by the tendon of teres major.

2. Shaft (humeral diaphysis): The shaft of the humerus is almost cylindrical in its proximal half
but is triangular on section in its distal half, which is compressed in an anteroposterior
direction. It has three surfaces and three borders:
- Anterior border: the anterior border starts on the front of the greater tubercle and runs
downwards almost to the lower end of the bone. Its proximal third forms the lateral lip of
the intertuberculous sulcus.
- Lateral border: its middle is marked by a V-shaped roughened area, the deltoid tubercle.
The limbs of the V are broad: the groove for the radial nerve runs downwards
behind the posterior limb and fades away on the lower part of the surface. At the lower
end of the bone, the lateral border forms the lateral supracondylar ridge
- Medial border: In the proximal third the medial border it forms the medial lip of the
intertubercular sulcus. In its middle third, the border is interrupted by the radial groove
(for radial nerve and profound brachial artery), which crosses the bone obliquely, passing
downwards and forwards from its posterior to its anterior surface.in the lower half of the
shaft; after that, the medial border becomes the medial supracondylar ridge
- The anterolateral surface is bounded by the anterior and lateral borders, and it’s covered
by deltoid which insert into the deltoid tubercle. Further distally the surface gives origin
to the lateral fibres of brachialis and brahioradialis.
- The anteromedial surface is bounded by the anterior and medial borders.
Coracobrachialis and brachialis are attached on this surface. A hook-shaped
process of bone, the supracondylar process, projects from the anteromedial surface of the
shaft above the medial epicondyle.
- The posterior surface, between the medial and lateral borders, is the most extensive
surface and is occupied mostly by the medial head of triceps (the medial part of the
posterior surface). A ridge descends obliquely and laterally across its proximal third, and
gives attachment to the lateral head of triceps. Above triceps, the axillary nerve and the
posterior circumflex humeral vessels wind round this aspect of the bone under cover of
deltoid. Below and medial to the attachment of the lateral head of triceps, a shallow

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 groove which contains the radial nerve and the profunda brachii vessels, runs downwards
and laterally to gain the anterolateral surface of the shaft.

3. Distal end (lower humeral epiphysis): The distal end of the humerus is a modified condyle: it
is wider transversely and has articular and non-articular parts. The articular part is curved
forwards, It articulates with the radius and the ulna at the elbow joint, and is divided by a
faint groove into a lateral capitulum, and a medial trochlea:
- The capitulum is a rounded, convex projection, considerably less than half a sphere, which
covers the anterior and inferior surfaces of the lateral part of the condyle of the humerus. It
articulates with the discoid head of the radius, which lies in contact with its inferior surface in
full extension of the elbow but slides onto its anterior surface during flexion.
- The trochlea is asymmetric, a pulley-shaped surface that covers the anterior, inferior and
posterior surfaces of the condyle of the humerus medially. It articulates with the trochlear
notch of the ulna. On its lateral side it is separated from the capitulum by a faint groove.

The non-articular part of the condyle includes the medial and lateral epicondyles,
olecranon and coronoid and radial fossae.
- Medial epicondyle: is a projection on the medial side of the condyle. Its posterior surface is
smooth and is crossed by the ulnar nerve, which lies in a superficial sulcus as it enters the
forearm. In this situation the nerve can be felt and rolled against the bone, and if it is hit,
characteristic tingling sensations result. The anterior surface of the medial epicondyle is
marked by the attachment of the superficial group of forearm flexors.
- Lateral epicondyle: the lateral border of the humerus terminates at the lateral epicondyle,
and its lower portion constitutes the lateral supracondylar ridge. The lateral and anterior
surfaces of lateral epicondyle gives attachment for the superficial group of the extensor
muscles of the forearm, the posterior surface gives origin to anconeus.
- Olecranon, coronoid and radial fossae: The olecranon fossa is a deep hollow on the posterior
surface of the condyle, immediately above the trochlea, that lodges the tip of the olecranon of
the ulna when the elbow is extended. A similar but smaller hollow lies immediately above the
trochlea on the anterior surface of the condyle and is termed the coronoid fossa. It
accommodates the anterior margin of the coronoid process of the ulna during flexion of the
elbow. A very slight depression lies above the capitulum on the lateral side of the coronoid
fossa. It is termed the radial fossa, since it is related to the margin of the head of the radius in
full flexion of the elbow.

FOREARM- RADIUS, ULNA

Radius: The radius is the lateral bone of the forearm:
1. Proximal end: The proximal end includes a head, neck and tuberosity. The head is discoid,
its proximal surface like a shallow cup for the humeral capitulum. The neck is the constriction
distal to the head. The tuberosity is distal to the medial part of the neck.
2. Shaft: The shaft has a lateral convexity, and is triangular in section having anterior, posterior
and interosseous borders, anterior, lateral and posterior surfaces. The interosseous membrane
is attached to the shaft, and connects the radius to the ulna.
3. Distal end: The distal end of the radius is the widest part. The lateral surface is slightly rough,
projecting distally as a styloid process. The smooth carpal articular surface is divided by
a ridge into medial and lateral areas. The anterior surface is a thick, prominent ridge, 2 cm
proximal to the thenar eminence. On the medial surface is the ulnar notch, which is smooth
and anteroposteriorly concave for articulation with the head of the ulna. The posterior surface
displays a palpable dorsal tubercle.

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 Ulna: The ulna is medial to the radius in the supinated forearm. Its proximal end is a massive
hook which is concave forwards. The lateral border of the shaft is a sharp interosseous crest. The
bone diminishes progressively from its proximal mass throughout almost its whole length, but at
its distal end expands into a small rounded head and styloid process.
1. Proximal end: The proximal end has large olecranon and coronoid processes and trochlear
and radial notches which articulate with the humerus and radius.
The olecranon is a projection which enters the humeral olecranon fossa in extension.
Its posterior surface is smooth, triangular and subcutaneous. Its anterior, articular surface
forms the proximal area of the trochlear notch
The coronoid process projects anteriorly distal to the olecranon. Its proximal aspect
forms the distal part of the trochlear notch. On the lateral surface, distal to the
trochlear notch, there is a radial notch which articulates with the radial head. The anterior
surface of the coronoid is triangular. Its distal part is the tuberosity of the ulna.
The trochlear notch articulates with the trochlea of the humerus. It is constricted at
the junction of the olecranon and coronoid processes
2. Shaft: The shaft is triangular in section in its proximal three-fourths, but distally is almost
cylindrical. It has anterior, posterior and medial surfaces and interosseous, posterior and
anterior borders. The interosseous border is a lateral crest in its middle two-fourths.
3. Distal end: has a head and styloid process. The head’s lateral convex articular surface fits the
radial ulnar notch. Its smooth distal surface is separated from the carpus by an articular disc.
The styloid process, a short, posterolateral projection of the distal end of the ulna, is palpable
about 1 cm proximal to the plane of the radial styloid. A posterior vertical groove is
present between the head and styloid process, for the tendon of extensor carpi ulnaris.

WRIST AND HAND

The skeleton of the hand consists of the carpus, metacarpus and the phalanges.
proximal = superior and distal = inferior
palmar = anterior and dorsal= posterior

Carpal bones:
The carpus contains eight bones: four each in proximal and distal rows. In radial (lateral) to
ulnar (medial) order:
-proximal row: the scaphoid, lunate, triquetrum and pisiform;
-distal row: trapezium, trapezoid, capitate and hamate.
The pisiform articulates with the palmar surface of the triquetrum, and is thus separated from the
other carpal bones, all of which articulate with their neighbours.
Metacarpals:
The metacarpus consists of five metacarpal bones, conventionally numbered in radio-ulnar
order. These are miniature long bones, with a distal head, shaft and proximal base. The rounded heads
articulate with the proximal phalanges. The metacarpal bases articulate with the distal carpal row and
with each other, except the first and second metacarpals.

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Phalanges:
There are 14 phalanges, three in each finger (proximal, middle and distal phalanges), two in
the thumb (proximal and distal phalanges). Each has a head, shaft and proximal base. The bases of the
proximal phalanges articulates with the metacarpal heads. The heads of the distal phalanges are non-
articular and carry a rough, crescentic palmar tuberosity to which the pulps of the fingertips are
attached.