Bones of Upper Limb:

[Source : Moore Clinically Oriented Anatomy]

Introduction
Pectoral girdle and bones of the free part of the upper limb- form the superior
appendicular skeleton
Pelvic girdle and bones of the free part of the lower limb form the inferior
appendicular skeleton
Articulation of the superior appendicular skeleton with the axial skeleton : only at the SC
joint (Sternoclavicular), allowing great mobility
Clavicles and scapulae of the pectoral girdle supported, stabilized and moved : by axioappendicular muscles that attach to the relatively fixed ribs, sternum, and vertebrae of
the axial skeleton
Clavicle (Collar Bone) :
-connects the upper limb to the trunk

- the shaft of clavicle has a double curve in a horizontal plane

Functions (Importance) of the clavicle

-serves as a moveable, crane-like strut (rigid support) for
suspension of scapula and the upper limb to keep them away from the trunk so that
the limb has maximum freedom of motion
strut being moveable allows the scapula to move on the thoracic wall at the
scapulothoracic joint (ST joint: physiological joint in which movement occurs betn
musculoskeletal str. rather than anatomical joint betn skeletal str. : joint where scapular
movements: elevation-depression, protraction-retraction, rotation) increasing the range
of motion of the limb
fixing strut in position (esp. after elevation) enables elevation of the ribs for deep
inspiration

-forms one of the bony boundaries of the cervico-axillary canal (passageway between the
neck and arm), affording protection to the NV(neurovascular) bundle supplying the
upper limb
-transmits shocks (traumatic impacts) from upper limb to the axial skeleton
Side determination:
-

A. Superior and inferior surfaces:

Superior surface lies just deep to skin and platysma (G. flat plate) muscle in the
subcutaneous tissue, is smooth
Inferior surface of clavicle- rough because strong ligaments bind it to the 1st rib
near its sternal end and suspend scapula from its acromial end
Structures and landmarks of inferior surface:
-conoid tubercle : near acromial end ; attachment for conoid ligament (medial
part of coracoclavicular ligament) by which remainder of the upper limb is
passively suspended from the clavicle
-trapezoid line : near acromial end of clavicle; attachment for trapezoid
ligament (lateral part of coracoclavicular ligament)
-subclavian groove (groove for the subclavius) in the medial third of the shaft of
the clavicle ; attachment of subclavius muscle
-impression for costoclavicular ligament : more medially , rough and often
depressed oval area ; attachment for ligament binding the 1st rib (L. costa) to
the clavicle , limiting the elevation of shoulder

B. Anterior and Posteior surfaces:

Anteriorly medial 2/3 of clavicle : Convex forward (like a hill medially_)
Anteriorly lateral 1/3 of clavicle : Concave forward
Posteriorly the opposite of the two in terms of curvature (concave and convex
backward respectively)
These curvatures : increase the resilience of the clavicle, gives it an appearance of an
elongated capital S.
-

C. Medial and lateral surfaces :

Sternal end : medial end; enlarged and triangular where it articulates with
the manubrium of the sternum at the SC (sternoclavicular) joint
Acromial end : lateral end; flat where it articulates with the acromion of the
scapula at the AC (acromioclavicular) joint
Synposis :

[Source : Grays Anatomy For Students]

Clavicle:
- as the only bony attachment between trunk and the upper limb
- palpable along the entire length
- has a gentle S-shaped contour , with the forward-facing convex part medial and
the forward-facing concave part lateral
- acromial (lateral) end : flat with a small oval facet on its surface for articulation
with a similar facet on the medial surface of the acromion of the scapula
whereas the sternal (medial) end : more robust and somewhat quadrangular
in shape with a much larger facet for articulation mainly with the manubrium
of the sternum , and to a lesser extent, with the 1st costal cartilage
- Inferior surface of lateral third of clavicle : possess a distinct tuberosity consisting
of a tubercle (the conoid tubercle) and a lateral roughening (the trapezoid line),
for the attachment of the coracoclavicular ligament
- In addition, the surfaces and margins of the clavicle are roughened by the
attachments of muscles that connect the clavicle to the thorax, neck, and upper
limb
- The superior surface is smoother than the inferior surface

Clavicular Attachments
[Source : BD Chaurasias Human Anatomy]

Attachments for muscles:

Origin: Deltoid, Pectoralis major, Sternocleidomastoid , Sternohyoid
Insertion: Trapezius, Subclavius
Attachments for ligaments:
Coracoclavicular ligament : Trapezoid part and Conoid part
Costoclavicular ligament
Description on attachments:
-Lateral end: margin for articulation or attachment with the capsule of AC joint
(joint capsule)
-Medial end: margin for articulation or attachment to :
-fibrous capsule of SC joint all around
-articular disc posterosuperiorly
-intraclavicular ligament superiorly
-Lateral 1/3 of shaft:
-Anterior border : Origin to deltoid (both superiorly and inferiorly)
-Posterior border : Insertion to trapezius (both superiorly and inferiorly)
-Conoid tubercle and trapezoid line for attachments of conoid and trapezoid
parts of the coracoclavicular ligament
-Medial 2/3 of shaft:
-Anterior surface : Origin to pectoralis major
-Half of the rough superior surface : Origin to the clavicular head of
sternocleidomastoid
-Oval impression on the inferior surface medially: attachment of
costoclavicular ligament

-Subclavian groove : Insertion of subclavius muscle and margins of

groove : attachment of clavipectoral fascia
-Posterior surface close to medial end inferiorly : Origin to sternohyoid
-Subclavian vessels and cords of brachial plexus pass towards the axilla
lying between the inferior surface of the clavicle and upper surface of 1st rib : Subclavius
acts as a cushion
Pecularities of Clavicle
-It is the only long bone that lies horizontally
-It is subcutaneous throughout
-It is the first bone to start ossifying
-It is the only long bone that ossifies in membrane
-It is the only long bone which has two primary centres of ossification
-There is no medullary cavity
-It is occasionally pierced by the middle supraclavicular nerve
-It receives weight of upper limb via lateral one-third through coracoclavicular
ligament and transmits weight of the upper limb to the axial skeleton via medial two-third
part
Ossification

-Clavicle: 1st bone in the body to ossify

-It ossifies from two primary centres and one secondary centre except for its
medial end which ossifies in membrane
-The two primary centres appear in the shaft between the fifth and sixth
weeks of intrauterine life , and fuse about the 45th day
-The secondary centre for the medial end appears during 15-17 years, and
fuses with the shaft during 21-22 years
-Occasionally there may be secondary centre for the acromial end
Clinically Applied Anatomy
-A. Clavicle fracture: Through (Cause)-------Indirect violence: Clavicle
commonly fractured by falling on the outstretched hand or Direct violence: Blow on the
clavicle
Common site of fracture: Junction between the two curvatures of the bone,
which is the weakest point

Result of fracture: Shoulder drooping as the lateral fragment is displaced

downwards by the weight of the limb as trapezius muscle alone is unable to support the
weight of upper limb.
-B. Cleidocranial Dysostosis : Clavicles congenitally absent, or imperfectly
developed in a disease --- in this condition, the shoulders droop and can be approximated
in front of the chest using an X-ray

Clavicle (Latin: Small key)

Clinical Relevance: Fracture of the

Clavicle
One of the functions of the clavicle is to transmit forces from the upper limb to the axial
skeleton. This makes it the most commonly fractured bone in the body. Fractures
commonly result from a fall onto the shoulder, or onto an outstretched hand.
The most common point of fracture is the junction of the medial 2/3 and lateral 1/3.
After fracture, the lateral end of the clavicle is displaced inferiorly by the weight of the
arm, and medially, by the pectoralis major. The medial end is pulled superiorly, by
the sternocleidomastoid muscle.
The suprascapular nerves (medial, intermedial and lateral) may be damaged by the
upwards movement of the medial part of the fracture. These nerves innervate the lateral
rotators of the upper limb at the shoulder so damage results in unopposed medial
rotation of the upper limb the waiters tip position

.
The Clavicle
(Ossa Extremitatis Superioris) & (Clavicula; Collar Bone)
---------THE END--------