1

Bones Of The Shoulder Girdle and

Arm
• The shoulder girdle consists of the
clavicle and the scapula, which
articulate with one another at the
acromioclavicular joint.
 The scapula
• This flat triangular bone lies on the posterior thoracic
wall between the 2nd and the 7th ribs and bears three
prominent features:
1- the glenoid fossa laterally (which is the scapula’s
contribution to the shoulder joint).
2- the spine on its posterior aspect, projecting laterally
as the acromion process which articulates with the
clavicle.
3- the coracoid process on its anterior aspect, projects
upward and forward above the glenoid cavity and
provides attachment for muscles and ligaments.
Clinical Notes

• Fractures of the scapula are very rare duo to

its strong muscular coverings, only by direct
and severe violence.
 Clavicle
• It lies horizontally and articulates with the
sternum and 1st costal cartilage medially, and
with the acromion process of the scapula
laterally and, in addition, is attached to the
coracoid process by the tough coracoclavicular
ligament.
• The clavicle is made up of a medial two-thirds
which is circular in section and convex
anteriorly, and a lateral one-third which is
flattened in section and convex posteriorly.
• This long bone has a number of unusual
features.
1- It has no medullary cavity.
2- It is the first to ossify in the fetus (5th–6th
week).
3- Although a long bone, it develops in membrane
and not in cartilage.
4- It is the most commonly fractured long bone in
the body.
• The third parts of the subclavian vessels
and the trunks of the brachial plexus pass
behind the medial third of the shaft of the
clavicle, separated only by the thin
subclavius muscle.
• The sternal end of the clavicle has
important posterior relations; behind the
sternoclavicular joints lie the common
carotid artery on the left and the
bifurcation of the brachiocephalic artery
on the right.
• The internal jugular vein lies a little more
laterally on either side.
• These vessels are separated from bone by
the strap muscles—the sternohyoid and
sternothyroid.
 Clinical features
• The clavicle has three functions:
1- to transmit forces from the upper limb to the
axial skeleton.
2- to act as a strut holding the arm free from
the trunk, to hang supported principally by
trapezius.
3- to provide attachment for muscles.
 The humerus
• The upper end of the humerus consists of a
head (one-third of a sphere) facing medially,
upwards and backwards, separated from the
greater and lesser tubercles by the anatomical
neck.
• The tubercles, in turn, are separated by the
bicipital groove along which emerges the long
head of biceps from the shoulder joint.
• Where the upper end and the shaft of the
humerus meet there is the narrow surgical
neck against which lie the axillary nerve
and circumflex humeral vessels.
• The shaft itself is circular in section above
and flattened in its lower part.
• The posterior aspect of the shaft bears the
faint spiral groove, demarcating the origins
of the medial and lateral heads of the
triceps between which wind the radial
nerve and the profunda vessels.
• The lower end of the humerus bears the
rounded capitulum laterally, for articulation
with the radial head, and the spool-shaped
trochlea medially, articulating with the
trochlear notch of the ulna.
• The medial and lateral epicondyles, on
either side, are extra-capsular; the medial is
the larger of the two, extends more distally
and bears a groove on its posterior aspect
for the ulnar nerve.
• Three important nerves thus come into
close contact with the humerus —the
axillary, the radial and the ulnar.
• They may be damaged, respectively, in
fractures of the humeral neck, midshaft
and lower end.
• Supracondylar fractures are common in
children.
• Injuries to the median, radial, and ulnar
nerves are not uncommon.
• Damage to or pressure on the brachial artery
can occur leading to Volkmann's ischemic
contracture.