Arm

Elbow joint

Forearm

Hand

Ulna

Radius

Humerus

Scapula

Clavicle

Phalanges

Carpals

Shouldergirdle

Metacarpals

Scapularspine

Humerus

Ulna

Radius

4th proximal phalanx

4th middle phalanx

4th distal phalanx

1st metacarpal

Shoulder joint

Acromio-clavicular joint

Scapula

Clavicle

Olecranon

Head of radius

Carpal bones

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bBones of the Upper Limb

Fig. 21.1 Skeleton of the upper limbRight limb. The upper limb is subdivided into three regions: arm, forearm, and hand. The shoulder girdle (clavicle and scapula) joins the upper limb to the thorax at the sternoclavicular joint.

A Anterior view. B Posterior view.

Clinical

Greenstick fractureIt is a fracture in a young, soft bone in which the bone bends and partially breaks, due to to the thick fibrous periosteum of the immature bone. It usually occurs during infancy and childhood when bones are soft. In some cases, it is difficult to diagnose because of no pain and swelling.

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Coracoid process

Clavicle

Medial epicondyle

Greater and lessertubercles

Acromion

Metacarpo-phalangeal joints

Inter-phalangeal

joints

Hook of hamate

Pisiform bone

Lateralepicondyle

Tubercle ofscaphoid

Tubercle oftrapezium

Inferiorangle

Scapular spine

Greater tubercle

Acromion

Superior angle

Triquetrum bone

Styloid process of radius

Head of radiusOlecranon

Metacarpals

Capitate bone

Styloid processof ulna

Phalanges

Shaftof ulna

Pisiform

Flexor retinaculum(roof of carpal tunnel)

Median n.

Palmaraponeurosis (cut)

Ulnar tunnel(with ulnar a. and n.)

Palmarcarpal lig.

DIP jointcrease

PIP jointcrease

MCP jointcrease

IP jointcrease

MCP jointcrease

Thenareminence

Thenarcrease

(“life line”)

Proximal wristcrease

Distal wrist crease

Hypothenareminence

Middle crease

Proximal trans-verse crease

Distal transversecrease

20 Surface Anatomy

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Fig. 20.3 Palpable bony prominencesof the upper limbExcept for the lunate and trapezoid bones, all of the bones in the upper limb are palpable to some degree through the skin and soft tissues.

Fig. 20.4 Surface anatomy of the wrist and handDIP, distal interphalangeal; IP, interphalangeal;MCP, metacarpophalangeal;PIP, proximal interphalangeal.

A Right limb, anterior view.

B Right limb, posterior view.

A Left palm and wrist. B Palm and wrist showingthe carpal and ulnar tunnels.

Clinical

Leprosy (Hansen disease)Leprosy or Hansen disease is a chronic infection caused by the bacterium Mycobacterium leprae. It is primarily a granulomatous disease of peripheral nerves and mucosa of upper respiratory tract. Skin lesions are primary external signs. If left untreated, leprosy can cause progressive and permanent damage to the skin, limbs, and eyes.

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