The upper limb is designed for mobility, reach, manipulation and communication. Its bones form a light but strong framework that positions the hand in space while transferring forces to the axial skeleton through the shoulder girdle. This page follows the limb from proximal to distal: shoulder girdle, humerus, forearm and hand.
Add your labelled upper-limb bones image here.
Why physiotherapy students must know the bones
Bone landmarks guide palpation, joint-axis alignment, muscle attachment, fracture precautions, range-of-motion measurement, movement analysis and safe manual handling. A physiotherapist must know not only a bone’s name but also its orientation, articulations, load-bearing surfaces, neurovascular relationships and common injury sites.
Learning outcomes
- List the bones of the pectoral girdle, arm, forearm and hand.
- Orient the clavicle, scapula, humerus, radius and ulna using reliable landmarks.
- Identify the major surfaces, borders, processes, fossae, tubercles and articular areas.
- Relate bony attachments to movement, stability and common injuries.
- Use bony landmarks for examination, measurement, exercise and patient education.
1. General organisation
Each upper limb has 30 bones distal to the shoulder girdle: one humerus, two forearm bones, eight carpals, five metacarpals and fourteen phalanges. The pectoral girdle adds a clavicle and scapula. The arm is the region between shoulder and elbow; the forearm lies between elbow and wrist; the hand is distal to the wrist.
| Region | Bones | Main functional idea |
|---|---|---|
| Shoulder girdle | Clavicle and scapula | Connects the limb to the axial skeleton and positions the glenoid cavity. |
| Arm | Humerus | Single long-bone lever between shoulder and elbow. |
| Forearm | Radius and ulna | Supports the elbow/wrist and permits pronation–supination. |
| Hand | Carpals, metacarpals and phalanges | Combines stability, sensation, grasp and fine manipulation. |
2. Clavicle
The clavicle is an S-shaped, subcutaneous strut between the manubrium and scapula. It holds the shoulder laterally away from the thorax, transmits forces from the limb to the trunk and protects the neurovascular bundle at the root of the neck.
2.1 Parts and orientation
- Sternal (medial) end: bulky and quadrangular; articulates with the clavicular notch of the manubrium and first costal cartilage at the sternoclavicular joint.
- Acromial (lateral) end: flatter; articulates with the acromion at the acromioclavicular joint.
- Body: medial two-thirds convex anteriorly and lateral third concave anteriorly.
- Inferior surface: has the conoid tubercle and trapezoid line for the coracoclavicular ligament, subclavian groove for subclavius and impression for the costoclavicular ligament.
2.2 Attachments and clinical relevance
| Attachment/feature | Significance |
|---|---|
| Sternocleidomastoid | Attaches near the medial clavicle; assists neck and shoulder positioning. |
| Pectoralis major | Attaches to the anterior medial clavicle; contributes to flexion, adduction and internal rotation of the arm. |
| Deltoid and trapezius | Attach along the lateral clavicle; coordinate elevation and scapular control. |
| Subclavius | Attaches to the inferior groove; helps stabilise the clavicle. |
| Coracoclavicular and acromioclavicular ligaments | Maintain scapular suspension and transfer load across the shoulder girdle. |
The middle third is a common fracture site because it is relatively unsupported and exposed. Assess deformity, skin tension, neurovascular status and shoulder function; do not force movement when fracture is suspected.
3. Scapula
The scapula is a flat, triangular bone on the posterolateral thorax, gliding over ribs two to seven. It provides a mobile base for the arm and numerous muscle attachments. The scapula is not directly joined to the thorax by a true synovial joint; the scapulothoracic interface depends on muscles, fascia and the thoracic contour.
3.1 Surfaces, borders and angles
- Costal/anterior surface: contains the broad subscapular fossa and ridges for subscapularis.
- Dorsal/posterior surface: divided by the spine into the supraspinous and infraspinous fossae.
- Superior border: contains the suprascapular notch, converted into a foramen by the superior transverse scapular ligament.
- Medial (vertebral) border: runs beside the spine and provides attachments for rhomboids, serratus anterior and parts of levator scapulae.
- Lateral (axillary) border: thickened near the glenoid and gives attachment to teres major/minor.
- Superior, inferior and lateral angles: the inferior angle moves around the thorax; the lateral angle carries the glenoid cavity.
3.2 Processes and glenoid region
| Structure | Description and importance |
|---|---|
| Spine of scapula | Prominent posterior ridge ending laterally as the acromion; separates supra- and infraspinous fossae. |
| Acromion | Overhangs the shoulder joint and articulates with the clavicle; attachment for deltoid and trapezius. |
| Coracoid process | Hook-like anterior projection; attachment for pectoralis minor, coracobrachialis, short head of biceps and coracoclavicular ligaments. |
| Glenoid cavity | Shallow, pear-shaped articular surface for the humeral head; deepened by the glenoid labrum. |
| Supraglenoid and infraglenoid tubercles | Origins for long heads of biceps and triceps respectively. |
| Scapular notch | Route for the suprascapular nerve; compression may weaken supraspinatus and infraspinatus. |
Scapular movement includes elevation, depression, protraction, retraction, upward rotation, downward rotation, anterior tilt and posterior tilt. Normal upward rotation requires coordinated trapezius and serratus anterior activity.
4. Humerus
The humerus is the long bone of the arm. Its proximal end participates in the glenohumeral joint; its distal end forms the elbow complex. The shaft is rounded proximally and more triangular distally.
4.1 Proximal humerus
- Head: smooth, spherical surface facing medially, superiorly and slightly posteriorly; articulates with the glenoid cavity.
- Anatomical neck: groove around the head where the capsule attaches.
- Greater tubercle: lateral projection for supraspinatus, infraspinatus and teres minor.
- Lesser tubercle: anterior projection for subscapularis.
- Intertubercular sulcus: contains the tendon of the long head of biceps; lips give attachment to pectoralis major, teres major and latissimus dorsi.
- Surgical neck: common fracture area close to the axillary nerve and posterior circumflex humeral vessels.
4.2 Shaft and distal humerus
| Feature | Attachment/relationship | Clinical point |
|---|---|---|
| Deltoid tuberosity | Insertion of deltoid. | Forceful deltoid contraction and fractures may affect the radial nerve below. |
| Radial groove | Radial nerve and profunda brachii artery pass posteriorly. | Mid-shaft fractures can produce wrist/finger extension weakness. |
| Medial/lateral supracondylar ridges | Attachments for brachialis region and forearm muscle origins. | Distal fractures may threaten brachial artery or median nerve. |
| Capitulum | Articulates with the head of the radius. | Participates in flexion/extension and forearm rotation. |
| Trochlea | Spool-shaped surface for the ulna. | Forms the main humeroulnar hinge. |
| Medial/lateral epicondyles | Common flexor and extensor origins; collateral ligament attachments. | Palpable landmarks in elbow pain and alignment. |
| Radial, coronoid and olecranon fossae | Receive forearm structures during elbow movement. | Permit flexion and extension without bony impingement. |
5. Radius and ulna
The radius lies laterally in anatomical position on the thumb side; the ulna lies medially on the little-finger side. They articulate with each other at proximal and distal radioulnar joints and are linked by the interosseous membrane.
5.1 Ulna
- Olecranon: posterior projection forming the point of the elbow and receiving triceps insertion.
- Coronoid process and trochlear notch: embrace the trochlea during elbow flexion/extension.
- Radial notch: articulates with the radial head.
- Ulnar tuberosity: insertion for brachialis.
- Ulnar shaft and head: the distal ulna is smaller; the head articulates with the radius but is separated from the carpus by an articular disc.
- Styloid process: distal palpable projection and attachment for wrist ligaments.
5.2 Radius
- Head: disc-shaped; articulates with the capitulum and radial notch of the ulna.
- Neck and radial tuberosity: biceps inserts on the tuberosity, producing flexion and supination.
- Interosseous border: attachment for the interosseous membrane.
- Distal end: broad, articulates mainly with scaphoid and lunate; has a radial styloid process and ulnar notch.
- Dorsal tubercle of Lister: pulley-like landmark guiding the extensor pollicis longus tendon.
During pronation, the radius crosses over the ulna; during supination, the bones are parallel. The interosseous membrane transfers load and provides muscle attachment while allowing rotation.
6. Bones of the hand
6.1 Carpal bones
Eight carpals are arranged in two rows. From lateral (thumb) to medial in the proximal row: scaphoid, lunate, triquetrum, pisiform. In the distal row: trapezium, trapezoid, capitate, hamate. The scaphoid is the main bridge between rows and is vulnerable to fracture; the hook of hamate and pisiform are palpable landmarks.
| Carpal feature | Clinical/functional importance |
|---|---|
| Scaphoid | Articulates with radius; waist fractures risk impaired blood supply and non-union. |
| Lunate | Central proximal carpal; participates in radiocarpal motion and may dislocate volarly. |
| Triquetrum/pisiform | Ulnar-side landmarks; pisiform is a sesamoid within flexor carpi ulnaris. |
| Trapezium | Saddle joint with first metacarpal enables thumb opposition. |
| Capitate | Largest carpal and central support of the distal row. |
| Hamate | Hook forms part of the carpal tunnel/Guyon canal boundaries. |
6.2 Metacarpals and phalanges
- Five metacarpals are numbered from thumb to little finger; each has a base, shaft, neck and head.
- Metacarpal heads form the knuckles and articulate with proximal phalanges.
- The thumb has two phalanges; each other digit has proximal, middle and distal phalanges.
- Distal phalanges support the nail beds and fingertip pulp, which are important for precision pinch and sensation.
- Sesamoid bones commonly occur near the thumb metacarpophalangeal joint and improve tendon mechanics.
7. Bony relationships and movement
| Movement goal | Bony contributors | Physiotherapy emphasis |
|---|---|---|
| Reach overhead | Clavicle elevation/posterior rotation, scapular upward rotation, humeral elevation and thoracic extension. | Assess the whole shoulder complex, not glenohumeral motion alone. |
| Push from a chair | Scapular protraction, elbow extension, wrist stability and hand contact. | Protect painful wrists, elbows and shoulders; train closed-chain control. |
| Grip a cup | Carpal stability, metacarpal alignment, finger flexion and thumb opposition. | Assess strength, sensation, joint range and object size. |
| Pronate/supinate | Radial head rotation, distal radioulnar movement and interosseous membrane. | Check elbow position and avoid substituting shoulder movement. |
8. Common injuries and precautions
- Clavicle fracture: protect the shoulder, monitor neurovascular status and progress movement only as prescribed.
- Proximal humeral fracture/dislocation: protect the axillary nerve and surgical repair; avoid unapproved loading or external rotation.
- Humeral shaft fracture: assess radial-nerve function and wrist/finger extension.
- Supracondylar/distal humeral injury: urgent attention to brachial artery, median nerve and compartment signs.
- Radial-head or olecranon injury: respect elbow stability and forearm rotation restrictions.
- Scaphoid fracture: anatomical snuffbox tenderness requires medical assessment even if radiographs are initially negative.
- Metacarpal/phalangeal fractures: protect alignment, tendon glide, oedema and functional hand use.
9. Practical learning activities
- Handle a model or skeleton and orient the clavicle, scapula, humerus, radius and ulna.
- Palpate the acromion, coracoid, spine of scapula, epicondyles, olecranon, radial/ulnar styloids, metacarpal heads and phalanges on a consenting partner.
- Draw the carpal rows from lateral to medial and identify the thumb-side and little-finger-side relationships.
- Demonstrate pronation and supination with the elbow by the side to show radius crossing and uncrossing the ulna.
- Match common fracture sites with nearby nerves or vessels that require monitoring.
10. Examination points and revision questions
High-yield points
- Each upper limb contains 30 bones distal to the shoulder girdle.
- The clavicle is a strut; the scapula is a mobile muscle-controlled base; the glenoid is shallow to permit mobility.
- The humeral surgical neck is close to the axillary nerve; the shaft’s radial groove is close to the radial nerve.
- The radius is lateral in anatomical position and crosses the ulna in pronation.
- The thumb’s trapezium–first metacarpal saddle joint enables opposition.
- List the bones of the upper limb from proximal to distal.
- Describe the surfaces, borders, processes and articulations of the scapula.
- Compare the proximal and distal features of the humerus.
- Explain the functional difference between radius and ulna during pronation and supination.
- Name the carpal bones in proximal and distal rows.
- Relate the surgical neck, radial groove and scaphoid waist to clinical precautions.
- Explain how the bony architecture supports reach, grip and fine manipulation.
References for further study
- OpenStax: Pectoral girdle
- OpenStax: Bones of the upper limb
- OpenStax: Appendicular skeleton context
- SlideShare: Bones of the upper limb
- TeachMeAnatomy: Upper-limb bones
Educational note: Use supervised practical teaching and local fracture/immobilisation protocols when applying this anatomy to patients.