The book providing full explanations of difficult anatomical relationships, and highlighting features of clinical significance throughout, this second edition remains an invaluable guide for students of anatomy across the medical and health sciences, and a handy reference for the busy clinician. | Chapter 4 Upper limb Introduction The upper limb accounts for 5% of the body weight. The movements of the clavicle and scapula, humerus, radius, ulna and wrist have one collective purpose – to put the hand into the desired position for whatever it is required to do. Since the limb is essentially suspended from the trunk of the body mainly by muscles and not by a large joint, it has great freedom of movement. The small sternoclavicular joint is the only bony connection between the upper limb and the axial skeleton (Figs. , , ). All other connections are muscular, mainly pectoralis major anteriorly, serratus anterior laterally and trapezius and latissimus dorsi posteriorly (Figs. , ), accounting for the great mobility of the shoulder girdle compared with the hip girdle (p. 22). Small gliding and rotatory movements take place at the clavicular joints to accompany scapular movements against the chest wall. Shoulder, axilla and arm Bony prominences – the clavicle (Figs. , , ) is palpable throughout its length and can be traced from the sternoclavicular joint to its lateral end, where it makes the acromioclavicular joint with the acromion, which is at the lateral end of the spine of the scapula. The acromion lies at a slightly lower level than the clavicle; on palpation there is a small ‘step down’ from clavicle to acromion. The tip of the coracoid process of the scapula is just deep to the anterior border of the deltoid and can be felt by pressing laterally in the deltopectoral groove (see below) about 1 cm inferior to the clavicle. Sternoclavicular joint – between the bulbous medial end of the clavicle and the manubrium of the sternum, the capsule encloses two joint cavities because a fibrocartilaginous disc separates the two bones. Adjacent to the joint is the costoclavicular ligament, which passes from the first rib and costal cartilage to the inferior surface of the clavicle, and is important as the fulcrum about which movements of .
