Overview
The
humerus is the only bone of the upper arm, and has a large number of muscular,
ligamentous and bony articulations. It forms a proximal joint with the scapula,
and a distal joint with the radius and ulna. As well as forming the bony
foundation for the muscles to attach to, the nerve also shares a close
anatomical relationship with the nerves of the upper limb, and the vessels.
Gross Anatomy
The humerus is the bone of the arm
and is a part of the appendicular skeleton. It is long and straight, with the head at the proximal end and
articulating surfaces at its distal end. The head projects superomedially with
respect to the shaft, and is supplied by the anterior and posterior humeral circumflex
arteries. These arteries arise from the third part of the axillary artery, and
penetrate the joint capsule. The superior, middle and inferior glenohumeral
ligaments thicken and support the joint capsule. They
provide resistance to translation of the humerus. The coracohumeral ligament limits posterior
translation of the flexed, adducted and internally rotated shoulder.
The
anatomical neck lies directly below the humeral head. The surgical neck lies at
the proximal part of the superior shaft. There are two tubercles that arise
from its anterolateral surface i.e. the greater and lesser. The lesser is the site of attachment of the infraspinatus and teres minor, and the greater tochanter allows
for the attachment of the subscapularis. Between these two tubercles is the
intertubercular sulcus, in which the tendon of the long head of biceps brachii
lies. This originates from the supraglenoid tubercle and runs in the intertubercular
sulcus. The pectoralis major, teres major and latissimus dorsi also insert on the intertubercular groove of the humerus. The pectoralis
muscle inserts on the lateral lip, the teres major inserts on the medial lip, and the latissimus
dorsi attaches in between. "A lady between two majors!"
The shaft
of the humerus has a spiral grove, in which the radial nerve and profunda
brachii artery run. The distal end of the humerus expands into two condyles with associated articulating surfaces. Just superior to these surfaces are the medial and
lateral epicondyles. The ulnar nerve runs behind the medial epicondyle, and the radial
nerve runs behind the lateral epicondyle. Above these articulating surfaces are the
medial and lateral epicondylar ridges that form the common flexor and common
extensor origins respectively. The capitulum is located laterally articulates with the head of the radius. The trochlea (named as it resembles a pulley shape)
articulates with the ulna. It is at the humeroulnar joint that flexion
and extension of the elbow occur. The humeroradial joint is mainly supportive. The
elbow joint complex is supported by the ulnar collateral (lateral epicondyle to
the supinator crest if the ulna) and radial collateral (lateral epicondyle to
the annular ligament) ligaments.