6a. The Bones of the Upper Extremity. 1. The Clavicle

(Ossa Extremitatis Superioris) & (Clavicula; Collar Bone)

The clavicle (Figs. 200, 201) forms the anterior portion of the shoulder girdle. It is a long bone, curved somewhat like the italic letter f, and placed nearly horizontally at the upper and anterior part of the thorax, immediately above the first rib. It articulates medially with the manubrium sterni, and laterally with the acromion of the scapula. 52 It presents a double curvature, the convexity being directed forward at the sternal end, and the concavity at the scapular end. Its lateral third is flattened from above downward, while its medial two-thirds is of a rounded or prismatic form. 1 Lateral Third.—The lateral third has two surfaces, an upper and a lower; and two borders, an anterior and a posterior. 2 Surface.—The upper surface is flat, rough, and marked by impressions for the attachments of the Deltoideus in front, and the Trapezius behind; between these impressions a small portion of the bone is subcutaneous. The under surface is flat. At its posterior border, near the point where the prismatic joins with the flattened portion, is a rough eminence, the coracoid tuberosity (conoid tubercle); this, in the natural position of the bone, surmounts the coracoid process of the scapula, and gives attachment to the conoid ligament. From this tuberosity an oblique ridge, the oblique or trapezoid ridge, runs forward and lateralward, and afford attachment to the trapezoid ligament. 3 Borders.—The anterior border is concave, thin, and rough, and gives attachment to the Deltoideus. The posterior border is convex, rough, thicker than the anterior, and gives attachment to the Trapezius. 4 Medial Two-thirds.—The medial two-thirds constitute the prismatic portion of the bone, which is curved so as to be convex in front, concave behind, and is marked by three borders, separating three surfaces. 5

FIG. 200– Left clavicle. Superior surface. (See enlarged image) Borders.—The anterior border is continuous with the anterior margin of the flat portion. Its lateral part is smooth, and corresponds to the interval between the attachments of the Pectoralis major and Deltoideus; its medial part forms the lower boundary of an elliptical surface for the attachment of the clavicular portion of the Pectoralis major, and approaches the posterior border of the bone. The superior border is continuous with the posterior margin of the flat portion, and separates the anterior from the posterior surface. Smooth and rounded laterally, it becomes rough toward the medial third for the attachment of the Sternocleidomastoideus, and ends at the upper angle of the sternal extremity. The posterior or subclavian border separates the posterior from the inferior surface, and extends from the coracoid tuberosity to the costal tuberosity; it forms the posterior boundary of the groove for the Subclavius, and gives attachment to a layer of cervical fascia which envelops the Omohyoideus. 6

FIG. 201– Left clavicle. Inferior surface. (See enlarged image) Surfaces.—The anterior surface is included between the superior and anterior borders. Its lateral part looks upward, and is continuous with the superior surface of the flattened portion; it is smooth, convex, and nearly subcutaneous, being covered only by the Platysma. Medially it is divided by a narrow subcutaneous area into two parts: a lower, elliptical in form, and directed forward, for the attachment of the Pectoralis major; and an upper for the attachment of the Sternocleidomastoideus. The posterior or cervical surface is smooth, and looks backward toward the root of the neck. It is limited, above, by the superior border; below, by the subclavian border; medially, by the margin of the sternal extremity; and laterally, by the coracoid tuberosity. It is concave medio-laterally, and is in relation, by its lower part, with the transverse scapular vessels. This surface, at the junction of the curves of the bone, is also in relation with the brachial plexus of nerves and the subclavian vessels. It gives attachment, near the sternal extremity, to part of the Sternohyoideus; and presents, near the middle, an oblique foramen directed lateralward, which transmits the chief nutrient artery of the bone. Sometimes there are two foramina on the posterior surface, or one on the posterior and another on the inferior surface. The inferior or subclavian surface is bounded, in front, by the anterior border; behind, by the subclavian border. It is narrowed medially, but gradually increases in width laterally, and is continuous with the under surface of the flat portion. On its medial part is a broad rough surface, the costal tuberosity (rhomboid impression), rather more than 2 cm. in length, for the attachment of the costoclavicular ligament. The rest of this surface is occupied by a groove, which gives attachment to the Subclavius; the coracoclavicular fascia, which splits to enclose the muscle, is attached to the margins of the groove. Not infrequently this groove is subdivided longitudinally by a line which gives attachment to the intermuscular septum of the Subclavius. 7 The Sternal Extremity (extremitas sternalis; internal extremity).—The sternal extremity of the clavicle is triangular in form, directed medialward, and a little downward and forward; it presents an articular facet, concave from before backward, convex from above downward, which articulates with the manubrium sterni through the intervention of an articular disk. The lower part of the facet is continued on to the inferior surface of the bone as a small semi-oval area for articulation with the cartilage of the first rib. The circumference of the articular surface is rough, for the attachment of numerous ligaments; the upper angle gives attachment to the articular disk. 8 The Acromial Extremity (extremitas acromialis; outer extremity).—The acromial extremity presents a small, flattened, oval surface directed obliquely downward, for articulation with the acromion of the scapula. The circumference of the articular facet is rough, especially above, for the attachment of the acromioclavicular ligaments. 9 In the female, the clavicle is generally shorter, thinner, less curved, and smoother than in the male. In those persons who perform considerable manual labor it becomes thicker and more curved, and its ridges for muscular attachment are prominently marked. 10

Structure.—The clavicle consists of cancellous tissue, enveloped by a compact layer, which is much thicker in the intermediate part than at the extremities of the bone. 11 Ossification.—The clavicle begins to ossify before any other bone in the body; it is ossified from three centers—viz., two primary centers, a medial and a lateral, for the body, 53 which appear during the fifth or sixth week of fetal life; and a secondary center for the sternal end, which appears about the eighteenth or twentieth year, and unites with the rest of the bone about the twenty-fifth year. 12

Contents -SUBJECT INDEX -BIBLIOGRAPHIC RECORD -ILLUSTRATION INDEX