Hyland Scott, Charlick Matthew, Varacallo Matthew A.
Edward Via College of OM - Virginia
Michigan State University College of Osteopathic Medicine
The clavicle is a sigmoid-shaped long bone with a convex surface along its medial end when observed from cephalad position. It serves as a connection between the axial and appendicular skeleton in conjunction with the scapula, and each of these structures forms the pectoral girdle. Though not as large as other supporting structures in the body, clavicular attachments allow for significant function and range of motion of the upper extremity as well as protection of neurovascular structures posteriorly. Each part of this long bone has a purpose in regards to its attachments that affects the overall physiology of the pectoral girdle. Medially, the clavicle articulates with the manubrial portion of the sternum, forming the sternoclavicular joint (SC joint). This joint, surrounded by a fibrous capsule, contains an intra-articular disc in between the clavicle and the sternum. Superiorly, the interclavicular ligament connects the ipsilateral and contralateral clavicle, together providing further stability. Laterally, the clavicle articulates with the acromion, forming the acromioclavicular ligament (AC joint). The surrounding area provides an attachment for the joint capsule of the shoulder. This joint, like the SC joint, is also lined by fibrocartilage and contains an intra-articular disc. The three main ligaments to support this joint are the AC ligament, the coracoclavicular ligament (CC), and the coracoacromial ligament (CA). The actual shaft of the clavicle is clinically divided into two parts clinically: medial two-thirds and lateral third. These locations are used to properly identify where muscles are attached. The medial two-thirds has an attachment site for the sternocleidomastoid (SCM) muscle and subclavius muscle along the subclavian groove superiorly and inferiorly, respectively. The anterior surface is an attachment for the pectoralis major and the posterior for the sternohyoid muscle. The costal tuberosity, which is where the costoclavicular ligament inserts and supports the SC joint, is also found on the inferior surface. The lateral third of the clavicle serves as attachments for the deltoid and trapezius muscles anteriorly and posteriorly, respectively. Inferiorly the conoid and trapezoid components of the CC ligament provide stability between the clavicle and the coracoid process of the scapula. The clavicle happens to be one of the most commonly fractured bones in the human body; fracture can be as a result of direct contact or force transmission from falling onto an outstretched hand. Depending on the level of displacement of the fracture, surgery may be indicated, and proper management is determined on an individual basis due to differentiating factors surrounding such injury.
锁骨是一根呈S形的长骨，从头部位置观察时，其内侧端表面呈凸形。它与肩胛骨一起作为轴向骨骼和附属骨骼之间的连接结构，这些结构共同构成了胸带。虽然锁骨不如身体中的其他支撑结构大，但它的附着点使上肢具有重要功能和较大的活动范围，同时还能对后方的神经血管结构起到保护作用。这根长骨的每个部分对于其附着点都有特定作用，进而影响胸带的整体生理功能。在内侧，锁骨与胸骨的柄状部分相连，形成胸锁关节（SC关节）。该关节被纤维囊包裹，在锁骨和胸骨之间有一个关节内盘。在上方，锁骨间韧带连接同侧和对侧锁骨，进一步增强稳定性。在外侧，锁骨与肩峰相连，形成肩锁关节（AC关节）。其周围区域为肩关节囊提供附着点。这个关节和SC关节一样，也衬有纤维软骨并含有一个关节内盘。支撑该关节的三条主要韧带分别是AC韧带、喙锁韧带（CC）和喙肩韧带（CA）。锁骨的骨干在临床上分为两部分：内侧三分之二和外侧三分之一。这些位置用于准确确定肌肉的附着点。内侧三分之二在锁骨下沟的上方和下方分别有胸锁乳突肌（SCM）和锁骨下肌的附着点。其前表面是胸大肌的附着点，后表面是胸骨舌骨肌的附着点。在其下表面还可找到肋结节，肋锁韧带附着于此并支撑SC关节。锁骨外侧三分之一分别是三角肌和斜方肌的附着点。在下方，CC韧带的圆锥部和梯形部为锁骨和肩胛骨的喙突之间提供稳定性。锁骨恰好是人体中最常发生骨折的骨头之一；骨折可能是由于直接接触或因摔倒时手掌伸展着地导致的力传递引起的。根据骨折的移位程度，可能需要进行手术，由于此类损伤存在不同的影响因素，具体治疗方案需因人而异。
