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Clavicle

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Structure of the clavicle seen from anterior, inferior and superior views.

The clavicle is an elongated, S-shaped bone that rests horizontally at the sternum across the upper part of the ribcage, and the acromial end of the scapula. This bone is an important part of the skeletal system since it plays an essential role in everyday functional movement, serving as the connection between the axial skeleton and the pectoral girdle.

As a result, the clavicle is able to act as a brace for the shoulder, allowing weight to be transferred from the upper limbs to the axial skeleton. Injuries of the clavicle seriously compromise everyday activities.

Key facts
Landmarks Superior surface: acromial facet
Inferior surface: sternal facet, costal tuberosity, conoid tubercle
Muscles Lateral third: trapezius muscle (posterior surface), deltoid muscle (anterior surface)
Medial third: sternocleidomastoid muscle (superior surface), pectoralis major muscle (anterior surface), subclavian muscle (inferior surface - subclavian groove), sternohyoid (medial end of clavicle)
Joints Acromioclavicular - between acromial head of clavicle and acromion of scapula
- ligament: acromioclavicular ligament
Sternoclavicular - between sternal end of clavicle and manubrium of sternum
- ligaments: sternoclavicular ligaments, anterior and posterior interclavicular ligaments
Clinical relation Fractures

This article will discuss the anatomy of the clavicle.

Contents
  1. Articulations
    1. Acromioclavicular joint
    2. Sternoclavicular joint
  2. Bony landmarks
    1. Extremities
    2. Superior surface
    3. Inferior surface
  3. Muscle attachments
  4. Fractures
  5. Sources
+ Show all

Articulations

Due to the clavicle’s structure, there are only two planar diarthrosis articulations that can be found. This type of articulation is also known as a ‘double plane joint’ – where two joint cavities are separated by a layer of articular cartilage.

Acromioclavicular joint

The first is the acromioclavicular joint, which is formed by the acromial end of the clavicle and the acromion of the scapula respectively. It enables slight gliding movement about the shoulder region. The synovial joint is surrounded by a capsule of articular cartilage filled with intra-articular synovium. 

From infancy, the articular cartilage starts off as hyaline cartilage, but soon develops into fibrocartilage (at the scapula acromion and the clavicle acromial end at ages 17 and 24, respectively).The acromioclavicular ligament forms a strong connection between the clavicle and the scapula acromion, which restricts movement about the clavicle at its acromial end.

Sternoclavicular joint

The other is the sternoclavicular joint, which is formed by the sternal end of the clavicle and the manubrium of the sternum. This synovial joint is important as it anchors the clavicle and scapula to the axial skeleton. However the joint enables a variety of limited movements of the arm, including:

  • protraction and retraction
  • depression and elevation
  • slight rotation

Like the acromioclavicular joint, the sternoclavicular joint is surrounded by an articular cartilage capsule, but with a fibrocartilage articular disk inside that creates a clavicular and a sternal synovial cavity. Sternoclavicular joint ligaments stabilize the joint on its anterior and posterior surfaces. The joint is also reinforced by two accessory ligaments:

  • The anterior interclavicular ligament, which covers the superior surface of the joint. This ligament is responsible for preventing dislocation of the clavicle upon shoulder depression.
  • The posterior costoclavicular ligament, which runs from the clavicle costal tuberosity to the superior and medial surface of the first rib. In contrast, this ligament prevents clavicle dislocation upon shoulder elevation.

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Sternoclavicular joint in a human skeleton. Notice how the medial ends of the clavicles articulate with clavicular fossae of the manubrium of sternum.

Bony landmarks

Extremities

The orientation of the clavicle can be distinguished by its ends: a broad, flat acromial end (referred to as the lateral third); and a round pyramidal-like sternal end (referred to as the medial two-thirds). Each end has unique bony landmarks, depending whether the superior or inferior surface of the bone is viewed.

Superior surface

The superior surface of the clavicle has a smooth appearance. The acromial facet can be seen at the far posterior edge of the acromial end. It appears as a small flattened oval surface and enables the clavicle to articulate about the acromion of the scapula in the acromioclavicular joint.

Inferior surface

In contrast, the inferior surface of the clavicle is quite rough and has many prominent lines, indicating sites where muscle and ligaments may attach to the bone. These landmarks include:

  • The sternal facet, found far at the edge of the sternal end. It is shaped like a triangle, with a posterior tip and an anterior base, and forms the sternoclavicular joint. 
  • The costal tuberosity, located at the sternal end of the bone. It is distinguished as a broad rough surface over 2 cm in length, and is the site where costoclavicular ligament attaches.
  • The conoid tubercle, which is found more laterally towards the acromial end. It appears as a rough eminence found where the flat portion of the clavicle meets the tip of the pyramidal sternal end. This feature acts as the site where the conoid ligament attaches.
  • The trapezoid line, which is also near the acromial end of the clavicle, running laterally from the conoid tubercle. It servers as an attachment site for the trapezoid ligament. 

Muscle attachments

A total of six muscles are attached to the clavicle, found distributed at either the lateral third or medial two thirds of the bone.

Two muscles are attached to the lateral third of the clavicle:

  • The trapezius muscle, which is attached along the posterior surface of the bone.
  • The deltoid muscle, where the anterior portion of the muscle is attached to the periosteum at the anterior surface of the bone.

Four muscles are attached to the medial third of the clavicle:

  • The sternocleidomastoid muscle, where the muscular clavicular head of the muscle is attached to the superior surface of the bone.
  • The pectoralis major muscle, which is attached to the anterior surface of the bone.
  • The subclavius muscle, which is attached to a groove found in the middle of the bone’s inferior surface. From there, the muscle extends into both lateral and medial areas of the clavicle.
  • The sternohyoid muscle, which attaches to the medial end of clavicle.

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