, projecting a little forwards towards its middle, so as to give a slight convexity of outline to the top of the chest and the bottom of the neck (fig. LXV. 2). It is attached by one extremity to the sternum (fig. LXV. 2) and by the other to the scapula (fig. LXV. 2), by moveable joints. The nature of an immoveable joint has been explained (63). In the connexion of the bones of the trunk, while the main object is to secure firmness of attachment, some degree of motion is at the same time obtained (81 et seq.): but the mode in which the several bones of the extremities are connected with each other and with the trunk, admits of so great a degree of motion, that these articulations are pre-eminently entitled to the name of moveable joints. The component parts of all moveable joints are bone, cartilage, synovial membrane, and ligament. The great character of a moveable joint is the approximation of two or more bones; yet these bony surfaces are never in actual contact, but are invariably separated from each other by cartilage. The cartilage either covers the entire extent of the articulating surface of the bones, as in the shoulder-joint, where both the head of the humerus and the cavity of the scapula that receives it are enveloped in this substance (fig. LXV. 7. 9), or a portion of it is placed between the articulating surfaces of the bones, as in the joint between the clavicle and sternum (fig. LXVII. a); which, when so placed, is termed an interarticular cartilage (fig. LXVII. a). By its smooth surface cartilage lessens friction; while by its elasticity it facilitates motion and prevents concussion. Slightly organized cartilage is provided with comparatively few blood-vessels and nerves. Had it been vascular and sensible like the skin and the muscle, the force applied in the movements of the joint would have stimulated the blood-vessels to inordinate action, and the sensibility of the nerves would have been the source of constant pain: every motion of every joint would have been productive of suffering, and have laid the foundation of disease. The facility and ease of motion obtained by the smoothness, elasticity, and comparative insensibility of cartilage are still further promoted by the fluid which lubricates it, termed synovia, secreted by a membrane called synovial, which lines the internal surface of the joint, and which bears a close resemblance to the serous (30). Synovia is a viscid fluid of the consistence of albumen (5). It is to the joint what oil is to the wheel, preventing abrasion and facilitating motion; but it is formed by the joint itself, at the moment when needed, and in the quantity required. The motion of the joint stimulates the synovial membrane to secretion, and hence the greater the degree of motion, the larger the quantity of lubricating fluid that is supplied. The several parts of the apparatus of moveable joints are retained in their proper position by ligamentous substance, which, as has been shown (96 and 97), is oftentimes so strong that it is easier to fracture the bone than to tear the ligament, and in every case the kind and extent of motion possessed by the joint are dependent mainly on the form of the articulatory surfaces of the bones and on the disposition of the ligaments.
143. In the joint formed by the clavicle and the sternum (fig. LXVII. a) an interarticular cartilage is placed between the two bones which are united, first by a strong fibrous ligament, which envelops them as in a capsule (fig. LXVII. 1); by a second ligament, which extends from the cartilage of the first rib to the clavicle (fig. LXVII. 4), by which the attachment of the clavicle to the sternum is materially strengthened; and by a third ligament which passes transversely from the head of one clavicle to that of the other (fig. LXVII. 3). The joint thus formed, though so strong and firm that the dislocation of it is exceedingly rare, yet admits of some degree of motion in every direction, upwards, downwards, forwards, and backwards; and this articulation is the sole point by which the scapula is connected with the trunk, and consequently by which the upper extremity can act, or be acted upon, by the rest of the body.
1. The fibrous capsule of the sternum and clavicle; 2. the
same laid open, showing a, the interarticular cartilage;
3. the ligament connecting the two clavicles; 4. the ligament
joining the clavicle to the first rib; 5. ligaments
passing down in front of the sternum.
144. The scapular extremity of the clavicle (fig. LXVIII. 6) is attached to the processes of the scapula (fig. LXVIII. 4. 3) by several ligaments of great strength (fig. LXVIII. 7, 8, 9). First by very strong fasciculi which pass from the upper surface of the clavicle to the acromion of the scapula (fig. LXVIII. 6); and secondly by two ligaments which unite the clavicle with the coracoid process of the scapula (fig. LXVIII. 8, 9). These ligaments are so powerful that they resist a force capable of fracturing the clavicle; and they need to be thus strong, for the clavicle is a shaft which sustains the scapula, and through the scapula the whole of the upper extremity; and the main object of the joint by which these bones are united, is to afford a firm attachment of the scapula to its point of support.
1. The clavicle; 2. the anterior part of the scapula;
3. the coracoid process; 4. the acromion process; 5. the humerus;
6. ligaments binding the scapular end of the clavicle
to the acromion; 7. 8. 9. ligaments passing from one
process of the scapula to the other; 10. the fibrous capsule
of the shoulder-joint.
145. The clavicle serves the following uses: it sustains the upper extremity; it connects the upper extremity with the thorax; it prevents the upper extremity from falling forwards upon the thorax; and it affords a fixed point for steadying the extremity in the performance of its various actions.
146. The glenoid cavity of the scapula (fig. LXV. 7) receives the head of the humerus, the bone of the arm (fig. LXV. 9), and the two bones being united by ligament form the shoulder-joint (fig. LXVIII.). This joint is what is termed a ball and socket joint, the peculiarities of which are two: first, beyond all others this mode of articulation admits of free and extensive motion; in the present case, there is the utmost freedom of motion in every direction, upwards, downwards, backwards, and forwards. In the second place, this mode of articulation admits of the motion of the limb without that of the body, or of the motion of the body without that of the limb. When at rest, the arm may be moved in almost any direction without disturbing the position of any other part of the frame; the manifold advantages of which are obvious. On the other hand, by careful management, very considerable variations in the posture of the body may be effected without the communication of any degree of motion to the limb; an unspeakable advantage when the limb has sustained injury, or is suffering from disease.