The analysis of the skeletal remains of Ohalo II man, aged 30–40 years at death and dated to 19 000 years BP, shows advanced and highly unusual ossification of the lower costosternal cartilage; the right humerus is morphologically larger and considerably more robust than the left; degenerative changes were noted unilaterally in the right glenohumeral, acromioclavicular and claviculosternal joints. There is a marked asymmetry of the atlas, axis and occipital condyles. The changes in the costochondral area of the lower anterior rib cage are considered to represent an infectious chronic osteomyelitic process. The marked discrepancy in size between the left and right shoulder girdles and humeri, and the evidence of degenerative disease exclusively on one side only may be the result of a traumatic brachial plexus nerve palsy. The asymmetrical atlas and axis are most probably anatomical variants that do not reflect clinical pathology.