COLLEGE OF MEDICINE AND HEALTH

SCIENCE
SCHOOL OF HEALTH SCIENCES
DEPARTEMNT OF PHYSIOTHERAPY
CLASS LEVEL: 1
ACADEMIC YEAR: 2021-2022 TRIMESTER: 2

MODULE NAME: APPLIED ANATOMY AND

PHYISIOLOGY 1

TITLE OF THE ASSIGNMENT: DIGITS

ASSIGNMENT/ PRACTICAL WORK: RING FINGER

GROUPE MEMBER
NAMES REGISTRATION
NISHIMWE ISIMBI Michelline 222001223
MUGISHE Gratien 222000903
ISHIMWE Donatien 222000612
MUSABESE Solange 222004492

Lecturer name: Chance Christian NDAHIRIWE

Done on 07/11/2022
RING FINGER

Ring finger or fourth finger is the fourth digit of the human hand, located between
the middle finger and the little finger. In anatomy, the ring finger is called digitus
medicinalis, the fourth digit, digitus annularis, digitus quartus, or digitus IV. In
Latin, the word anulus means "ring", digitus means "digit", and quartus means
"fourth".

The ringer finger is comprised of three phalanges, or bones, extending from the
hand’s fourth metacarpal bone. The proximal phalanx provides the base of the
finger, which connects to the intermediate phalanx via the knuckle joint. At the end
of the finger, the distal phalanx provides support to the sensitive pulp of the
fingertip.

Oxygenated blood arrives at the finger through the common palmar artery, which
extends off of the palmar arch connecting the ulnar and radial arteries. The ulnar
artery is the main supply of blood to the ring finger.
The median, radial, and ulnar nerves provide sensory innervation to this finger
The metacarpal associated with the ring finger, shaping the palm, and allowing
proper use of the hand. It is divided into a head and a base, joined by the long shaft
or body, it is located between the distal carpal bones and the fourth
proximal phalanx.

The metacarpals of ring finger at its base, there are two proximal facets
articulating with the distal carpal bones capitate and hamate, the proximal surface
is quadrangular and serves for the articulation with the hamate bone.

There are also two more articular surfaces at the base, medially and laterally,
joining the fourth metacarpal with the third and fifth metacarpals respectively.
On the distal end, it has an articular facet on its head for the fourth proximal
phalanx base. The shaft provides the insertion point for the third palmar
interosseous and the ulnar head of third dorsal interosseous on its lateral side, while
the medial side is where the fourth dorsal interosseous attaches.
Joint of ring finger

Joints are cartilage surfaces that connect bones to each other. This cartilage allows
our bones to glide smoothly against one another, allowing us painless movement.
There are four joints in this finger.

Distal Interphalangeal Joint (DIP): The DIP joint is located at the tip of the
finger, just before the finger nail starts. Arthritis can develop at this joint, and it is
also commonly fractured.

Proximal Interphalangeal Joint (PIP): The PIP joint is the joint just below the
DIP joint. It is located below the top two bones of the finger and allows the finger
to bend and extend. This joint can become stiff easily after injury and has very
limited side to side motion

Metacarpophalangeal Joint (MCP): The MP joint is where the hand bone meets
the finger bone, referred to as the “knuckle.” These joints are very important,
allowing us to bend/flex and spread our fingers.

Carpometacarpal Joint (CMC Joint): The CMC joint is located at the bottom of
the hand bone. It has much more motion than the index or middle fingers. This
permits the hand to change its shape and adapt to grasping objects of different size
and shape. Because this joint is more mobile, it is more common to have a fracture
or dislocation of this joint. CMC bossing does not typically occur at this joint.

Interphalangeal joint

The interphalangeal joints of the hand are synovial hinge joints that span between
the proximal, middle, and distal phalanges of the hand
The proximal interphalangeal joint (PIPJ or PIJ) is located between the proximal
and middle phalanges, while the distal interphalangeal joint (DIPJ or DIJ) is found
between the middle and distal phalanges
Articulation surface of fourth interphalengial joint

Each interphalangeal joint is composed of the head of the more proximal

phalanx and the base of its distal counterpart. This means that, for example, the
proximal interphalangeal joint is formed by the union of the head of the proximal
phalanx with the base of the middle phalanx. This same pattern applies to the distal
Interphalangeal joint, meaning that it is formed by the articulation of the head of
the middle phalanx with the base of the distal phalanx

Joint capsule and ligaments

Surrounding each interphalangeal joint is a fibrous joint capsule, the inner lining
of which is comprised of a synovial membrane. Strengthening each joint capsule
are two collateral ligaments and a palmar ligament, also known as a
palmar/volar plate. Dorsally, the joint capsule is strengthened by a broadening of
the extensor tendons. This extensive ligamentous contribution to each joint capsule
increases the articular surface of the phalangeal base, improving joint congruence.

Collateral ligaments
The collateral ligaments course on either side of each interphalangeal joint, arising
from the head of the more proximal phalanx or extending to the palmar, or volar,
aspect of its distal counterpart. Arising from each collateral ligament is an
accessory ligament, which extends anteriorly to attach to the fibers of the palmar
ligament. These ligaments help to prevent excessive adduction-
abduction movements of the interphalangeal joints.

Palmar ligament
The palmar ligament is a thick plate of fibrocartilage located on the palmar
surface of each interphalangeal joint. This ligament has a characteristic upside
down “U” shape, with its distal part arching across the base of the distally lying
phalanx to blend with the accessory collateral ligaments.
Nerve supply

The interphalangeal joints of the hand receive innervation from the proper
palmar digital nerves, arising from both the median and ulnar nerves.
The lateral half of digit 4 are innervated by the median nerve, while the medial
half of digit 4 and the entirety of digit 5 are innervated by the ulnar nerve.
Blood supply

Ring finger interphalangeal joint receives oxygenated blood via the proper palmar
digital arteries, which are the distal extensions of the superficial palmar arch.

Metacarpophalangeal joints (MCP) of ring finger

Metacarpalphalanges joint are a collection of condyloid joints that connect the

metacarpus, or palm of the hand, to the fingers.

metacarpophalangeal joint is formed by the convex heads of the metacarpal bones

of ring bone which are received by the concave bases of the proximal phalanges.
The primary movements of the metacarpophalangeal joints are flexion, extension,
abduction, adduction, circumduction and limited rotation. These joints play an
important role in the functionality of the hand providing stability and flexibility of
the fingers which is facilitated by the ligaments, joint capsule, and adjacent
musculotendinous structures.

Articular surfaces

Metacarpophalangeal joint of ring finger is the connection between the palm and
the fingers. The proximal articular facet is located on the rounded biconvex head of
the metacarpal bones. This articular surface is wider anteriorly than posteriorly.
The metacarpal heads articulate with the much smaller concave articular facets
located on the bases of proximal phalanges. The facets of the phalanges are
elongated anteriorly by the palmar ligament that functions as a hinge. Both
metacarpal and phalangeal articular surfaces are lined with hyaline cartilage.

Ligaments and joint capsule

The joint is enveloped by a loose fibrous capsule, attached close to the margins
of articular facets. On its medial and lateral sides, the joint capsule is thicker and
strengthened by collateral metacarpophalangeal ligaments. A palmar
metacarpophalangeal ligament mainly replaces the capsule on its anterior aspect,
while the posterior capsule receives fibres from the tendons of the long
extensors of the forearm (namely extensor pollicis longus, extensor indicis, and
extensor digitorum and extensor digiti minimi)

1. Collateral ligaments

The collateral ligaments are major stabilizers of the MCP joint and located on both
radial and ulnar aspects of the joint. They consist of proper collateral and accessory
collateral ligaments. Working together, these strong ligamentous bands limit the
range of motion in both flexion-extension and adduction-abduction axes.
The proper collateral ligaments expand from the posterior tubercles on the
dorsolateral aspect of the metacarpal head to the palmar aspect of the adjacent
proximal phalanx, just distal to the base. The primary role of these ligaments is
to limit flexion of the MCP joint.
2. Palmar ligament
The palmar ligament (also referred to as the palmar, or volar, plate) is a
dense fibrocartilaginous thickening located on the palmar aspect of the MCP joint
capsule. They are loosely attached to the palmar aspect of the metacarpal neck, but
firmly adhered to the palmar surface of the base of the adjacent proximal phalanx.
The sides of the palmar ligament blend with the collateral ligament. The main
function of this ligament is to prevent hyperextension of the MCP joint.

3. Deep transverse metacarpal ligaments

The deep transverse metacarpal ligaments are the narrow fibrous bands that run
across the palmar aspect of the second to fifth metacarpophalangeal joints,
connecting them together. They are situated anterior to interossei muscles and
posterior to lumbricals. These ligaments mainly contribute to the stability of the
MCP joints during grip functions.

Nerve supply

Deep branch of ulnar nerve

Ramus profundus nervi ulnaris
The metacarpophalangeal joints are innervated by the following nerves;
Posterior interosseous nerve, a branch of radial nerve (C5-T1)
The deep terminal branch of the ulnar nerve (C8-T1)
Palmar branches of the median nerve (C6-T1)

Blood supply

The arterial supply to the MCP joints is provided by branches of

the radial and ulnar arteries;
Princeps pollicis artery
Palmar and dorsal metacarpal arteries
Radialis indicis artery
Common palmar digital arteries

Carpal metacarpal joint of ring finger

The CMC joints of ring finger are surrounded and stabilized by a common fibrous
capsule. This fibrous capsule is lined by a synovial membrane that secretes
viscous synovial fluid, which acts as a lubricant. The synovial membrane is usually
continuous with the lining of the intercarpal joints.
The joint cavity of the CMC joints extends proximally and distally, communicating
with the midcarpal and intermetacarpal joint spaces, respectively. The articular
surfaces of the CMC joints are lined by hyaline cartilage.

The CMC joints are stabilized by three sets of ligaments: dorsal carpometacarpal
ligaments, palmar carpometacarpal ligaments and interosseous ligaments.
These soft tissue structures are actually thickenings of the fibrous joint capsule
surrounding the CMC joints.

The dorsal carpometacarpal ligaments

Located on the dorsal aspect of the hand, are the strongest and offer the most
reinforcement to the CMC joints. They comprise a total of seven ligamentous bands
that extend obliquely between the dorsal surfaces of the distal row of carpal bones
and the four medial metacarpal bases. Metacarpal 4 from the capitate and hamate.

The palmar carpometacarpal ligaments,

Located on the palmar aspect of the hand, are very similar to their dorsal
counterparts.

The interosseous ligaments

This is the smallest stabilizers of the CMC joints. They are comprised of two thick,
fibrous bands that extend between the inferior aspect of the distal margins of the
capitate and hamate bones and the third and fourth metacarpal bases.

Nerve supply
The CMC joints are innervated from three sources, all of which initially originate
from the brachial plexus:
Anterior interosseous nerve of forearm, which is a branch of the median nerve (C8-
T1)
Posterior interosseous nerve of forearm, which stems from the radial nerve (C7-C8)
Deep and dorsal branches of ulnar nerve (C7-C8).

Blood supply
Blood supply to the CMC joints comes from the palmar and dorsal carpal
anastomotic arches. These are formed by the union of the palmar and dorsal carpal
branches of radial artery.
Arteries,veins and nerves that supply ring finger
Artery Proper palmar digital arteries,
dorsal digital arteries .
Vein Palmar digital veins, dorsal digital
veins
Nerve Dorsal digital nerves of radial nerve,
Dorsal digital nerves of ulnar nerve,
Proper palmar digital nerves of
median nerve

Atlanto-axial joint

The atlantoaxial joint is a complex joint between the atlas (C1) and the axis (C2). It
is composed of three synovial joints; one median atlantoaxial joint and two lateral
atlantoaxial joints.
The left and right lateral atlantoaxial joints are the articulations between the
inferior articular surface of the lateral mass of atlas (C1) and the superior articular
surface of the lateral mass of axis (C2). Since these are synovial joints, their
articular surfaces are covered with hyaline cartilage.

Joint capsule

The lateral atlantoaxial joints

Lateral atlanto-axial joints are wrapped with loose fibrous capsules, lined by
synovial membrane. The joint capsule attaches on the lateral articular facets of the
joints, enclosing the lateral masses of both the atlas and axis. Each side of the joint
capsule is reinforced by an accessory atlantoaxial ligament.

Ligaments

The accessory atlantoaxial ligament supports the posterior aspect of the lateral
atlantoaxial joints. It is formed as a lateral extension from the deep laminae of the
tectorial membrane. The ligament attaches superiorly on the posterior aspect of the
lateral mass of the atlas near its transverse ligament, blending with the fibers of the
posterior capsules.

Median atlantoaxial joint

Articular surfaces
The median atlantoaxial joint is a pivot type of synovial joint. Broadly, the joint
is formed by the dens of axis (odontoid process) surrounded by an
osteoligamentous ring composed of the anterior arch of atlas anteriorly and the
transverse ligament of atlas posteriorWithin this osteoligamentous ring there are
actually two sets of articulations, each with their own synovial cavity. The first is
the articulation between the anterior articular facet of the dens of
axis (cervical vertebra 2) and the inner surface of the anterior arch of the
atlas (cervical vertebra 1). The second articulation is formed between the
posterior articular facet of the dens of axis and the anterior surface of
the transverse ligament of atlas.

Joint capsule

The median atlantoaxial joint contains two synovial cavities, one on each side of
the dens of axis. The posterior synovial cavity, between the dens and the transverse
ligament, is the larger of the two. Each synovial cavity is enclosed by a thin joint
capsule lined by synovial membrane. This joint capsule is relatively loose,
especially in the superior portion, thus allowing a substantial range of motion
movement to occur within the joint.
Ligaments

There are several ligaments securing the median atlantoaxial joint. The main
ligaments of the joint connect the atlas to the axis, these ligaments are collectively
known as the cruciform ligament is a complex of three ligaments, one
horizontal and two longitudinal, that together resemble a cross, hence the
name.
The three bands that form the cruciform ligament are as follows:

Transverse ligament of atlas: the transverse ligament of atlas is a strong, broad

ligament that runs transversely between the lateral masses of the atlas, attaching to
tubercles on their medial aspects.

Superior longitudinal band of cruciform ligament: arises from the superior

margin of the median part of the transverse ligament of atlas and ascends to insert
at the basilar part of the occipital bone.

Inferior longitudinal band of cruciform ligament: arises from the inferior

margin of the median part of the transverse ligament of atlas and descends to attach
on the posterior aspect of the body of axis.
In addition to the main ligaments, there are several accessory ligaments of the
median atlantoaxial joint that connect the axis (C2) with the occipital bone.

Tectorial membrane of cervical vertebral column: represents the superior

continuation of the posterior longitudinal ligament. This strong, broad band
originates on the posterior aspect of the body of the axis, from which it ascends to
insert on the anterior edge of the foramen magnum. It attaches near the hypoglossal
canals, blending with the spinal dura mater (meninges). The tectorial membrane
covers the posterior surface of the dens. It is situated posterior to the cruciform and
alar ligaments.

Alar ligaments: these paired ligaments course obliquely in a superolateral

direction from the posterolateral margins of the apex of dens of axis (C2), to attach
on the medial parts of the occipital condyles. The short but strong alar ligaments
act to limit excessive motion within the atlantoaxial joint.

Apical ligament of dens: originates from the apex of dens fanning out superiorly
to attach to the anterior margin of the foramen magnum. The apical ligament lies in
front of the superior longitudinal band of the cruciform ligament, and inserts in
between the two alar ligaments. Also termed the apical dental ligament, this
represents the vestigial cranial continuation of the notochord. Its biomechanical
relevance is disputed.

Anterior atlantoaxial membrane: a continuation of the anterior longitudinal

ligament, this membrane spans the length from the inferior border of the atlas to
the inferior part of the axis. Continues to the occiput as the anterior atlanto-
occipital membrane

Posterior atlantoaxial membrane: a superior continuation of the ligamentum

flavum, it traverses the gap between the atlas and axis, from the inferior border of
the posterior arch of the atlas to the upper borders of the laminae of the axis.
Continues to the occiput as the posterior atlanto-occipital membrane

Innervation/ Nerve supply

The atlantoaxial joint is innervated by branches of the ventral primary ramus of

the second cervical spinal nerve.
Blood supply
The atlantoaxial joint receives arterial blood supply from the anastomosing
branches of the deep cervical, occipital and vertebral arteries.

References
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