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Ulnar Deviation


Ulnar deviation, also known as ulnar drift, is a progressive deformity of the hand caused by the swelling of the metacarpophalangeal joints (knuckles), which results in the fingers bending towards the little finger side of the hand while the wrist bones deviate towards the thumb side.

The primary cause of ulnar deviation is rheumatoid arthritis, although other conditions such as systemic lupus erythematosus or psoriatic arthritis may also be responsible. Very rarely, synovitis can also cause the condition.

Ulnar drift is a progressive disease. The first signs may include
  • swelling at the knuckles
  • difficulty fully straightening the fingers at the knuckles
  • slight indication of the fingers drifting to the little finger side, particularly the index and long fingers
  • gradually diminishing finger grip and pinching strength, along with hand function

  • Later signs may include
  • deviation of the wrist
  • inability to touch thumb to the index finger
  • Diagnosis:
    Your doctor will look for signs of heat and swelling around the wrist and knuckle joints and will gently palpate (touch) the hand and wrist to test for tenderness or pain. You will be asked to carefully move your wrist and hand to determine range of motion, strength, and grip. The doctor will also be ruling out other conditions while these tests are performed.

    Crushed ice, in a bag wrapped in a towel, will help to reduce the inflammation and therefore the pain. Ice can be applied several times a day for as long as is comfortable.

    Placing a warm, damp cloth to the hand, while the hand is stretched as far as comfortably possible, will help to increase stretch.

    Ultrasound or Transcutaneous Nerve Stimulation (TNS) may be used to reduce pain in the joints.

    Wearing a soft splint at night, and when the hands are painful and swollen, will keep the fingers properly aligned and allow motion at the knuckles. Research does not show that wearing a splint will help correct the deformity, but it can improve hand function and strength.

    Exercises will help to maintain flexibility and strength.

    Severe ulnar deviation may require surgery to relieve pain and improve hand function, although improvement in movement would probably be limited and grip strength would not be improved.

    While the joints are inflamed, stretching exercises should be avoided so as not to risk overstretching and tearing delicate tissues.

    Active Stretch:
    With your fingers gently stretched in front of you, bend the fingertips and middle finger joints (DIP and PIP joints) and slightly bend the knuckles (MCP joints). Keeping the DIP and PIP joints bent, straighten the MCP joints. Hold the stretch for 10-30 seconds. Repeat 3 times.
    Place your palm flat on a table and hold a pencil on the thumb side of each finger in turn. Keeping the pencil in place, push against it with your finger. Hold for 6 seconds. Repeat 5-10 times.
    Finger walk:
    Place your palm flat on a table. Extend your thumb and 'walk' your fingers towards your thumb.
    Wrist bend:
    Place your palm flat on a table. Slowly bend your hand toward the thumb side. Hold for 10 seconds then slowly bend your hand toward the little finger side. Hold for 10 seconds. Repeat 5-10 times.

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