Table of ContentsView AllTable of ContentsOverviewSymptomsCausesDiagnosisTreatmentPreventionOutlook
Table of ContentsView All
View All
Table of Contents
Overview
Symptoms
Causes
Diagnosis
Treatment
Prevention
Outlook
Ulnar deviation is a deformity of the hand that affects people with rheumatoid arthritis (RA) and other inflammatory diseases.Also known as ulnar drift, it occurs when your knuckles—called themetacarpophalangeal(MCP) joints—become swollen, causing your fingers to bend abnormally toward the ulna bone on the outermost side of your forearm.
Ulnar distortion can be painful and aesthetically undesirable. Over time, it can make it difficult to perform daily tasks that require gripping, like opening a jar, twisting a doorknob, or using a zipper.
Verywell / Hilary Allison
Over time, the condition can cause you to have some trouble performing daily activities. It can also cause your hands to look bent and distorted.
Swelling of the knuckles is the main symptom of ulnar deviation.Other signs and symptoms include:
You may also experience body-wide symptoms, such as fatigue or weight loss, and pain and stiffness in similar joints, like your toes. This can occur when ulnar deviation is due to an underlying autoimmune disease.
Ulnar deviation is most commonly associated withrheumatoid arthritis (RA), but it can occur with other conditions as well.
Rheumatoid Arthritis
Rheumatoid arthritiscauses chronicinflammationof the MCP joints, which damages the joint capsule and surrounding structures and can result in ulnar drift.This causes joint erosion that can be seen on X-rays.
Osteoarthritis
Eventually, your bones start to rub together, damaging the joints and potentially causing them to become bent and distorted.
Lupus
Ulnar deviation can also occur with the autoimmune diseaselupusand other diffuse connective tissue disorders (DCTDs), such as scleroderma, polymyositis, andSjögren’sdisease.
Psoriatic Arthritis
Ulnar deviation is sometimes seen in psoriatic arthritis (PsA), but it is not very common. When it does, it typically occurs in reverse and is related to psoriatic nail disease.
In PsA, the deformity starts in the distalinterphalangeal(DIP) joint at the top of the finger. Over time, it can move to the proximal interphalangeal (PIP) joint in the middle of the finger and then travel to the other joints in the hand and wrist.
Brachial Plexus Palsy
Pigmented Villonodular Synovitis (PVNS)
There is also an association between ulnar drift and an uncommon disorder known aspigmentedvillonodular synovitis(PVNS).In PVNS, the tissue lining your joints and tendons (synovium) grows abnormally.
Genetics
Genetics may play a factor in ulnar deviation as well. According to researchers at Texas Tech University, a type of ulnar deviation commonly referred to as windblown hand may run in families.
In windblown hand, the fingers tilt outward in an almost uniform fashion and cannot be corrected without pain. It may be present at birth but commonly develops in early adulthood.
Smoking
Smoking cigarettes increases your risk of autoimmune diseases, like RA and lupus, which are associated with ulnar drift.In addition, smoking worsens joint pain and inflammation and lowers the effectiveness of disease-modifying antirheumatic drugs (DMARDs) like methotrexate.
Ulnar deviation is usually evident from an examination of your hand. Your medical history will also be considered.
To assess the severity of ulnar drift, healthcare providers measure the joint angle using agoniometer, a combination of a protractor and ruler with two moveable arms.
One arm of the goniometer is placed over the metacarpal (the finger bone that connects the knuckle to the hand). The other arm is moved so it is parallel to the proximal phalanx (the bone extending upward from the knuckle).
After the healthcare provider gets a measurement, they’ll usually ask you to straighten your hand as much as possible to actively correct the alignment and then take a second measurement.
This test is also used to measure radial finger drift, in which fingers deviate toward the thumb rather than the little finger.
Your healthcare provider may also use other hand-function tests andX-raysto get more information about bone and tissue damage as well asdeformity of the hand.
If an underlying disease such as rheumatoid arthritis or lupus is suspected, but not yet diagnosed, blood tests may be used to investigate further.
There is no cure for ulnar drift, which tends to progress over time. Lifestyle changes, exercises, therapies, and interventions can help ease discomfort and potentially slow progression.
Lifestyle Changes
The following lifestyle changes can help you avoid too much strain on your joints, which can worsen symptoms of ulnar drift:
Talk to your healthcare provider if you’re finding it hard or painful to complete routine manual tasks. They may be able to recommend assistive devices to make things easier.
Hand Exercises
You may be able to improve your ulnar deviation symptoms with hand exercises. These primarily involve stretching and are recommended to preserverange of motionas much as possible.
Physical activities that put undue pressure or stress on the hands, such as planks or riding a bicycle (which requires gripping the handlebars) should be avoided.
Splinting
Splinting is sometimes recommended to properly position the MCP joints and relieve pain.Generally, splints are worn at night or during rest periods in the daytime.
Medications and Therapies
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can relieve pain.
Other options for treating hand swelling and pain include:
Surgery
Metacarpophalangeal (MCP) arthroplastyis a surgical method of improving pain, alignment, and function in people with ulnar drift. The procedure involves replacing painful knuckle joints with artificial knuckle joints.
For eight to 12 weeks after the surgery, patients wear hand splints and perform exercises to maintain and increase motion in the healing hand. This is known as post-operative therapy.
Preventing Disease Progression
If your ulnar deviation is diagnosed early enough, your healthcare provider will likely suggest you wear splints to keep your fingers from bending any more than they already have.
These types of splints may help slow disease progression:
If your condition is diagnosed early, you may be able to control your symptoms without it affecting your quality of life.
Summary
Ulnar deviation is a hand deformity where fingers lean toward the outer side of the hand. Symptoms include swollen knuckles, pain and stiffness in the hand, and difficulty bending your fingers. Also called ulnar drift, it is more common in people with inflammatory autoimmune diseases like rheumatoid arthritis, psoriatic arthritis, and lupus. Osteoarthritis, a nerve injury, or genetics can also cause it.
Ulnar deviation treatment aims to maintain hand function, relieve pain, and manage underlying autoimmune disease. Surgery may sometimes be needed to fix the deformity, relieve pain, and improve functioning.
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