Rheumatoid arthritis (RA) is an inflammatory disorder, meaning it can cause inflammation in many different parts of the body. Over time, inflammation from RA may result in joint deformity, among other symptoms. One such deformity is known as ulnar deviation, or ulnar drift. In a person with ulnar deviation, the joints in the wrist and hand shift. This shifting causes the fingers to bend toward the ulna (a long bone found in the forearm).
If you or your doctor suspect that you may be developing ulnar deviation, several steps can help you manage discomfort and protect your joints from further damage. As always, let your rheumatologist or health care provider know if you experience any new or worsened joint symptoms. They will be able to help determine the cause and work with you to find the right treatment.
Ulnar drift is characterized by two problems that can occur at the metacarpal phalangeal (MCP) joints: ulnar deviation and volar subluxation. Ulnar deviation occurs when synovitis (inflammation of the synovial membrane that cushions the joints) has caused problems in the ligaments (connective tissues) or muscles in the wrist and hand.
When hand or wrist ligaments have become weakened, the flexor tendon (a strong, smooth cord connecting the forearm muscles to the thumb and finger bones) can become dislocated and shift toward the palm and the ulna.
The primary symptom of ulnar deviation is a hand that bends toward the wrist. Many myRAteam members have described what this looks like: “I have ulnar drift in both my hands,” wrote one member. “My fingers all drift away from my thumbs, making it hard to hold things.” Another member described ulnar drift as “when your fingers slide sideways,” noting that this deformity caused their hands to become “pretty nonfunctional.” Dysfunction is a common problem among members. Many find that the symptoms of this deformity make everyday chores difficult.
Ulnar drift may also cause other symptoms. The inflammation underlying this deformity can result in warmth, swelling, or pain in the wrist, hand, and finger joints. Some people with ulnar drift also find that they experience crepitus (grating sounds) or clicking in the wrist. One member shared that their ulnar drift causes visible shifts in their joints: “Some days, I watch and feel my baby finger and thumb completely move in front of my eyes.”
Ulnar drift can also lead to reduced grip strength and limited range of motion in the fingers, causing the difficulties that so many members complain about. The extent of these problems can vary — as one member described, “I have two affected fingers on each hand. The little fingers and the index fingers both drift, but I am OK to hold lightweight items.”
As this member went on to point out, ulnar drift may lead to other complications — namely, problems with the ulnar nerve. “My main issue,” they wrote, “is at my elbows, where the ulnar nerve is cutting into my bones.” The same was true for another member, who shared, “My hands turn outward, which is called ulnar drift. Because of this, I have nerve pain in both elbows (ulnar nerve) due to the abnormal positions of my hands.”
Rheumatoid arthritis causes chronic inflammation. This disease often affects the synovium (soft tissue lining the joints) between the small joints in the hands and wrists — especially the metacarpophalangeal joints in the fingers (the knuckles). Over time, inflammation in the MCP joints causes damage to the areas surrounding the joints (joint capsules) and nearby ligaments. Long-term inflammation can cause the fingers to appear swollen (puffy) and to shift or bend at abnormal angles, leading to the characteristic bent appearance of the hand in ulnar deviation.
Diagnosing ulnar deviation usually begins with a physical examination. A rheumatologist or other health care provider will likely start by checking for signs of inflammation (such as pain, heat, redness, and swelling) in the wrist and MCP joints. They may also feel the MCP joint for effusion (the accumulation of synovial fluid in the joint capsule).
Your doctor may then assess your hand function and range of motion in your wrist and MCP joints using several physical tests. These tests involve moving your fingers, hands, and wrists in different ways to assess your grip strength, mobility, and other factors that may be affected or impaired by ulnar deviation. Certain specialized forms of these tests may also be used to identify how ulnar deviation has affected your joints and their functioning.
Treatment for ulnar deviation aims to manage symptoms and discomfort and prevent the deformity from worsening. This often begins with treating the underlying condition causing ulnar deviation — in this case, rheumatoid arthritis.
There are several types of treatments for RA, including oral medications, injections, surgery, and lifestyle changes like diet and exercise. You and your rheumatologist can work together to find the right treatments for you.
Aside from treatments for RA, a rheumatology expert or other health care provider may recommend the following for managing ulnar deviation:
There are several ways of managing pain and discomfort with ulnar deviation.
Over-the-counter pain relievers can help reduce pain and swelling. These medications include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, as well as Aleve (naproxen) and Tylenol (acetaminophen). Talk to your doctor before taking these medications, as they will be able to recommend the right dosage and frequency for managing your discomfort.
Heat and cold therapy have different benefits for ulnar deviation. Icing the affected joints can help decrease pain and swelling. Applying moist heat while stretching to the end of your current range of motion can help increase your stretch.
Transcutaneous electrical nerve stimulation (TENS or TNS) can help decrease pain caused by ulnar drift. A TENS unit is a battery-powered device that relieves pain by delivering low-voltage electrical impulses through electrodes placed on the skin.
Physical therapy may help you manage ulnar deviation caused by problems with the wrist muscles or ligaments. Your rheumatologist or a physical therapist can recommend wrist and hand exercises to increase strength and improve range of motion. These exercises may be particularly useful after soaking the hands in paraffin wax. A warm bath of this melted wax may help relieve pain and stiffness and improve hand function when followed by exercise.
Supportive splints can provide compression and support to hands or wrists affected by ulnar deviation, particularly while performing hand exercises. There are many different types of splints, some of which can be custom-made. Your rheumatologist can advise you on the best splint for your needs and recommend a splinting regimen.
There are several ways you can protect your hand and wrist joints and help prevent additional stress or injury. It is recommended that you avoid certain movements, such as a lateral pinch, which is used to turn a key or use a nail file (instead, use a tip-to-tip pinch, putting the tips of your fingers together.) An occupational therapist can advise you on ways to adapt your everyday activities to protect your joints and prevent the worsening of your symptoms.
Rheumatoid arthritis can pose many challenges, and dealing with its symptoms can be difficult. The good news is that you don’t have to go it alone. On myRAteam, more than 146,000 people come together to ask questions, provide advice, and share their stories with others who understand life with rheumatoid arthritis.
Have you developed ulnar deviation with RA? Tell members about your experience by leaving a comment below or by posting on myRAteam.