Introduction
Ulnar deviation or ulnar drift is a condition that affects the bones of the hand, that is it affects the knuckle or metacarpophalangeal joints. The affected joints become swollen and cause the fingers to bend abnormally towards the little finger. It is caused by the inflammation of the knuckle joints and the surrounding structures of the wrist and hand joints. The fingers bend towards the ulna bone of the forearm so it is said as ulnar deviation or ulnar drift. This deviation limits the person's daily activities like grasping or holding things. However, people with ulnar drift can use their hands but in a limited way.
What Are the Causes of Ulnar Deviation?
Ulnar deviation is caused by chronic inflammation, or by injuries to the ligaments, muscles, and tendons surrounding the joints of the hands and wrists. It may also be caused by some congenital abnormalities. Some medical conditions can also cause ulnar deviation or ulnar drift.
The medical conditions which can cause ulnar deviation are:
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Rheumatoid Arthritis - It is the most common cause of ulnar deviation. Rheumatoid arthritis is a disease that targets joint tissues. In persons with rheumatoid arthritis, the inflammation affects the metacarpophalangeal joint which makes the joints wear and bones erode. In persons with rheumatoid arthritis, ulnar deviation also occurs in the wrists. The outer tendon of the joints is stronger than the inner one, which makes the fingers bend towards the pinky finger which in turn makes the hand look distorted.
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Osteoarthritis - It potentially causes ulnar deviation. It is not caused by the inflammation of rheumatoid arthritis. However, it causes ulnar deviation by gradually wearing the joint cartilage due to age or overuse. When the cartilage wears away, the bones rub each other in the joints and cause the fingers to bend.
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The other causes are smoking, lupus (an autoimmune condition that affects joints), psoriatic arthritis, and brachial plexus palsy (a congenital condition that affects the nerves of the hand).
What Are the Symptoms of Ulnar Deviation?
The primary symptoms of ulnar deviation or ulnar drift are:
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Fingers bend towards the wrist.
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Swelling in the fingers, and hand joints.
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There will be limited movement of fingers.
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There will be a reduction in the grip strength of the fingers.
When the condition progresses, the person may experience the following:
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Excessive warmth and pain in the wrist, hand, and finger joints.
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The wrist, writing, and finger joints will be tender when the person moves or flexes their fingers.
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The person may not be able to fully flex their fingers and their hand muscles may become tight.
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The person may not be able to grasp or hold objects and not be able to do specific tasks related to the index finger and the thumb such as squeezing or zipping.
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The other symptoms, when caused by rheumatoid arthritis, are weight loss, exhaustion, and stiffness of the affected joints.
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After completing reviewing the patient's medical history, the doctors perform some physical examination related to their symptoms.
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The doctor may ask the patient to move or flex their hand and fingers to observe the range of movements. If the fingers bend towards the ulnar bone direction and make clunking sounds when moving during the physical examination then they may indicate that as ulnar deviation or ulnar drift.
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Healthcare providers may also suggest X- rays to observe the deviation and other surrounding structures of the affected joints such as muscles, ligaments, and tendons.
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X-rays also help doctors to find the exact cause of the ulnar deviation such as rheumatoid arthritis or osteoarthritis. They may also suggest a blood test to find if it is caused by lupus.
What Are the Treatments for Ulnar Deviation?
As ulnar deviation is a chronic and progressive condition, the treatment involves the management of symptoms and long-term follow-up to maintain the quality of life of a person.
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Medications: Doctors prescribe NSAIDs (non-steroidal anti-inflammatory drugs) for relieving pain and swelling. They may also prescribe Ibuprofen and Naproxen for relieving the pain. They also refer to a rheumatologist, who prescribes disease-modifying anti-rheumatic drugs (DMARDs) which help to reduce the ulnar deviation progression.
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Physiotherapy: Physical therapy and exercises help in managing symptoms. The exercises and physical therapy depend on the severity. In people with less severe ulnar deviation, the therapist may suggest simple hand, wrist, and finger exercises that can be done by themselves at home whereas if the severity is high, the patient may require a splint to keep their fingers in place.
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Other Treatments: Doctors may recommend home remedies such as cold and hot therapies which help in relieving pain and swelling. Applying heat to the fingers while doing extended movements helps to increase the range of motion of the fingers. They also suggest transcutaneous nerve stimulation to treat pain by using electric impulses and lower pain in the ulnar deviated fingers.
What Are the Methods to Prevent Disease Progression of Ulnar Deviation?
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The doctors recommend wearing splints on the fingers to prevent them from bending. There are different types of splints such as hand-resting splints, exercise splints, and metacarpophalangeal splints. Their use depends on the affected parts. These splints are always recommended to wear at night. They help to relax the muscles and surrounding structures of the affected joints and also in reducing inflammation and pain.
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People can prevent or reduce ulnar deviation through some lifestyle changes such as by avoiding more strain on the joints.
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More strain on the joints can be prevented by using both hands for holding heavy objects, avoiding using handles on the objects, and avoiding activities that move fingers in the ulnar direction.
Conclusion
By performing physical therapies some patients may get out from ulnar deviation that is they may not notice their symptoms. It mainly depends on the severity and progression of the condition. If the ulnar deviation or ulnar drift is caused by rheumatoid arthritis, osteoarthritis, or lupus, the doctors recommend long-term follow-up and management of the condition. Reaching out to specialized doctors and physical therapists may increase the quality of life of the affected person.
