Ulnar Drift in Rheumatoid Arthritis and Other Diseases

This Complication of RA Can Cause Pain and Distortion in the Hands

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an x ray of a hand
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​Ulnar drift, also referred to as ulnar deviation, is a deformity of the hand that occurs when your knuckles—called the metacarpophalangeal (MCP) joints—become swollen and causes your fingers to bend abnormally toward the ulna bone on the outermost edge of your forearm. It is most commonly associated with rheumatoid arthritis (RA) as well as other inflammatory diseases, such as lupus or psoriatic arthritis.

The distortion caused by ulnar drift can be painful, aesthetically undesirable, and, over time, may make daily tasks that require gripping—such as opening a jar, twisting a doorknob, or using a zipper—challenging.

Signs and Symptoms

Swelling of the knuckles is the main symptom of ulnar deviation. Other signs and symptoms include:

  • Loss of ability for the thumb to oppose the index finger
  • Warmth in your wrist, hand, and finger joints
  • Pain or tenderness in the hand
  • Inability to fully flex your fingers or make a fist
  • Tightness and stiffness in the hand

Causes

Ulnar drift is primarily associated with rheumatoid arthritis; chronic inflammation of the MCP joints damages the joint capsule and surrounding structures. It may also occur with other inflammatory conditions or connective tissue diseases, such as lupus or psoriatic arthritis. Research has also revealed an association with an uncommon disorder known as pigmented villonodular synovitis (PVNS), a disease in which the tissue lining the joints and tendons in the body (synovium) grows abnormally.

Osteoarthritis can also result in ulnar drift. With this condition, joint cartilage wears away due to overuse or age, rather than being damaged by autoimmune disease. Eventually, your bones start to rub together, damaging the joints and potentially causing them to become bent and distorted.

Diagnosis

To assess the severity of ulnar drift, a device called a goniometer may be used. The stationary arm of the goniometer is placed over the metacarpal (the finger bone that connects the knuckle to the hand) while the movable arm is placed parallel to the proximal phalange (the bone extending upward from the knuckle). After the degree of deformity is determined, the patient is usually asked to straighten their hand, if possible, to actively correct the alignment and a re-measurement is taken. Other hand function tests may also be used to evaluate the severity of the deformity.

Your doctor may also take X-rays to get more information about bone and tissue damage.

If an underlying disease such as rheumatoid arthritis or lupus is suspected, blood tests may be used to confirm the diagnosis.

Treatment

There is no cure for ulnar drift, which tends to progress over time. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can relieve pain.

Other options for treating hand swelling and pain include ice, moist heat, paraffin wax baths, use of a transcutaneous electrical nerve stimulation unit, or TENS unit, and ultrasound therapy.

Hand exercises, which primarily involve stretching, are recommended to preserve range of motion as much as possible. Exercises that put pressure or stress on the hands, such as planks or riding a bicycle (which requires gripping the handlebars)—should be avoided.

Splinting is sometimes recommended to properly position the MCP joints, relieve pain, and possibly slow disease progression. Generally, splints are worn at night or during rest periods in the daytime. If your ulnar deviation is diagnosed early enough, your doctor 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:

  • MCP joint splints, which you can wear during the day to support your fingers and help you grip objects with less pain
  • Hand-resting splints, which are usually worn at night on your wrist and fingers to relax your MCP joint and reduce inflammation and pain
  • Exercise splints, which support your MCP joint when you extend or flex your fingers to help reduce joint tightness or inflammation

In addition, the following lifestyle changes can help you avoid too much strain on your joints:

  • Use both hands to lift and hold heavy objects.
  • Avoid using the handles on objects such as pots or coffee mugs (but do use oven mitts for hot objects to protect your hands).
  • Try to avoid doing too many activities that move your fingers in the ulnar direction, such as opening jars or using doorknobs (keep internal doors cracked, for example).

Finally, talk to your provider if you are finding it hard or painful to complete routine manual tasks. He or she may be able to recommend assistive devices to make things easier.

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Article Sources
  • Kelley's Textbook of Rheumatology. Ninth edition. Firestein et al. Elsevier Saunders. Clinical Features of Rheumatoid Arthritis. Chapter 70. Hands and Wrists. Page 1112.
  • Volar Subluxation of Metacarpophalangeal Joint
  • Best Practice Recommendations for Management of Ulnar Drift Deformity in Rheumatoid Arthritis. Vancouver Coastal Health. The Arthritis Society (Canada).