Ulnar deviation, or ulnar drift, is a medical condition that causes the joints in the wrist and hand to shift so that the fingers bend toward the ulna bone on the outside of the forearm.

Inflammation in the knuckle joints and problems affecting the ligaments or muscles in the wrist and hand can result in ulnar deviation.

People who have ulnar deviation can still use their hands and fingers. However, over time, they may find certain activities, such as tying shoelaces or gripping small objects, more difficult.

In this article, learn more about the symptoms and causes of ulnar deviation, as well as the treatment options.

Ulnar deviation in person with rheumatoid arthritis. Image credit: Aljeannoir, 2015.Share on Pinterest
Ulnar deviation is a possible symptom of rheumatoid arthritis.
Image credit: Aljeannoir, 2015.

The primary symptom of ulnar deviation is that the hand bends toward the wrist.

Other symptoms of ulnar deviation include:

  • swelling, warmth, or pain in the wrist, hand, and finger joints
  • limited range of motion of the fingers
  • reduced grip strength

People can develop ulnar deviation as a result of chronic inflammation, problems with the ligaments or muscles, or structural congenital abnormalities.

Some underlying medical conditions can also cause ulnar deviation, including:

Rheumatoid arthritis

Ulnar deviation can occur due to chronic inflammation from rheumatoid arthritis (RA).

RA is a chronic inflammatory disease in which the body's immune system attacks the soft tissue or synovium that lines the surface of joints.

RA often affects the synovium between small joints in the hands and wrists, especially the metacarpophalangeal (MCP) joints, or knuckles, in the fingers.

Prolonged inflammation of the MCP joints can cause the fingers to appear swollen and to bend at abnormal angles.

As RA progresses, inflamed synovial cells can invade and damage the surrounding cartilage and bone, causing pain, joint deformities, and permanent joint damage.

RA has no specific cause, but its known risk factors include:

  • genetics and family history
  • infections
  • physical injuries
  • stress or emotional trauma
  • environmental exposures

Lupus

Lupus is an autoimmune disease that can affect any part of the body, including the joints, skin, and organs. According to the Office on Women's Health, women represent about 90% of adults with lupus in the U.S.

Lupus can affect the joints in the fingers and wrists, and it may cause ulnar deviation over time.

Other symptoms of lupus include:

  • muscle and joint pain

Osteoarthritis

Slight ulnar deviation in hand affected by rheumatoid arthritis. Image credit: James Heilman, MD, 2010.Share on Pinterest
Osteoarthritis is another type of arthritis that can cause joint deformity.
Image credit: James Heilman, MD, 2010.

Osteoarthritis (OA) is another possible cause of ulnar deviation.

OA is the most common type of arthritis, affecting over 30 million adults in the United States, according to the Centers for Disease Control and Prevention (CDC).

This condition causes pain, stiffness, and inflammation in the joints.

OA develops gradually as the cartilage between joints breaks down due to use and aging.

Psoriatic arthritis

There is an association between this type of arthritis and psoriasis, a chronic autoimmune condition that causes flaky, painful patches of skin. Like other forms of arthritis, psoriatic arthritis may cause ulnar deviation over time.

Approximately a quarter of people with psoriasis have psoriatic arthritis, according to a 2019 study.

Brachial plexus palsy

Brachial plexus palsy is a congenital condition that affects the nerves in the arm. It can cause weakness and loss of motion in the shoulder, arm, hand, and fingers.

Children born with brachial plexus palsy often develop ulnar deviation later in life.

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A doctor can give advice about exercises for ulnar deviation.

Treatments for ulnar deviation focus on managing symptoms and preventing the problem from getting worse.

The first step in treating ulnar deviation involves diagnosing and treating the underlying condition.

Using over-the-counter or prescription anti-inflammatory medications can control chronic inflammation and help reduce swelling and pain in the hand.

Splints and hand braces can keep the fingers in place while adding extra support to the wrist.

People may choose to undergo surgical procedures to fix a damaged ligament. Children born with brachial plexus palsy can undergo a ligament transplant or tendon transfers to correct ulnar deviation.

Ulnar deviation due to problems affecting the muscles or ligaments in the wrist may respond to physical therapy. Wrist and hand exercises may increase muscle strength and improve range of motion. People can perform these exercises at home while wearing a splint or a brace to keep the fingers from moving.

It is best to speak with a doctor before trying any new exercises. Exercises that they may recommend for ulnar deviation include:

  • Wrist flexion and extension:
    • place the forearm on a table so that the wrist bends over the edge
    • flex the wrist backward until the fingers point upward
    • relax the hand so that it bends over the table again
    • alternate between flexing and relaxing the hand
  • Tendon gliding:
    • begin with the fingers straight
    • make a hook fist by bending the fingers at the second knuckle
    • make a full fist
    • straighten the fingers and return to the starting position

Read about more hand and wrist exercises in this article.

Other home remedies to relieve painful inflammation in the hand and wrist include:

  • applying a hot or cold compress
  • eating more omega-3 fatty acids
  • massaging the joints gently
  • reducing stress with meditation and deep breathing exercises

Ulnar deviation causes the fingers to bend toward the outside of the hand. This condition often results from chronic inflammation relating to conditions such as arthritis.

However, people can develop ulnar deviation due to problems affecting the muscles or ligaments in the hand. Ulnar deviation is also a common complication of brachial plexus palsy.

Treating the underlying medical condition can help reduce ulnar deviation. People can relieve their symptoms with anti-inflammatory medications and physical therapy.