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Ulnar deviation, or ulnar drift, occurs when the joints in the wrist and hand shift so that the fingers bend toward the ulna bone on the outside of the forearm. This condition can result from chronic inflammation, problems with the ligaments or muscles, or structural congenital abnormalities. The primary symptom of ulnar deviation is that the hand bends towards the wrist, which can make certain activities, such as tying shoelaces or gripping small objects, difficult over time. Treatment for ulnar deviation typically involves managing symptoms and preventing the condition from worsening, with a focus on treating the underlying cause. The flexor carpi ulnaris (FCU) is a muscle that plays a role in ulnar deviation, as it is responsible for flexing and adducting the hand at the wrist joint.
| Characteristics | Values |
|---|---|
| Definition | Ulnar deviation is a condition where the fingers bend towards the ulna bone on the outside of the forearm. |
| Causes | Problems with the joints, muscles, or ligaments in the wrist or knuckles. |
| Symptoms | Bending of the fingers towards the outside of the hand. |
| Treatment | Anti-inflammatory medications, physical therapy, occupational therapy, splints, hand braces, and in some cases, surgery. |
| Muscles Involved | Flexor Carpi Ulnaris (FCU) and Extensor Carpi Ulnaris. |
| Muscle Function | The FCU is a powerful wrist flexor and assists in wrist adduction and forearm flexion. |
| Anatomy | The wrist is a series of small joints connecting the radius and ulna bones in the forearm to the carpals in the hand. |
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What You'll Learn
The flexor carpi ulnaris (FCU) muscle
The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint. It is the most medial flexor muscle in the superficial compartment of the forearm. The FCU has two heads: a humeral head and an ulnar head. The humeral head originates from the medial epicondyle of the humerus via the common flexor tendon, while the ulnar head originates from the medial margin of the olecranon of the ulna and the upper two-thirds of the dorsal border of the ulna by an aponeurosis.
Between the two heads of the FCU passes the ulnar nerve and ulnar artery. The FCU is the only muscle in the anterior compartment that is fully innervated by the ulnar nerve, which gains access to the forearm by passing between the humeral and ulnar heads of the muscle. The FCU receives its arterial blood supply from the ulnar collateral arteries, along with the anterior and posterior ulnar recurrent arteries.
The FCU inserts onto the pisiform, hook of the hamate (via the pisohamate ligament), and the anterior surface of the base of the fifth metacarpal (via the pisometacarpal ligament). The tendon of the FCU can be seen and palpated beneath the skin immediately proximal to the wrist joint. It is the most medial of the tendons in the distal forearm, sitting just before the wrist.
The FCU acts in tandem with the flexor carpi radialis to flex the wrist and with the extensor carpi ulnaris to adduct the wrist. Together, the FCU and the extensor carpi ulnaris produce ulnar deviation or ulnar flexion, where the hand and wrist tilt towards the pinky and ulna.
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Ulnar deviation and wrist flexion
Ulnar deviation occurs when the joints in the wrist and hand shift, causing the fingers to bend towards the ulna bone on the outside of the forearm. This condition often results from chronic inflammation related to conditions such as arthritis. Ulnar deviation can also be caused by problems with the ligaments or muscles in the hand and wrist, or by structural congenital abnormalities.
The wrist is a series of small joints that connect the radius and ulna (the two bones in the forearm) to the carpals in the hand. The radiocarpal joint, located at the intersection of the distal end of the radius and the proximal row of carpals, allows the hand and wrist to move up and down and side to side. This side-to-side movement causes the hand and wrist to "tilt" into radial and ulnar deviation.
The flexor carpi ulnaris (FCU) is a superficial flexor muscle of the forearm that flexes and adducts the hand. It is the most powerful wrist flexor and the only anterior forearm compartment muscle completely innervated by the ulnar nerve. The FCU tendon is a landmark for locating the ulnar nerve and artery during surgery.
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Ulnar nerve and artery
The ulnar nerve and the flexor carpi ulnaris muscle work together to tilt the hand and wrist toward the little finger and ulna in a movement known as ulnar deviation. The ulnar nerve is the only nerve in the anterior compartment that fully innervates the flexor carpi ulnaris muscle. The ulnar nerve gains access to the forearm by passing between the humeral and ulnar heads of the flexor carpi ulnaris.
The ulnar nerve and artery are both crucial to the upper limb and its functions in daily life. The ulnar artery is one of the two main arteries in the forearm, arising from the brachial artery as its larger terminal branch at the level of the cubital fossa. It starts just below the elbow and extends along the outer edge of the forearm, closest to the little finger. It supplies oxygenated blood to the forearm, wrist, hand, and fingers.
The ulnar nerve and artery travel distally together and enter the hand through the Guyon canal, also known as the ulnar tunnel. The ulnar nerve is located directly radial to the ulnar artery. The ulnar artery plays a significant role in the blood supply to the flexor carpi ulnaris muscle.
The ulnar nerve and artery are vulnerable to injury due to their superficial location in the volar wrist. They can be injured together with the flexor carpi ulnaris tendon because of their close anatomical relationship. Ulnar artery transection can lead to substantial blood loss, requiring direct pressure and elevation to control the bleeding.
In summary, the ulnar nerve and artery are important anatomical structures that contribute to the function of the upper limb. They supply oxygenated blood to the forearm, wrist, hand, and fingers, as well as innervate the flexor carpi ulnaris muscle, which is crucial for ulnar deviation.
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Ulnar deviation causes
Ulnar deviation is caused by issues with the joints, muscles, or ligaments that result in the fingers bending towards the bone on the outside of the forearm. It is often observed at birth and can be mild or severe. The ulna is frequently absent or hypoplastic, leading to marked pronation or anterior bowing of the ulna, which causes the hand to orient internally or posteriorly. This can result in decreased growth of the distal radial physis, ulnar deviation of the wrist, bowing of the radius, and dislocation of the radial head.
Ulnar deviation can also develop later in life due to chronic inflammation, problems with ligaments or muscles, or structural congenital abnormalities. Underlying medical conditions, such as rheumatoid arthritis, osteoarthritis, and brachial plexus palsy, can contribute to ulnar deviation. Osteoarthritis, the most common form of arthritis, causes joint pain, stiffness, and inflammation, leading to ulnar deviation over time. Brachial plexus palsy is a congenital condition affecting arm nerves, resulting in weakness and loss of motion in the upper extremities.
The flexor carpi ulnaris and extensor carpi ulnaris muscles are primarily responsible for ulnar deviation of the wrist. These muscles work together to cancel flexion and extension, pulling the hand and wrist towards the ulna, or pinky finger side. The flexor carpi ulnaris is the most medial flexor muscle in the forearm's superficial compartment. It adducts and flexes the wrist, working in tandem with the flexor carpi radialis and extensor carpi ulnaris to achieve ulnar deviation.
Ulnar deviation can be treated through anti-inflammatory medications and physical therapy, focusing on passive stretching and splinting to correct deviation deformities at the wrist. Surgical corrections are also an option, depending on the specific deformities present. Procedures can involve the hand, wrist, forearm, and elbow, with the most frequent interventions addressing the thumb and thumb web space.
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Ulnar deviation treatments
Ulnar deviation is a condition in which the fingers bend towards the little finger, often caused by chronic inflammation of the connective tissue supporting the MCP joints. This inflammation is usually associated with autoimmune diseases such as rheumatoid arthritis (RA), lupus, scleroderma, polymyositis, and Sjögren's disease. It can also be caused by joint deformity due to osteoarthritis or psoriatic arthritis. Genetics may also be a factor, with a type of ulnar deviation called windblown hand potentially running in families.
Ulnar deviation treatment focuses on managing symptoms and preventing the condition from worsening. The first step is diagnosing and treating the underlying condition. Over-the-counter or prescription anti-inflammatory medications can be used to control chronic inflammation and reduce swelling and pain in the hand. Doctors may recommend non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve) to manage pain and swelling. In more severe cases, a rheumatologist may prescribe disease-modifying anti-rheumatic drugs (DMARDs) to halt the progression of ulnar deviation.
Additionally, exercise treatment can help manage symptoms. Depending on the severity, treatment may range from simple wrist, hand, and finger exercises to wearing a splint or hand brace to keep the fingers in place and provide extra support to the wrist. Physical therapy or occupational therapy can be beneficial for ulnar deviation caused by problems with muscles or ligaments in the wrist or hand. These exercises can increase muscle strength and improve the range of motion.
In rare cases, surgery may be recommended to fix deformities, relieve pain, and improve functioning. For children born with brachial plexus palsy, a ligament transplant or tendon transfer can correct ulnar deviation. Transcutaneous nerve stimulation, which uses electricity to treat pain, is another option to reduce pain associated with ulnar deviation. Home treatments such as hot or cold therapy can also provide relief by helping to increase the range of motion and reduce pain and swelling.
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Frequently asked questions
Ulnar deviation is a condition where the fingers bend towards the ulna bone on the outside of the forearm. It is caused by problems with the joints, muscles, or ligaments in the wrist or knuckles.
Ulnar deviation can cause the fingers to bend towards the outside of the hand, making certain activities, such as tying shoelaces or gripping small objects, difficult over time.
The flexor carpi ulnaris (FCU) and extensor carpi ulnaris muscles are involved in ulnar deviation. They work together to cancel flexion and extension, pulling the hand and wrist towards the ulna.
Treatment for ulnar deviation focuses on managing symptoms and preventing the condition from worsening. Doctors may recommend anti-inflammatory medications, physical therapy, or occupational therapy to treat the underlying condition. In some cases, surgical procedures may be necessary to fix damaged ligaments.
Ulnar deviation can be caused by chronic inflammation, structural congenital abnormalities, or conditions such as arthritis or brachial plexus palsy.
