Logan Steele
Ulnar deviation is a condition where the fingers bend towards the ulna bone on the outside of the forearm. This happens when the joints in the wrist and hand shift due to problems with the joints, muscles, or ligaments. The condition can cause the hand to tilt and glide from side to side. The muscles involved in ulnar deviation are the flexor carpi ulnaris and extensor carpi ulnaris, which work together to cancel flexion and extension, pulling the hand towards the ulna. The flexor carpi ulnaris is the most medial flexor muscle in the forearm and is the only muscle in the anterior compartment innervated by the ulnar nerve.
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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 is the only muscle in the anterior compartment that is fully innervated by the ulnar nerve. The ulnar nerve gains access to the forearm by passing between the humeral and ulnar heads of the FCU.
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. The ulnar head originates from the olecranon and proximal part of the posterior border of the ulna. Between the two heads passes the ulnar nerve and ulnar artery.
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 FCU tendon insertion serves as a landmark in finding the ulnar nerve and ulnar artery, which are lateral to the tendon at the wrist joint. The FCU shares a common tendon with the other wrist flexors and can be involved in various pathologies associated with them, such as medial epicondylalgia.
The FCU flexes and adducts the hand at the wrist joint. It acts in tandem with the flexor carpi radialis to flex the wrist and with the extensor carpi ulnaris to adduct the wrist. The FCU can be palpated by locating the bony landmarks associated with the muscle, including the medial epicondyle (origin), the olecranon process (to identify the ulna), and the pisiform bone (insertion). After identifying these landmarks, the person is asked to perform ulnar deviation and wrist flexion simultaneously to locate the FCU muscle.
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Ulnar deviation treatment
Ulnar deviation is a condition that causes the fingers to bend towards the little finger due to swollen knuckle bones. It is often a result of chronic inflammation caused by arthritis or other underlying medical conditions. Treatment for ulnar deviation focuses on managing symptoms and preventing the condition from worsening.
The first step in treating ulnar deviation is diagnosing and treating the underlying condition. Ulnar deviation is commonly associated with rheumatoid arthritis (RA), but it can also occur with other conditions such as lupus, osteoarthritis, psoriatic arthritis, and brachial plexus palsy. Treating the underlying condition can help reduce ulnar deviation. For example, medication can be used to slow down the progression of RA and improve symptoms.
To relieve painful inflammation in the hand and wrist, anti-inflammatory medications, both over-the-counter and prescription, can be used to control chronic inflammation and reduce swelling and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve) can be recommended by a doctor to help manage pain and swelling.
In some cases, a doctor may refer patients to a rheumatologist, who may prescribe disease-modifying anti-rheumatic drugs (DMARDs) to halt ulnar deviation progression. However, smoking cigarettes lowers the effectiveness of DMARDs.
In rare cases, surgery may be recommended to fix a damaged ligament, relieve pain, and improve functioning. Surgical procedures depend on the specific deformities present and can include ligament transplants, tendon transfers, and other corrective procedures for the hand, wrist, forearm, and elbow.
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Ulnar deviation causes
Ulnar deviation, also known as ulnar drift, is a hand deformity that occurs when the knuckle bones, or metacarpophalangeal (MCP) joints, become swollen, causing the fingers to bend abnormally toward the little finger. This condition is progressive and can cause the hands to appear bent and distorted. It is often linked to arthritis, particularly rheumatoid arthritis (RA), an autoimmune disorder that causes inflammation and damage to the MCP joints and surrounding structures. Over time, this can lead to joint erosion and bone erosion. While RA is the most common cause, ulnar deviation can also occur with other autoimmune diseases such as lupus and diffuse connective tissue disorders (DCTDs), including scleroderma, polymyositis, and Sjögren's disease.
In addition to autoimmune conditions, ulnar deviation has been associated with brachial plexus palsy (BPP), a type of paralysis resulting from nerve injuries in the shoulder. BPP can arise from various factors, including sports injuries, trauma, inflammation, pressure, or tumours. Another uncommon disorder linked to ulnar deviation is pigmented villonodular synovitis (PVNS), characterised by abnormal growth of the tissue lining the joints and tendons (synovium). Genetics may also play a role, as suggested by the occurrence of a hereditary form of ulnar deviation known as windblown hand, where the fingers tilt outward and cannot be corrected without pain.
Ulnar deviation is typically noticed at birth and can present with a range of abnormalities. Hand abnormalities are prevalent, with a high percentage of cases involving missing fingers, syndactyly, and radial-sided hand defects. Elbow abnormalities, such as radial head dislocation and radiohumeral synostosis, are also common. Despite these abnormalities, individuals with ulnar deviation may still retain good functionality. Early intervention with passive stretching and splinting can help correct deviation deformities at the wrist and improve overall hand function.
While ulnar deviation does not typically interfere with daily tasks initially, it can progress over time, making certain activities more challenging. Treatment focuses on managing symptoms and maintaining quality of life. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are often recommended to manage pain and swelling. Splinting is another approach to positioning MCP joints correctly and relieving pain. In more severe cases, surgery may be considered to improve function and aesthetics, although the number of reported cases of surgical intervention is relatively small.
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Ulnar nerve and artery
The ulnar nerve is one of the three main nerves in the arm and controls the muscles in the forearm and hand. It is located in the arm and runs from the shoulder to the hand, supplying movement and sensation to the forearm and hand. The nerve is responsible for the ability to move the fingers and feel sensations on the palm-side of the hand.
The ulnar artery is one of the two main arteries in the forearm. It is a branch of the brachial artery, which arises from the cubital fossa and traverses through the medial (ulnar) side of the forearm. Starting just below the elbow, it extends along the outer edge of the forearm, closest to the pinky finger. It is responsible for providing oxygen-rich blood to the forearm, wrist, hand, and fingers.
The ulnar artery plays a significant role in the blood supply to the forearm muscles, wrist bones and joints, and the hand. It provides an important contribution to the vascular supply to the hand and upper extremity. As it travels through the forearm, it runs deep to the flexor carpi ulnaris muscle and radial to the ulnar nerve. It then enters the hand through the Guyon canal, also known as the ulnar tunnel, a longitudinal fibro-osseous tunnel at the wrist.
The ulnar artery forms the superficial palmar arch, an important vascular structure in the hand. The superficial palmar arch curves radially and lies deep to the palmar aponeurosis and superficial to the flexor tendons. Common digital arteries emerge from the superficial palmar arch to supply blood to the ulnar three digits and the ulnar aspect of the index finger.
The ulnar nerve and artery are closely related anatomically and can be injured together. The ulnar artery transection can lead to substantial blood loss, and pulsatile bleeding may occur from the ulnar aspect of the wrist.
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Ulnar deviation exercises
Ulnar deviation is a condition that can be observed at birth, and it can cause a range of abnormalities in the elbow, wrist, and hand. While some cases may have mild symptoms, others may experience severe issues, such as missing fingers or hand defects. To address ulnar deviation and improve wrist strength, specific exercises can be performed. Here are some ulnar deviation exercises that can aid in strengthening the wrist and managing associated symptoms:
Straight Bar Ulnar Deviation:
This exercise involves using a straight bar attachment to challenge the muscles of the forearm. Begin by holding one end of the bar with your elbow extended and your arm in a fixed position. Position the bar so that it extends straight behind you. Then, bend your wrist to bring your little finger closer to your forearm, performing an ulnar deviation movement. The exercise becomes easier when your grip is closer to the centre of the bar.
Resisted Ulnar Deviation:
Resisted ulnar deviation is beneficial for strengthening the wrist after an injury. It can help reduce symptoms like swelling, stiffness, and pain caused by injuries or inflammatory conditions. This exercise is particularly useful when there is mild pain.
Passive Stretching and Splinting:
For individuals with ulnar deviation, early intervention with passive stretching and splinting can be crucial to correcting deviation deformities at the wrist. These exercises can help improve functionality and correct any abnormalities.
It is important to note that the specific exercises recommended for individuals with ulnar deviation may vary depending on the severity of their condition and the affected body parts. Seeking professional advice from a healthcare provider or physiotherapist is always recommended before starting any new exercise routine. They can guide you in choosing the most suitable exercises and ensure proper form to promote safe and effective recovery or management of ulnar deviation.
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Frequently asked questions
Ulnar deviation is when the fingers bend towards the ulna bone on the outside of the forearm due to problems with the joints, muscles, or ligaments.
Ulnar deviation involves the flexor carpi ulnaris (FCU) and extensor carpi ulnaris muscles.
Ulnar deviation can be caused by chronic inflammation, problems with the ligaments or muscles, or structural congenital abnormalities. It is often associated with conditions such as arthritis.
