I've seen ulnar drift in my rt hand over the last yr. Is it something to worry about? When? What?I've seen ulnar drift in my rt hand over the last yr. Is it something to worry about? When? What?

The inflammation is controlled by Orencia and I only use Prednisone to knock down a flare and quickly taper. However, I've noticed the rightward drift of my fingers increasing over the last yr. I'll look down at my hand and see it resting with the palm and the fingers extending from the palm facing rightward. To hold both hands out straight (i.e., normally), I can feel in my right hand that I need to engage the muscles to keep the fingers straight. It isn't a major effort to do that, but I need to be aware of it, lest they drift back rightward.

Contextual Information on the rest of the right hand (I'm right-handed):
My right pinky has become bent (curved like a speed "hump" on a street, as opposed to a steeper speed "bump") and I can only straighten it by stretching out my entire palm and finger muscles, and even then it doesn't always completely flatten like the other fingers, unless I try to straighten only that finger, while leaving the others relaxed. Just looking at the finger in a relaxed state, it is always curved. I find myself straightening it with my other hand in an effort to stretch it straight. On occasion, but not currently, I have pain in the metacarpal phalangeal joint or the finger knuckle itself. As a result of my thumb joint being in frequent pain and swollen, I had surgery in 2008 on the right thumb knuckle to move the tendon back in place, in which a "screw" was placed to hold it and I was no longer able to flatten that joint. I have occasional discomfort in that joint and tend to flatten it out for relief.

Back to the ulnar drift:
First, my rheumatologist is pleased with how well I am doing on the Orencia, such that I have much less frequent swelling and was able to be taken off methotrexate and using prednisone only for a decreased frequency of flares.

My concern is that I am developing the ulnar drift deformity. My rheumatologist said that I don't need to worry, since I can move them back. He said there is another type where it is permanent. I asked him to confirm that was he was saying was that my being able to move them back means I don't have to worry about it being permanent (because it would already be).

Still, that doesn't make sense to me. I see my fingers drifting right becoming more pronounced. Last year, I was so worried I had a physical therapist give me some finger exercises to do to strengthen the muscles between the fingers (with palm flat on a surface, moving each finger back and forth one by one).

I would appreciate some clarification about ulnar drift, whether it is a sign of damage and pending deformity (or else, why would it be happening to begin with?), and what I should best do about it, watch for, etc.

On pages 271-2 in:
Apfelberg DB, Maser MR, Lash H, et al: Rheumatoid
hand deformities: Pathophysiology and treatment. West
J Med 129:267-272, Oct 1978,

the authors stated, "The indications for the use of silastic prosthetic
devices in the metacarpal phalangeal and interphalangeal joints include destruction of the articular joint surfaces with ulnar drift,
severe subluxation and persistent painful motion." It was recommended that synovitis be treated early in the disease process before articular
surfaces are damaged. This is only one article talking about the progression and damage from ulnar drift and what might be done about it, but it indicates that this a known and seemingly common deformity in RA.

I realize that the course of action for each case would vary, but my question is when is it that I should be thinking about what the ulnar drift is signifying about the disease process. I can't buy the "nothing to worry about" conclusion I received from my doctor. I also realize that doctors are individuals and can take various approaches in patient treatment. I am interested in hearing your thoughts on this and what I should be aware of.

I'm sorry my question took so long to ask. It was difficult to sum it up so that it reflected my circumstances.

Thank you in advance for any insight you could give me and for taking the time to read my detailed question. ;-)

Answers from our Doctors

tshaver's picture
Dr. Timothy S. Shaver says:

Patients with rheumatoid arthritis may develop ulnar drift of the digits even when the inflammatory component of their disease and their symptoms appear to be under control. This can be due to laxity of the soft tissues that may be residual from a period of active inflammation or due to structural damage of the joints themselves. If no hand films have been performed in the last year or two, I'd start here. Otherwise, if no structural damage is evident, a visit to Occupational Therapy can be useful, where joint protection measures can be pursued or splints can be designed, and the latter could potentially slow down the ulnar drift. In the absence of intractable pain or loss of hand function, I would not see an indication for surgery simply to cosmetically correct the deformity. It otherwise sounds like the inflammation is under control, and hopefully the drift in the digits will either halt or stabilize if you remain under good control.

Answered on: Friday, October 23, 2015 - 16:25


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