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Your Fingers Are Leaning Towards the Little Finger. A Splint Can’t Pull Them Back. Here’s What It CAN Do.
An ulnar drift splint, also called an MCP ulnar deviation splint, holds the knuckles in line when rheumatoid arthritis makes the fingers DRIFT towards the little-finger side.
Worn during daily tasks, it eases knuckle pain, lines the fingers up for pinch and grip, and takes away some of the force that pushes the drift further. A resting splint at night helps during flares.
It doesn’t reverse a drift that has already set. It works best early, alongside good control of the arthritis itself.
Here’s what you’re living with. The fingers fan sideways like they’re all trying to point at the same thing. Pinch slides off the side of the index finger. Jar lids win. The knuckles ache by evening, and your rings sit crooked.
And here’s the bit nobody tells you early enough. Every pinch and every twist adds a little more sideways push. Once the tendons have slipped off the top of the knuckles, every grip pulls the fingers further across, and over years the knuckles can start to slide downwards too. At that point no splint lines them back up.
You can’t control everything about rheumatoid arthritis. You CAN control a lot of the force going through those knuckles every day.
Why do the fingers drift in rheumatoid arthritis?
- Inflamed joint lining stretches the ligaments that hold the knuckles and the tendons in place. See rheumatoid arthritis in the hands.
- The extensor tendons slip off the top of the knuckles towards the little-finger side, like a sagittal band injury in slow motion.
- Everyday grip pushes the fingers the same way. Opening jars, turning keys and pinching with the thumb all add sideways force.
- Once the tendons sit off-center, every grip pulls the fingers further across.
- The wrist often joins in, tilting the other way, which sets the fingers up to swing further towards the little finger.
The splint can’t undo the drift. It can take away the force that keeps making it worse.
Is it rheumatoid arthritis or something else?
- Blood tests for rheumatoid factor, anti-CCP antibodies and inflammation markers.
- X-rays show joint space, erosions and whether the knuckles have started to slip.
- Ultrasound shows active inflammation in the joint lining and around the tendons, sometimes before X-rays change.
- Other causes: lupus and psoriatic arthritis can drift the fingers too. Osteoarthritis usually hits the end and middle finger joints and the thumb base, not the knuckles. See types of arthritis in the hands.
A rheumatologist sorts out the diagnosis and the medication. A hand therapist sorts out the splint, the exercises and how you use the hand. You want both.
Can a splint fix ulnar drift?
Honest answer: no. Not once it’s set.
- What it does while you wear it: lines the fingers up, which usually means less knuckle pain and a better pinch.
- What it might do over time: reduce the sideways force during the tasks that cause the most drift. The research on splints slowing drift over years is limited, so I don’t sell it as a cure.
- What it can’t do: shorten stretched ligaments, or put slipped tendons back on top of the knuckles.
Which ulnar drift splint is best?
- Soft splints: neoprene or fabric with dividers between the fingers. Comfortable for day use and easy to wear during tasks. Most people start here.
- Thermoplastic splints: a firmer base across the palm with posts or loops that guide each finger back into line. Better control, a bit bulkier.
- Resting splints at night: for active flares, a resting hand splint shaped to support the knuckles in line.
- Ring splints: for swan neck or unstable finger joints that often come with drift. See figure-of-eight ring splints and swan neck deformity.
The right one is the one you’ll actually wear while cooking. A perfect splint in a drawer does nothing.
How long should I wear an ulnar drift splint?
- By day, for the hard tasks. Cooking, cleaning, gardening, carrying, long spells of typing. Usually a few hours spread across the day, not all day.
- At night during a flare. A resting splint while the knuckles are hot and swollen, then back off once the flare settles.
- Off for exercises, washing and rest. A hand splinted all day with no movement stiffens.
- Long term. Rheumatoid arthritis is a long game. Most people use a day splint on and off for years, more during bad patches.
Where are you in the window?
- OPEN: the fingers drift but push back into line easily. This is when a splint, exercises and joint protection do the most.
- CLOSING: the drift is stiffening, and the fingers only partly come back into line. Splinting and joint protection still matter, and it’s time to ask whether the arthritis is properly controlled.
- SHUT: the drift is fixed, or the knuckles have slipped downwards. A splint won’t line them up. The goal changes to comfort and function, and this is where surgery comes into the conversation.
Exercises for ulnar drift
Gentle and regular beats hard and occasional. During a hot flare, keep to gentle movement only.
- Finger walks: hand flat on the table. Lift and move each finger, one at a time, towards the thumb side. Start with the index. 5 to 10 times, 2 to 3 times a day.
- Tendon glides: straight hand, hook fist, full fist, straight fist. 10 times, twice a day. Keeps the tendons sliding and the joints moving.
- Straight-finger lift: hand flat, palm down. Lift each finger off the table and lower it. 10 times each, once or twice a day. Works the muscles that hold the knuckles straight.
- Gentle grip: squeeze soft putty with the fingers kept in line, 10 times, once a day, when the hand isn’t flaring. Your therapist will tell you if your joints need a different program.
Joint protection that takes the force off
- Open jars with your left hand, close them with your right. That way the twist pushes your fingers towards the thumb side, not away from it.
- Turn keys with the palm using a key turner, instead of pinching.
- Thicker handles on pens, cutlery, toothbrushes and garden tools. Less squeeze, less force.
- Two hands, palms flat for kettles, pots and plates.
- Carry bags on the forearm, not hooked on the fingers.
- Push up from a chair with flat palms, not on bent knuckles.
When is surgery considered?
- Tendon realignment: for drift that’s still flexible but painful, the surgeon can move the slipped tendons back to the middle of the knuckles.
- Knuckle joint replacement: for fixed drift with pain and poor function. Afterwards a dynamic splint is usually worn for around 6 weeks, then a night splint for about 3 months, sometimes longer. An ulnar drift splint by day protects the new alignment after that.
- Tendon repair or transfer: when a tendon has ruptured over a worn joint.
Work, driving and daily tasks
- Desk work: usually fine. A soft splint can be worn while typing, with breaks every 30 to 45 minutes to move the hands.
- Manual work: depends on the disease activity and the job. Gripping tools for hours is hard on drifting knuckles. Padded handles and job changes during flares help.
- Driving: a padded steering wheel cover reduces the squeeze. Avoid driving during a flare if you can’t grip firmly enough to control the car in an emergency.
Problems to watch for
- Pressure on fragile skin, especially on steroid or other thinning medications.
- Swelling during a flare making a splint too tight.
- Stiffness if the splint is worn all day with no movement.
Get it checked today if
- A finger suddenly can’t straighten at the knuckle, or drops. That can mean a ruptured tendon, and earlier repair usually goes better.
- One joint is suddenly hot, red and very painful, especially with a fever. On immune-lowering medication, an infected joint needs ruling out urgently.
Get it checked if
- Hot, swollen joints despite your treatment. Your rheumatologist needs to know.
- Drift getting worse quickly.
- Skin breaking down under the splint.
- Numbness or tingling in the thumb, index and middle fingers. Carpal tunnel syndrome is common in rheumatoid arthritis.
This is one of dozens of splints a hand therapist makes. See what a hand therapist does for the full list.
Line the knuckles up during the day, rest them at night in a flare, and control the arthritis underneath.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Fingers that are drifting faster this year than last deserve a review with both your rheumatologist and a hand therapist.
Part of: Hand, wrist and elbow splints: which one, why and how long
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.