PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

1. 1
ULNAR DEVIATIONSPROBLEM BASED LEARNING (PBL)
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

2. • Also known as ulnar drift.
• Condition:
• Wrist or fingers shift in the direction of the
Ulna
• Or it shift towards the little finger side of the
forearm.
• Due to inflammation at metacarpophalangeal
joints.

3. involvement in both
hands with enlarged
metacarpophalangeal
joints and ulnar deviation

4. Physiological movement of the wrist
Measure by protractor goniometer.

5. Boggy Joint Swelling

6. • In trigger 2,
- The patient noticed the formation of boggy
swelling on her fingers, wrist and elbows.

7. Causes: Synovitis
- Synovitis causes ‘boggy’ joint swelling
- The skin overlying the affected joint is
warm and red due to increased in blood
flow.
- On palpation, the swelling is tender (not
hard but pain)

8. In RA,
immune system attacks the lining of the joint
(synovium)  Inflammation  Releasing
chemicals  Synovium thickening and damaging
the bones, cartilage, ligament and tendon

9. BOUTONNIERE DEFORMITY

10. ANATOMY OF FINGER

11. • PIP joint to become flexed (bent)
• DIP joint is pulled up into too much extension
(hyperextension)

12. CAUSES
• This disorder most often results from rheumatoid
arthritis
• but can also result from injury (such as deep cuts,
joint dislocations, or fractures)
• People with rheumatoid arthritis can develop the
disorder because they have long-standing
inflammation of the middle joint of a finger.
• If the deformity is caused by an injury, the injury
usually occurs at the base of a tendon (called the
middle phalanx extensor tendon)

13. The tendons which straighten these joints are
a bit complicated. They are like strings running
from the the sides and the back of the finger
to a sheet on the top of the finger.
When the finger is hit or bent forcefully in just
the wrong way, the sheet on the top of the
finger (the central slip of tendon) tears away
from its attachment
As a result, the middle joint (called the
proximal interphalangeal joint) becomes
“buttonholed” between the outer bands of the
tendon that runs to the end of the finger (that
is, the bones of the joint push out through the
bands of the tendon like a button through a
buttonhole).

14. TREATMENTNON SURGICAL SURGICAL

15. NON SURGICAL
Protection: If you participate in sports, you may have to wear protective
splinting for several weeks after the splint is removed.
Exercises: Your physician may recommend stretching exercises to improve the
strength and flexibility in the fingers.
Splints: A splint will be applied to the finger at the middle joint to straighten it. This
keeps the ends of the tendon from separating as it heals. It also allows the end joint
of the finger to bend. It is important to wear the splint continuously for the
recommended length of time -- usually 6 weeks for a young patient and 3 weeks for
an elderly patient. Following this period of immobilization, you may still have to wear
the splint at night.

17. SURGICAL
• The deformity results from rheumatoid
arthritis.
• The tendon is severed.
• A large bone fragment is displaced from its
normal position.
• The condition does not improve with splinting.

18. BOUTONNIERE VS SWAN NECK