Diagnosis

An X-ray is usually taken to confirm the diagnosis. X-rays are usually the only imaging procedures that can be meaningful. However, they are usually only meaningful if the disease is already in an advanced stage.

A positive x-ray result is only obtained if bony changes have already formed as a result of the more advanced arthrosis. In such stages, X-rays taken under stress can also show instability of the joint. This is then usually due to a loosened capsule ligament apparatus.

History

The arthrosis of the thumb saddle joint usually progresses insidiously, so that its full picture develops only over a longer period of time (months to years). In addition, not every course is the same, so that the intensity of the symptoms can vary considerably from patient to patient. At the beginning of the disease, load-dependent pain in the area of the ball of the thumb gradually occurs (e.g. rotational movements when unscrewing lids, gripping difficulties), which usually return in resting states.

Over time, however, the intensity, frequency and duration of the painful complaints increase until there are hardly any painless phases – neither under stress nor at rest. In the further course of the disease, the thumb saddle joint becomes more and more deformed due to arthrosis, so that the thumb no longer sits completely centrally in the joint and the external contour of the thumb or ball of the thumb can also change. The coordination of hand movements becomes worse and worse and gripping movements weaker and weaker. In the final stage, when the thumb saddle joint is completely stiffened, even a complete functional failure of the thumb is possible and thus a functional restriction of the entire hand. – Metacarpal bone (thumb)

Large polygonal bone (Os trapezium)

Treatment of arthrosis of the thumb saddle joint

In the majority of cases, arthrosis of the thumb saddle joint is treated conservatively. Surgical techniques are used only rarely and in cases of severe disease. The primary goal of conservative therapy is to relieve pain in the thumb and thereby improve the ability of the affected hand to function.

Pain relief is achieved by treating the underlying inflammation. Since this is an inflammation that is not caused by bacteria, no antibiotics are used. The basis of conservative therapy is the immobilization of the thumb.

If necessary, a so-called thumb orthosis can be used, but it should not be worn permanently. In addition to protecting the thumb, local cooling of the thumb saddle joint can also alleviate complaints. In addition, ointment dressings (e.g. Voltaren® ointment) and anti-inflammatory non-steroidal anti-rheumatic drugs (NSAIDs) such as diclofenac or ibuprofen are used.

In the latter case, however, the intake should be limited in time due to their side effect profile. If adequate pain relief is not achieved with the above-mentioned measures, a cortisone injection into the joint space can be given. Although this often leads to a permanent improvement of the symptoms, it should not be carried out too often due to the side effects.

If the symptoms persist despite correct implementation of the above-mentioned therapy, a surgical procedure may be considered. Among the possible conservative forms of therapy are If it is a simpler form of thumb saddle joint arthrosis, and especially if the arthrosis has been detected at an early stage, conservative therapy in the form of physiotherapy is usually indicated. During this time, additional drug therapy is usually carried out in the form of taking specific rheumatism medication (Celebrex®, Voltaren®, Ibuprofen), which is intended to relieve the acute pain in particular.

If pain occurs during periods of stress, the patient is usually prescribed an orthosis/bandage. It must be taken into account that although the joint is protected, muscles are also weakened, for example. For this reason, orthosiss/bandage should only be worn if urgently necessary, for example in load situations.

Wearing should never become a habit! Cortisone is usually injected when the joint space in thumb saddle joint arthrosis has only been minimally altered by cartilage wear. The injection is made directly into the joint, so there are also injection-related risks, such as the risk of infection.

Side effects of cortisone, which affect the entire body, generally do not occur. The aim of such an injection is to bring about as long a phase of freedom from symptoms as possible. Overly frequent injections should be avoided, as in addition to the general risk of infection, regression of skin and fatty tissue can also occur.

Treatment with heat
Taking so-called anti-inflammatory drugs (NSAIDs)
Corticoid infiltration in the joint area
Manual therapy (form of physiotherapy)
Immobilisation of the joint by applying a cuff or a splint

The use of a tape in the treatment of arthrosis of the thumb saddle joint is a good conservative therapy option. The characteristic of tape bandages is that although the thumb saddle joint is stabilised and its mobility is deliberately restricted, complete immobilisation is not achieved. The slightly elastic plaster strips of these so-called functional bandages, which stick to the skin above the joint, transfer the forces generated in the joint to the skin and thus support the capsule-ligament apparatus, prevent excessive movement and improve the perception of movement.

In addition, they can relieve pain, correct joint malpositions and improve lymph drainage. The so-called kinesiotape, which is applied to the thumb saddle joint by the treating physician or physiotherapist using a specific adhesive technique, is particularly well established. In most cases, surgery as a therapeutic measure for arthrosis of the thumb saddle joint is only considered when the alternative, conservative therapy methods have been exhausted and have not led to a desired result over a longer period of time.

First of all, a classic arthroscopic procedure under outpatient general anaesthesia may be useful, which gives the attending physician the opportunity to obtain a direct picture of the joint situation and the extent of the arthrosis on the one hand, and to carry out initial therapeutic measures (e.g. smoothing of joint cartilage) on the other. These can, preferably in the early stages, already lead to relief of symptoms. A further possibility for moderately advanced arthrosis in the thumb saddle joint is so-called denervation, in which the pain-transmitting nerve fibres of the thumb saddle joint are destroyed under local anaesthetic.

However, a disadvantage of this procedure is that the effect does not necessarily last in the long term, as the pain transmission can be taken over by other nerve fibres after a few years and the arthrosis symptoms can therefore reoccur over time. In cases of highly advanced arthrosis of the thumb saddle joint, arthroscopic surgery is usually no longer sufficient, so that other surgical methods must be used. One possibility is joint replacement, which can be performed with or without foreign material.

The so-called resection arthroplasty is based on a joint replacement made from the patient’s own tissue. The thumb saddle joint destroyed by arthrosis is removed under regional or general anaesthesia (the large polygon bone is usually removed) and reconstructed from the forearm (from the radial flexor carpi muscle) using a donor tendon. Although the operation is more complicated in this case, the thumb length and loss of strength can be compensated for to a large extent.

The thumb saddle joint can also be reconstructed using artificial endoprostheses. These consist of an anchorage in the first metacarpal bone, on which a ball sits, and an artificial socket with a special coating, which is inserted in the trapezoid bone. Whether the two components fit together as in a natural joint or are flexibly connected is optional.

However, the insertion of artificial saddle joint prostheses is also occasionally used in the surgical treatment of arthrosis of the thumb saddle joint, although studies have not yet been able to establish any significant advantages over autologous tissue replacement. In saddle joint arthroplasty, the large polygon bone involved in the thumb saddle joint is removed. Although this technique has a high success rate, the patient must expect a relatively long healing process of three to six months, during which time the mobility of the thumb is initially severely restricted.

In addition, the thumb is shortened as a result of the bone removal and the remaining strength is reduced. A physiotherapeutic treatment of the hand is necessary in any case in order to keep the extent of restricted movement and reduced strength as low as possible. A further procedure is the so-called resection augmentation transfixation arthroplasty (RATA), which does not use either the patient’s own or foreign material transplants.

Here, too, the defective polygon bone involved in the joint is removed under general anesthesia and then the joint capsule is reinforced without foreign material, while at the same time the metacarpal of the thumb is fixed to the index finger bone with a wire. This wire, which remains in the hand for approx. 6 weeks, enables a stable scarring, which allows sufficient mobility and stability of the thumb saddle joint.

After fitting an endoprosthesis, there is a risk of infection as well as the risk of it breaking out of its anchoring in the bone or falling victim to material fatigue. With regard to the materials used, there have been repeated innovations over the past decades in order to optimize the life of the endoprosthesis. Although great progress has been made in this respect, there is a lack of long-term studies on the durability of the latest developments.

In addition to a conservative or surgical therapy method, it is also possible to try to treat thumb saddle joint arthrosis with homeopathic approaches. Although in many cases the effect of alternative medical healing methods cannot be fully scientifically proven, they offer a good possibility for many patients with arthrosis complaints to relieve their symptoms. One possibility is to take a certain Schuessler salt combination (No.

1, 2, 8, 9, 11, 16) to relieve the pain of the thumb saddle joint arthrosis. Other remedies for the treatment of arthrosis in homeopathy include Rhus toxicodendron (poison sumac; drops D12), Caulophyllum (female root; drops D6), Dulcamara (bittersweet; drops D12) as well as the use of certain medicinal plants such as nettle, devil’s claw, dandelion or cayenne pepper. But acupuncture and the local use of leeches can also have analgesic, anti-inflammatory and decongestant effects.