The thumb is involved in 25 percent of daily activities. However, if the thumb causes pain or actual loss of function occurs, enormous suffering occurs as a further consequence. Rhizarthrosis is usually responsible for thumb pain.
What is rhizarthrosis?
The thumb saddle joint provides the connection between the first metacarpal bone and the carpus, so there is a connection to the base of the thumb. If rhizarthrosis, an osteoarthritis of the thumb saddle joint, occurs subsequently pain, which – depending on the course of the disease – can become increasingly severe.
Causes
One reason why rhizarthrosis occurs may be mechanical overuse of the thumb. Sometimes ligament instability can also trigger rhizarthrosis. The pain is caused by the worn joint cartilage. Subsequently, the thumb swells; inflammation occurs in the tissue. This is followed by the typical bone changes (formation of jagged edges) and a narrowing of the joint. In the advanced stage of the disease, the cartilage coating is worn away to such an extent that the bones rub against each other.
Symptoms, complaints, and signs
Affected individuals initially complain of pain with the tip grip between the index finger and thumb; sometimes there is also a pressure pain on the extensor side. Even twisting movements can cause pain. Since the movements are everyday activities, those affected notice relatively quickly that the thumb is “insulted.” Screw caps can no longer be opened without pain; even carrying beverage bottles can sometimes cause pain. Those affected describe the feeling of an “unstable thumb”; thus, patients repeatedly describe that the thumb feels “wobbly.” Initially, the discomfort occurs only in the context of direct activity; subsequently, pain at rest or at night also occurs.
Diagnosis and course of the disease
The physician makes the diagnosis on the basis of clinical examinations and an X-ray of the thumb. From this, the physician can detect a malposition of the joint, and he can sometimes also detect the typical changes that are possible in the course of osteoarthritis. However, before making the diagnosis of rhizarthrosis, he must be able to rule out other diseases – such as infections, gout or other rheumatic diseases. Patients usually respond to conservative treatment. However, rhizarthrosis is a classic wear-and-tear disease, so symptoms can worsen – over a period of years. In the final stage, there is usually a stiffening of the joint, so that the thumb can hardly be moved.
Complications
If rhizarthrosis exists, this initially leads to increasing instability of the thumb joint, associated with pain and a loss of strength in the hand. This increases the risk for accidents and falls. In general, physical performance also decreases and those affected can no longer perform tasks at work and in everyday life as before. Occasionally, poor posture occurs due to osteoarthritis, which in the long run leads to joint wear and permanent deformities. Rarely, after surgery for rhizarthrosis, there are severe movement disorders of the entire hand, often accompanied by swelling, pain and decalcification of the hand bones. In addition, bleeding, wound healing disorders, and inflammation in the area of the surgery may occur. Deep infections rarely occur, but may require follow-up surgery and cause permanent dysfunction. If a major cutaneous nerve is injured, numbness often develops and may persist for months. In severe cases, there is a permanent loss of skin sensation. Apart from these complications, the prescribed drugs can also cause discomfort and late effects. Possible effects include kidney and liver damage and chronic gastrointestinal disorders.
When should you see a doctor?
A loss of hand strength, increasing problems with twisting movements, and stabbing pain in the thumb joint are symptoms that may indicate rhizarthrosis. Medical advice is needed if the symptoms gradually become more severe and cannot be alleviated by rest and cooling.At the latest when palpable osteophytes are noticed in the thumb or instability of the thumb joint occurs, this must be clarified by a physician. Patients who already suffer from osteoarthritis should inform the responsible physician. Risk groups also include people who subject their hands to excessive stress, such as climbers and bodybuilders. Rhizarthrosis is treated by a specialist in arthritic diseases. Other points of contact are the orthopedist or the general practitioner. Treatment is provided by various specialists as well as physiotherapists. If the pain persists, an alternative medical practitioner may prescribe a suitable natural remedy. If the symptoms persist despite all measures, the doctor must be informed. It is possible that further treatment in a specialist clinic is needed to cure the condition, at least symptomatically.
Treatment and therapy
Initially, medical professionals opt for conservative treatment. This means that the patient should avoid overloading; this means that he must take it easy on his thumb. Subsequently, a thumb bandage is applied. Conservative basic therapy also includes ice applications and the use of various anti-inflammatory drugs (diclofenac or even ibuprofen). Sometimes electrotherapy can also lead to an improvement in the symptoms. If there is no improvement, further therapies – such as intra-articular injections with hyaluron, acupuncture or mixed corticoid injections – can provide relief from the symptoms. However, if conservative treatments fail, any medical professional will recommend surgery. Before deciding on surgery, the medical professional must discuss several options with the patient. On the one hand, there is the fusion surgery (arthrodesis). The advantage of the operation is that the joint can be loaded more heavily, but the disadvantage must not be disregarded under any circumstances – the thumb can only be moved to a limited extent after the operation. Furthermore, there must be no signs of wear and tear on the adjacent joints, as these can be aggravated – by the operation. For this reason, arthrodesis is recommended exclusively for young patients. Another option is the endoprosthesis made of silicone, plastic or metal. These are models that are also used in knee or hip operations. However, due to a lack of positive long-term results, this surgical method has not yet been able to gain 100 percent acceptance. Resection arthroplasty, on the other hand, is a standard procedure. The physician makes an incision about four centimeters long so that he can remove the carpal bones that have changed due to the disease. He then creates more space so that the bone can no longer rub against the bone. In order to improve stability, a tendoplasty is performed. This is a type of “bioprosthesis” which has provided excellent results to date. However, patients must be aware that – from the time of the operation – they will have less thumb strength, although this circumstance – in many cases – is not a real problem. Resection arthroplasty is usually performed on an outpatient basis. After the surgery, a plaster splint is applied (for about two weeks); after that, the patient must wear a thumb brace (for four weeks). However, the remaining fingers can be moved without problems, even after the procedure.
Prevention
Rhizarthrosis can be prevented only to a limited extent. Researchers have concluded that acidic and sugary foods, nicotine, alcohol, meat, white flour and table salt can promote rhizarthrosis. For this reason, it is advisable for people who consume too many acidic or sugary foods to change their diet. If the medical profession has already diagnosed rhizarthrosis, the right diet can provide relief from symptoms; furthermore, the course of the disease is favored positively.
Aftercare
Follow-up care is necessary when rhizarthrosis is treated surgically. In most cases, the patient wears a thumb splint for a period of about six weeks. If, on the other hand, a prosthesis is inserted, the splint is worn for about three to four weeks. If the surgical wound heals well, the skin sutures on the thumb saddle joint can be removed again after 10 to 14 days. There is no need to worry about any major pain.Usually, the patient only feels the tightening of the thread when it is lifted with the tweezers. As an alternative to a thumb splint, a plaster cast can also be applied. Although this is not a must, it has a positive effect on the healing of the wound. The pain is also kept within limits by immobilizing the thumb. As a rule, the bandage is changed two to three times in the week after the operation. If the wound heals optimally, one or two dressing changes are sufficient. If swelling and pain occur after the surgical procedure, painkilling medication can also be used. Some patients suffer from sensory disturbances on the extensor side of the thumb after surgery, such as tingling or numbness. However, if the scar matures, these sensation reductions disappear on their own after a few weeks or months.
Here’s what you can do yourself
Patients who have rhizarthrosis can prevent the disease from progressing by consistently wearing splints and regularly cooling the affected area of the body. Large loads on the hand should be avoided. After extreme strain, hand gymnastics and targeted warming of the wrist help. This should be accompanied by a change in diet. To avoid hyperacidity, foods such as coffee, alcohol, table salt and spicy foods should be avoided. Sufficient fluid intake is also important. Food supplements with collagen hydrosylate, omega-3 fatty acids and glucosamine support the cartilage tissue and the joint fluid. Rhizarthrosis should be examined by a doctor, as there may be a serious underlying cause. In severe cases, surgical intervention is necessary, after which the patient must take it easy. Persistent complaints indicate a serious underlying condition that must first be diagnosed and treated. Rhizarthrosis can also be treated preventively by specifically avoiding stress on the hand and especially the wrist. This can be achieved, for example, by means of medical underpads or regular massages. If a pronounced arthrosis has already developed as a result of the rhizarthrosis, a specialist must be consulted.
