Rhizarthrosis

The thumb is involved in 25 percent of daily activities. However, if the thumb causes pain or if there is an actual loss of function, the result is enormous suffering. Usually the Rhizarthrosis responsible for thumb pain.

What is rhizarthrosis?

The thumb saddle joint ensures the connection of the first metacarpal bone with the wrist so that there is a connection to the base of the thumb. It comes to one Rhizarthrosis, an arthrosis of the thumb saddle joint, pain occurs as a result, which - depending on the course of the disease - can become increasingly severe.

causes

One reason why rhizarthrosis occurs can be mechanical overuse of the thumb. Sometimes ligament instability can also trigger rhizarthrosis. The pain is caused by the worn out articular cartilage. As a result, the thumb swells; inflammation occurs in the tissue.

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This is also followed by the typical bone changes (marginal jagged formation) and a narrowing of the joints. In the advanced stages of the disease, the cartilage coating is so worn away that the bones rub against each other.

Symptoms, ailments & signs

Occasionally, osteoarthritis leads to poor posture, which in the long term leads to joint wear and tear and permanent malpositions.
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Those affected initially complain of pain when holding the tip between the index finger and thumb; Sometimes there is also pain on the extensor side. Even turning movements can cause pain. Since the movements are daily activities, those affected notice relatively quickly that the thumb is “offended”.

Screw caps can no longer be opened painlessly; even carrying bottles of drinks can sometimes be painful. Those affected describe the feeling of an "unstable thumb"; this is how the patients repeatedly describe that the thumb would feel "wobbly". At the beginning the complaints only occur in the context of a direct activity; subsequently there is also pain at rest or at night.

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Diagnosis & course of disease

The doctor makes the diagnosis on the basis of clinical examinations and an X-ray of the thumb. This enables the doctor to recognize a misalignment of the joint, whereby he can sometimes also determine the typical changes that are possible in the course of osteoarthritis. However, before diagnosing rhizarthrosis, he must be able to rule out other diseases - such as infections, gout or other rheumatic diseases.

Usually, patients respond to conservative treatment. However, rhizarthrosis is a classic wear and tear disease, so that the symptoms can worsen over the years. In the final stage, the joint usually stiffens so that the thumb can hardly be moved.

Complications

If there is rhizarthrosis, this initially leads to increasing instability of the thumb joint, combined with pain and loss of strength in the hand. This increases the risk of accidents and falls. In general, physical performance also decreases and those affected can no longer cope with tasks at work and in everyday life as before.

Occasionally, osteoarthritis leads to poor posture, which in the long term leads to joint wear and permanent malpositions. After a rhizarthrosis operation, severe movement disorders occur in the entire hand, often accompanied by swelling, pain and decalcification of the hand bones. In addition, bleeding, wound healing disorders and inflammation can occur in the area of ​​the procedure.

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Deep infections are rare, but they can require reoperations and cause permanent dysfunction. If a larger cutaneous nerve is injured, numbness often develops, which can persist for months. In severe cases, there is a permanent loss of skin feel. Apart from these complications, the prescribed medication can also cause discomfort and long-term effects. Damage to the kidneys and liver as well as chronic gastrointestinal diseases are possible.

When should you go to the doctor?

A loss of strength in the hand, increasing problems with turning movements and sharp pain in the thumb joint are symptoms that can indicate rhizarthrosis. Medical advice is required when the symptoms gradually worsen 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 doctor. Patients who already suffer from osteoarthritis should inform their doctor. Risk groups also include people who put excessive strain on their hands, such as climbers and bodybuilders.

Rhizarthrosis is treated by a doctor specializing in arthritic diseases. Other points of contact are the orthopedist or general practitioner. The treatment is carried out by various specialists and physiotherapists. If the pain persists, an alternative doctor can prescribe a suitable natural remedy. If the symptoms persist despite all measures, the doctor must be informed. Further treatment in a specialist clinic may be necessary to cure the condition at least symptomatically.

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Treatment & Therapy

At the beginning, the medical professionals opt for conservative treatment. This means that the patient should avoid overloading; that means that he has to go easy on his thumb. A thumb bandage is then applied. Conservative basic therapy also includes ice applications and the intake of various anti-inflammatory drugs (diclofenac or ibuprofen).

Electrotherapy can sometimes lead to an improvement in the symptoms. If there is no improvement, further therapies - such as intra-articular injections with hyaluronic acid, acupuncture or mixed corticoid injections - can alleviate the symptoms. However, if conservative treatments fail, every medical professional will recommend surgery.

Before the doctor decides to have the operation, he must discuss several options with the patient. On the one hand, there is the stiffening operation (arthrodesis). The advantage of the operation lies in the fact that the joint can be subjected to greater stress, whereby the disadvantage must by no means be ignored - the thumb can only be moved to a limited extent after the operation.

In addition, there must be no signs of wear and tear on the adjacent joints, as these can be made worse by the operation. For this reason, arthrodesis is only recommended for young patients. Another possibility is the endoprosthesis made of silicone, plastic or metal.

These are models that are also used in knee or hip operations. However, due to the lack of positive long-term results, the surgical method has not yet fully established itself. On the other hand, resection arthroplasty is standard. The doctor makes an approximately four centimeter long incision so that he can remove the carpal bones that have changed due to the disease.

As a result, it ensures a gain in space so that the bone can no longer rub against the bone. Tendon plastic surgery is performed to improve stability. This is a kind of "bioprosthesis" that has so far provided excellent results. However, patients must be aware that they will have less thumb strength - after the procedure - although that fact - in many cases - is not a real problem.

Resection arthroplasty is usually performed on an outpatient basis. After the operation, a plaster splint is put on (for around two weeks); then the patient must wear a thumb bandage (for four weeks). However, the remaining fingers can be moved without any problems even after the procedure.

prevention

Rhizarthrosis can only be prevented to a limited extent. Researchers have come to the conclusion that acidic and sugary foods, nicotine, alcohol, meat, white flour and table salt can promote rhizarthrosis. For this reason, it is advisable when people who consume too many acidic or sugary foods make a diet change. If the doctor has already diagnosed rhizarthrosis, the right diet can provide relief from the symptoms; Furthermore, the course of the disease is favored positively.

Aftercare

Follow-up care is necessary if rhizarthrosis is treated surgically. In most cases, the patient will wear a thumb splint for about six weeks. If, on the other hand, a prosthesis is used, the splint is worn for around three to four weeks.

If the surgical wound heals well, the skin threads on the thumb saddle joint can be removed after 10 to 14 days. Greater pain is not to be feared. Most of the time, the patient only feels the thread being pulled 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. Usually 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, pain reliever medication can also be used. Some patients suffer from sensitivity disorders on the extensor side of the thumb such as tingling or numbness after the operation. If the scar matures, however, these diminished feelings disappear on their own after a few weeks or months.

You can do that yourself

Patients who have rhizarthrosis can prevent the disease from progressing by consistently wearing splints and regularly cooling the affected body area. Great strain on the hand should be avoided.After extreme stress, hand exercises and targeted warming of the wrist help.

In addition, the diet should be changed. In order to avoid over-acidification, corresponding foods such as coffee, alcohol, table salt and spicy foods should be avoided. Adequate fluid intake is also important. Dietary supplements with collagen hydrosylate, omega-3 fatty acids and glucosamine support the cartilage tissue and the synovial fluid.

The rhizarthrosis should be examined by a doctor, as there may be a serious cause. In severe cases, an operation is necessary, after which the patient has to 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 strain on the hand and, in particular, the wrist. This can be achieved, for example, with medical pads or regular massages. If severe osteoarthritis has already developed as a result of the rhizarthrosis, a specialist must be consulted.