When should you see a doctor?
You should consult a doctor if:
- you have persistent pain in the thumb area, despite rest
- You notice restrictions in everyday life (problems with gripping, no longer able to turn)
- Advanced joint destruction is suspected
Rhizarthrosis
Causes, symptoms and treatment
Imagine waking up in the middle of the night because your hand is tingling or numb. Perhaps you feel like you can no longer move your fingers properly – as if they have fallen asleep. These symptoms are typical signs of carpal tunnel syndrome, one of the most common so-called constriction syndromes of the upper extremity. But what exactly is behind it and how can the problem be treated effectively? Here you can find out everything about the causes, symptoms and the latest treatment options – from gentle measures to targeted surgical interventions.
Osteoarthritis in the thumb saddle joint - what is it?
Rhizarthrosis affects the thumb saddle joint, which wears out. This serves as a connection between the large polygonal bone (a carpal bone) and the first metacarpal bone. The metacarpal bone is then connected to the first two finger bones of the thumb. Rhizarthrosis is the most common form of joint wear and tear (osteoarthritis) in the hand.
Stages of rhizarthrosis
The mobility of the thumb decreases due to wear and tear in the joint, which considerably restricts hand function. As with all osteoarthritis, there are four stages that need to be distinguished:
- Stage I: The cartilage is still largely intact, but altered. The joint space may be widened by fluid.
- Stage II: The joint space becomes narrower, the first bony changes (osteophytes) are visible. Small free joint parts may appear.
- Stage III: The joint space is severely narrowed. There are clear bone changes, larger free joint bodies and bone thickening.
- Stage IV: In addition, neighboring joints (especially the STT joint) are now also affected by wear.
How does rhizarthrosis develop?
Rhizarthrosis is caused by increasing wear and tear of the joint cartilage, which serves as a buffer between the bones. The cause of rhizarthrosis can be divided into primary and secondary rhizarthrosis.
Primary rhizarthrosis is unexplained in most cases. However, women over the age of 50 are most commonly affected, and hormonal changes during the menopause can be a trigger. However, incorrect and excessive strain are also a cause of rhizarthrosis.
Secondary rhizarthrosis is caused by a poorly healed injury or constant overloading can lead to permanent damage to the thumb saddle joint. If this injury heals poorly, wear and tear can occur and osteoarthritis of the thumb saddle joint develops.
Pain in the thumb: symptoms of rhizarthrosis
Rhizarthrosis causes particular pain during rotational movements and gripping.
Pain in the thumb: symptoms of rhizarthrosis
Rhizarthrosis causes particular pain during rotational movements and gripping.
- Rotational movements: In addition to pain, movement restrictions often occur - for example when opening glasses or turning a key. In most cases, the pain is so severe that the movement cannot be performed at all.
- Gripping: Pain when gripping glasses or bottles, closing buttons on a shirt or even unsteadiness when gripping, in combination with wobbling, are possible symptoms of rhizarthrosis.
- Strength: As the disease progresses, there is also a loss of strength in the thumb - holding heavier objects becomes increasingly difficult.
- Swelling and pressure sensation: A visible swelling at the thumb joint and a feeling of pressure when touching the thumb.
- Misalignment: Advanced rhizarthrosis can lead to a change in the shape of the thumb.
Diagnosis of rhizarthrosis
The diagnosis of rhizarthrosis is determined as follows:
- Medical history (patient interview): Typical complaints such as pain when gripping or moving the thumb provide an initial indication for the doctor treating the patient.
- Physical examination: The next step is to palpate the thumb saddle joint - this touch is usually painful, which is a further indication of rhizarthrosis.
- Grind test (functional test): The grind test follows next: the doctor performs rotating movements on the thumb. Pain, rubbing noises or grinding noises indicate rhizarthrosis.
- X-ray: If rhizarthrosis is present, a narrowing of the joint space and bone compression can be seen on the X-ray.
- Important note: The X-ray image does not indicate the intensity of the pain! Slight changes in the thumb saddle joint can cause severe pain - or vice versa.
Treatment options for rhizarthrosis
Whether conservative or surgical treatment is chosen depends on the degree of wear.
Conservative therapy
On the one hand, patients are prescribed a splint. This supports and relieves the thumb saddle joint. There are several different types: Splints made of plastic or metal, but also leather, which also supports the wrist.
Non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed as painkillers, which are either applied directly to the thumb as an ointment or taken as tablets.
If the thumb saddle joint becomes inflamed, the doctor can administer a cortisone injection directly into the joint. These have an anti-inflammatory effect, but can only be administered for a short time.
Ergo-therapy, electrotherapy and radiotherapy are also helpful for rhizarthrosis.
Surgical treatment
In advanced stages, conservative therapies usually no longer help. Surgical treatment is therefore arranged depending on the stage.
When operating on rhizarthrosis, the doctor chooses the appropriate procedure for the individual patient. The most common procedure is trapezius resection – a small carpal bone (os trapezium) is removed and the gap stabilized with a tendon strip. Alternatively, the joint can be stiffened (arthrodesis), an artificial joint can be inserted or pain-conducting nerve branches can be cut in order to alleviate the symptoms.
Living with rhizarthrosis
Rhizarthrosis can noticeably restrict everyday life, but does not have to be a reason to lose independence. Many sufferers learn to cope well with the disease, especially if it is treated early and everyday life is adapted accordingly.
Working with rhizarthrosis is still possible in many cases, especially with mild to moderate symptoms. It is important to load the wrists as evenly as possible, avoid monotonous or very force-intensive movements and use aids if necessary.
There are also many ways to relieve the hand in everyday life – for example with bottle openers with leverage, non-slip pads or special kitchen aids. Heat, relaxing hand baths and targeted movement exercises can also alleviate symptoms.
Rhizarthrosis cannot be completely prevented, as it often occurs due to age or predisposition. Nevertheless, the following measures help to keep the joints healthy for as long as possible:
- Avoid repeated overloading (e.g. by compensating for hand-intensive activities)
- Learn wrist-friendly movement sequences
- Exercise hand and thumb muscles regularly
- Treat inflammation at an early stage (e.g. for rheumatism)
- Seek medical help in good time at the first symptoms
Your specialist for hand surgery in Vienna - Dr. Sebastian Farr
Priv.-Doz. Dr. Sebastian Farr is a specialist in orthopaedics and hand surgery with many years of experience as a senior physician at the Orthopaedic Hospital Speising. At his surgery in the 1st district, he offers comprehensive advice and individual treatment options for diseases and injuries of the hand and upper extremities. From diagnosis to treatment and aftercare, Dr. Farr will accompany you personally and attaches great importance to precise diagnostics and targeted treatment. The aim is to restore hand function in the best possible way and to alleviate pain in the long term.
Arrange a consultation today by e-mail, online or by telephone and let Priv.-Doz. Dr. Sebastian Farr personally about your treatment options – for more comfort, quality of life and an active life!
FAQ - frequently asked questions about rhizarthrosis
What does the development of rhizarthrosis feel like?
Initially, rhizarthrosis often manifests itself as slight pain when gripping or turning, for example when opening bottles or writing. The symptoms often disappear again at rest.
Can rhizarthrosis be cured?
A complete cure is not possible as it is a matter of wear and tear. However, with targeted treatment, the symptoms can be significantly alleviated and progression slowed down.
Can you do sport despite rhizarthrosis?
Yes, sports that are easy on the joints such as swimming, cycling or special hand exercises are recommended. It is important to avoid overloading.
What can I do myself against rhizarthrosis?
Heat applications, ergonomic aids, targeted exercises and avoiding one-sided strain help to relieve the joints and maintain mobility.
Is rhizarthrosis always operated on?
No. Many patients cope well with conservative measures. Surgery is usually only necessary at an advanced stage if the pain is severe and permanently debilitating.
Can I continue to work with rhizarthrosis?
In most cases, yes – depending on the job. With ergonomic adjustments, breaks and, if necessary, a workplace evaluation, many occupational requirements can still be mastered.
What tips are there for dealing with rhizarthrosis?
Use aids, avoid overloading and pay attention to ergonomic handling during everyday activities.