February 2, 2023 Author : Vitor Vidinha What is rhizarthrosis? Rhizarthrosis is the arthrosis of the joint at the base of the thumb : The two bones that form this joint are the trapezium and the 1 st metacarpal bone; The joint is called the trapeziometacarpal joint. For adequate functionality, in the relationship between the trapezium and the 1 st metacarpal bone in the joint, there must be: Joint congruence, that is, an anatomically correct position that allows the contact and sliding of the articular bone surfaces and the stability of the joint; Adequate mobility for the functions of the thumb. Who can develop rhizarthrosis? The trapeziometacarpal joint can begin a process of continuous wear and tear, which affects the cartilage, ligaments and tissue (called synovial tissue) that lines the inner walls of the joint and results in a rhizarthrosis. Anyone can develop rhizarthrosis, but there are anatomical, hereditary, and hormonal factors that contribute to its development . Postmenopausal women are a particularly susceptible group to symptomatic rhizarthrosis. Although it makes sense that repetitive manual work could be a risk factor for rhizarthrosis, this relationship has not yet been scientifically proven. Less frequently, rhizarthrosis can arise in a post-traumatic context, as a sequel of a fracture or luxation involving the joint at the base of the thumb, or secondary to a rheumatological disease. Symptoms and diagnosis Complaints that lead to seeking medical care are usually: Pain at the base of the thumb . Pain at the base of the thumb, in the region immediately proximal to the crease between the thumb and forefinger, is suggestive of rhizarthrosis. Functional limitation with range of motion alterations , which translates into inability to perform many common tasks. The symptoms are generally progressive and impose a marked functional limitation, even in the simplest tasks, such as, using a key, opening the lid of a bottle and many others. Work, home, and personal activities become persistently painful. Medical evaluation reveals impaired range of motion, swelling, and joint deformity. Hand X-ray is the exam that allows confirming the diagnosis of rhizarthrosis . Treatment of rhizarthrosis As a general rule, the first therapeutic approach should be conservative. Temporary immobilization of the thumb with a removable splint relieves complaints, especially if associated with activity limitation. Corticosteroid injection into the trapeziometacarpal joint has a reasonable success rate in relieving pain in the early stages of the disease, even if the effect is temporary. In the more advanced stages, this benefit seems to fade. Although not free of complications, these are rare, and associating an anesthetic drug with the preparation to be injected, the procedure is practically painless. Physiotherapy , as part of an expectation of temporary symptomatic relief, can also play a valuable role. In cases refractory to conservative treatment, surgery may be considered . There are several surgical procedures, and the decision on the type of intervention to be performed is decided taking into account: The patient age; The type of daily activity performed; The degree of joint destruction. The therapeutic options for each of the stages of rhizarthrosis should always be discussed between the patient and the hand surgeon . Clarification about the expected results and the foreseeable recovery time for the different types of treatment are fundamental for the patient decision-making. Meet the orthopedics clinical team from Hospital da Luz. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
