Rhizarthrosis
Introduction[edit | edit source]
Trapeziometacarpal (TMC) arthritis ( also known as Rhizarthrosis ) is arthritis of the first carpometacarpal (CMC) joint of the thumb. The CMC joint of the thumb, or TMC joint plays a critical role in the normal functioning of the thumb. It is the most important joint connecting the wrist to the metacarpus. Osteoarthritis of the TMC is a severely disabling condition; up to twenty times more common among elderly women than in average.[1]
Eitiology[edit | edit source]
Causes of TMC arthritis are:
- Excessive repetitive use of the CMC joint of the thumb
- Subluxation
- Lesion of the ligaments or a fracture.
- Laxity of the CMC joint (can be hereditary, increased risk for ligament injuries, a primary stimulus in the development of arthritis. Also causes a hyperextension, which is another primary stimulus for the development of arthritis.[3]
- Weakness of the cross links of the fingers (ligament oblique anterior). These ligaments are the most important stabilisers of the fingers. [4]
- Using thumb in occupation e.g. Work-related thumb pain in physiotherapists is a prevalent problem among physiotherapists who administer manual techniques. Factors that appear to be associated with thumb pain include CMC mobility and thumb strength[5].
Signs and Symptoms[edit | edit source]
The first signs of arthritis in the thumb are
- pain, tenderness, and stiffness at the base of your thumb. This occurs with gripping, pinching, or clasping something between the thumb and index fingers or when a mild force, such as when you twist a key in a lock or turn a door handle. An ache after activity can also be a feature.
- Decreased strength and range of motion e.g. opening jars or doing up buttons may become difficult.
- Appearance. The joint may become swollen or develop a bony bump. The joint may appear squarish and enlarged.[6]
Diagnosis[edit | edit source]
- Noticeable lumps or swelling on the first CMC joint
- Thumb CMC grind test
- Plain radiographs showing degenerative changes (bone spurs, thinning of cartilage, loss of joint space) in affected joints are usually diagnostic.[7]
Treatment[edit | edit source]
Conservative measures are the first options for CMC arthritis and can ameliorate symptoms in most cases. These include
Behaviour modification[edit | edit source]
e.g. Try to avoid: clenching your hands when carrying things; repetitive movements that involve pinching or twisting
Physiotherapy[edit | edit source]
Techniques include
- range-of-motion and stretching exercises to improve thumb motion.
- Advance to include strength exercise for the thump and fingers.
- Dexterity and fine motor exercises for the hand and thumb. [10]
- Application of therapeutic heat or cold
- Application of electro therapeutic techniques e.g. Therapeutic US, TENS. US has been found to have the ability to evoke a broad range of therapeutically beneficial such as improved pain and functional outcomes, positive cartilage healing properties and positive phonophoresis for hyaluronan. [11]
- Acupuncture. May work in pain relief for some people.[12]
- Splinting, designed to help reduce pain, prevent deformity, or prevent deformity from getting worse. To wear at night, during flare ups and when doing heavy work with hand.[10]
- Clinical trials have provided evidence that a combination of joint mobilization, neural mobilization, and exercise helps with CMC joint pain.[13]
Pain relief[edit | edit source]
Options include
- Topical medications, such as capsaicin or diclofenac, which are applied to the skin over the joint
- Over-the-counter pain relievers, such as acetaminophen, ibuprofen or naproxen sodium
- Prescription pain relievers, such as celecoxib (Celebrex) or tramadol (Conzip, Ultram)
- Injections. Corticosteroid injections can offer temporary pain relief and reduce inflammation.[7]
.
Surgery [edit | edit source]
If the diagnosis of ‘rhizarthrosis’ is determined too late, none of the above treatments will be helpful. Because of severe pain and movement restriction, surgery could be inevitable.
References[edit | edit source]
- ↑ Wikipedia. CMC joint. Available from: https://en.wikipedia.org/wiki/Carpometacarpal_joint (last accessed 13.4.2019)
- ↑ Mayo clinic. Causes remedies for thumb arthritis. Available from: https://www.youtube.com/watch?v=iVbOPCu5Ius. (last accessed 13.4.2019)
- ↑ Wolf JM, Schreier S, Tomsick S, Williams A, Petersen B. Radiographic laxity of the trapeziometacarpal joint is correlated with generalized joint hypermobility. The Journal of hand surgery. 2011 Jul 1;36(7):1165-9. Available from: https://www.jhandsurg.org/article/S0363-5023(11)00353-4/abstract (last accessed 14.4.2019)
- ↑ A. Gondim Teixeira, Pedro & Omoumi, Patrick & J Trudell, Debra & Ward, Samuel & Blum, Alain & L Resnick, Donald. (2010). High-resolution ultrasound evaluation of the trapeziometacarpal joint with emphasis on the anterior oblique ligament (beak ligament). Skeletal radiology. 40. 897-904. 10.1007/s00256-010-1068-0. Available from: https://www.researchgate.net/publication/49647832_High-resolution_ultrasound_evaluation_of_the_trapeziometacarpal_joint_with_emphasis_on_the_anterior_oblique_ligament_beak_ligament
- ↑ Snodgrass SJ, Riyett DA, Chiarelli P, Bates AM, Rowe LJ. Factors related to thumb pain in physiotherapists. Australian Journal of Physiotherapy. 2003 Jan 1;49(4):243-50. Available from:https://www.sciencedirect.com/science/article/pii/S0004951414601409 (last accessed 10.4.2020)
- ↑ Healthline. Basal joint arthritis. Available from: https://www.healthline.com/health/basal-joint-arthritis#symptoms (last accessed 14.4.2019)
- ↑ 7.0 7.1 Mayo clinic. Thumb arthritis. Available from: https://www.mayoclinic.org/diseases-conditions/thumb-arthritis/diagnosis-treatment/drc-20378344 (last accessed 14.4.2019)
- ↑ Healing hands rehab. CMC arthritis. Available from: https://www.youtube.com/watch?v=wCIA1_tksjA&feature=youtu.be (last accessed 14.4.2019)
- ↑ LB hand therapy. Thumb stability exercises. Available from: https://www.youtube.com/watch?v=rf4R7udarNg&feature=youtu.be
- ↑ 10.0 10.1 Central physiotherapy. Arthritis of the thumb. Available from: https://www.centralphysicaltherapy.com/Injuries-Conditions/Hand/Hand-Issues/Arthritis-of-the-Thumb/a~282/article.html (last accessed 14.4.2019)
- ↑ Srbely JZ. Ultrasound in the management of osteoarthritis: part I: a review of the current literature. The Journal of the Canadian Chiropractic Association. 2008 Mar;52(1):30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258240/ (last accessed 15.4.2019)
- ↑ Arthritis Foundation. Acupuncture and osteoarthritis. Available from: https://www.arthritis.org/living-with-arthritis/treatments/natural/other-therapies/mind-body-pain-relief/oa-acupuncture.php (last accessed 15.4.2019)
- ↑ Jospt. The Effectiveness of a Manual Therapy and Exercise Protocol in Patients With Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial. Available from: ☀https://www.jospt.org/doi/full/10.2519/jospt.2013.4524 (last accessed 14.4.2019)
- ↑ Dartmouth-Hitchcock. Basal joint arthritis. Available from: https://www.youtube.com/watch?v=iSA1BSSQLPA (last accessed 15.4.2019)