Rhizartrosis

Original Editor - Jona Van den Broeck Top Contributors - Lucinda hampton, Kim Jackson and Jona Van den Broeck
an xray image of OA of the first CMC joint

Introduction

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]

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Eitiology

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 (ligg. oblique anterior). These ligaments are the most important stabilisers of the fingers.  [4]
  • Using thumb in occupation eg 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

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 eg opening jars or doing up buttons may become difficult.
    Grip .jpg
  • Appearance. The joint may become swollen or develop a bony bump. The joint may appear squarish and enlarged.[6]

Diagnosis

  • 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

Conservative measures are the first options for CMC arthritis and can ameliorate symptoms in most cases. These include

Behaviour modification

eg Try to avoid: clenching your hands when carrying things; repetitive movements that involve pinching or twisting

Physiotherapy

Techniques include

  • range-of-motion and stretching exercises to improve thumb motion.
[8]
[9]
  • Dexterity and fine motor exercises for the hand and thumb. [10]
  • Application of therapeutic heat or cold
  • Application of electro therapeutic techniques eg 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

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]

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Surgery

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.

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References

  1. Wikipedia. CMC joint. Available from: https://en.wikipedia.org/wiki/Carpometacarpal_joint (last accessed 13.4.2019)
  2. Mayo clinic. Causes remedies for thumb arthritis. Available from: https://www.youtube.com/watch?v=iVbOPCu5Ius. (last accessed 13.4.2019)
  3. 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)
  4. 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
  5. 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)
  6. Healthline. Basal joint arthritis. Available from: https://www.healthline.com/health/basal-joint-arthritis#symptoms (last accessed 14.4.2019)
  7. 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)
  8. Healing hands rehab. CMC arthritis. Available from: https://www.youtube.com/watch?v=wCIA1_tksjA&feature=youtu.be (last accessed 14.4.2019)
  9. LB hand therapy. Thumb stability exercises. Available from: https://www.youtube.com/watch?v=rf4R7udarNg&feature=youtu.be
  10. 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)
  11. 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)
  12. 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)
  13. 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)
  14. Dartmouth-Hitchcock. Basal joint arthritis. Available from: https://www.youtube.com/watch?v=iSA1BSSQLPA (last accessed 15.4.2019)